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Acne: Something Old, Something New

Acne: it’s just one of the many reasons to be glad you’re not a teenager any more. If you are lucky, you’ve outgrown this scourge by now- – although the disorder can persist into adulthood.

In the context of a busy office practice, and given the plethora of available —  and ever expanding — treatment options for acne of varying severity, how can you quickly tailor an effective regimen?  

To help you sort through the various topical, systemic, and hormonal agents now available, Drs. Janet Purath and Theresa Coyner offer Pharmacologic Therapy for Acne: A Primer for Primary Care, published in Clinician Reviews.[1](CE credits are available.) These authors write that many of the 50 million Americans who have acne presented to a primary care clinician for care. Their article includes helpful Tables that provide specific details about various topical treatments, including topical retinoids, oral antibiotics. A brief overview of their discussion follows.

Topical retinoids
The comedolytic and anti-inflammatory effects of these agents make them a mainstay in the management of acne.[1] Primary adverse effects are dry, red skin, which can be ameliorated with noncomedogenic emollients.

Topical antibiotics and anti-inflammatory agents
Agents such as benzoyl peroxide, erythromycin, and clindamycin come in a variety of formulations. These are usually well tolerated, though dryness and erythema may develop.

Oral antibiotics
Purath and Conyers caution that oral antibiotic therapy for acne is controversial given rising rates of bacterial resistance. They advise reserving these agents for patients with moderate to severe acne or widespread acne in whom topical therapy is ineffective. Oral antibiotics should not be given as monotherapy, and should not be given for more than 3 months.[1]

Hormonal therapy is reserved for women whose acne is affected by fluctuating hormone levels.

This oral systemic retinoid is a highly effective treatment for patients with nodular acne that is refractory to other acne therapies.

A new acne medication
A new medication will soon become available for the treatment of acne. In October of 2018, the FDA approved Seysara (sarecycline hydrochloride), indicated for the treatment of inflammatory lesions of non-nodular moderate to severe acne vulgaris in patients who are ≥9 years old. The drug, a first in class tetracycline-derived oral antibiotic, is expected to be available early in 2019.[2] The medication, which comes in tablet form and is available in 3 dosages —  60 mg, 100 mg, and 150 mg – is taken once daily with or without food.

The drug is contraindicated in anyone who is hypersensitive to any of the tetracyclines. Warnings and precautions that apply to tetracyclines in general also apply to Seysera: these include the potential for fetal harm when administered to a pregnant woman, permanent tooth discoloration when used in children who are developing teeth, and risk of retarded skeletal development in the developing fetus. 

Last updated on 9/25/19.

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