# Acne vulgaris {#article-title-2}

Acne may be common, but it causes considerable distress and doctors should treat it effectively, not trivialise it 

Acne vulgaris is common and affects nearly all adolescents and adults at some time in their lives. Although overall health is not impaired, acne is not a trivial disease; it can produce cutaneous and emotional scars that last a lifetime. 1 2 Numerous psychological problems stem from acne, even resulting in decreased employability in adulthood.3 Fortunately, acne is eminently treatable, and this review provides an outline of current treatments.

### Summary points

A literature review augmented my extensive experience of the topic. I used Entrez PubMed for all literature searches.

Acne has a complex aetiology, involving abnormal keratinisation, hormonal function, bacterial growth, and immune hypersensitivity. 1 2 The disease is limited to pilosebaceous follicles of the head and upper trunk because the sebaceous glands in these regions are particularly active. The primary acne lesion is the “blackhead” (microcomedo), an impaction and distension of the follicle with improperly desquamated keratinocytes and sebum. The stimulus for comedogenesis is uncertain.

At puberty, when androgens stimulate the production of sebum, pre-existing comedones become filled with lipid and may enlarge to become visible. Subsequently, some patients also begin to show signs of inflammation. Comedones that become inflamed are nearly always clinically invisible before the pimple develops.

Inflammatory acne is the result of the host response to the follicular inhabitant Propionibacterium acnes , 1 4 which is a member of the normal flora and is a harmless …

/pdf/commentary-a-uk-primary-care-perspective-on-treating-acne-2ktoti48m4.pdf

Commentary: A UK primary care perspective on treating acne.

α-Hydroxy acid (AHA) peels and home regimens have recently been recognized as important adjunctive therapy in a variety of conditions including photodamage, actinic damage, melasma, hyperpigmentation disorders, acne, and rosacea. Overall in our experience and in the literature, AHAs have a proven level of safety and efficacy in a variety of skin types. Although their exact mechanism of action is unknown, it has been demonstrated that AHAs improve these disorders by thinning the stratum corneum, promoting epidermolysis, dispersing basal layer melanin, and increasing collagen synthesis within the dermis. In patients with photodamage, AHA peels and topical products are often combined with retinoids and other antioxidants for maximum benefit. Similarly, synergistic effects of fluorouracil and glycolic acid are observed in the treatment of diffuse actinic keratoses. For patients with melasma, AHA peels and combination products containing bleaching agents such as hydroquinone, kojic acid, and glycolic acid seem to have increased efficacy. Acne and rosacea patients can see improved results when standard regimens like antibacterials and topical retinoids are supplemented with AHA peels and lotions. However, care should always be taken prior to commencing treatment with AHA peels and topical products. By obtaining a thorough history and physical examination, the physician will identify any specific factors like medications, prior procedures and medical conditions which can affect the outcome of the peel. During the interview, there should be open discussion of patient questions and concerns so that realistic expectations can be made. Pre- and post-peel regimens should also be reviewed in full as patient compliance is essential to ensure the success of a series of AHA peels.

α-Hydroxy Acid-Based Cosmetic Procedures

Tretinoin is the most effective available topical comedolytic agent, but topical application may lead to erythema, peeling and burning of the skin. During the past few decades many reports have documented an emergence of antibiotic resistance by Propionibacterium acnes during treatment of acne. Furthermore, systemic antimicrobials used in the treatment of acne have been causally associated with various shortand long-term adverse effects. Clarina cream, a polyherbal formulation containing extracts of Aloe barbadensis, Prunus amygdalus, Alternanthera sessilis, and Rubia cordifolia, was found to be beneficial in topical treatment of acne vulgaris. The present study was planned to evaluate the efficacy and safety of Clarina cream in management of acne vulgaris.

Evaluation of efficacy and safety of Clarina cream in newly diagnosed and previously treated cases of acne vulgaris

Acne vulgaris is the most common dermatologic disorder in the United States. Although its cause is unknown, various factors are implicated in its pathogenesis. No single topical antiacne medication acts on all the major pathophysiologic events. Combined use of agents with different modes of action provides better patient outcomes than monotherapy. Topical fixed-combination therapies include antibiotics with benzoyl peroxide (BPO) or retinoids, and retinoids with BPO. With increased efficacy can come increased irritation from the combination or formulation excipients. Surfactants, preservatives, and high levels of organic solvents including alcohols found in some products are potential irritants. This review considers data on topical fixed-combination acne medications and developments focused on newer lower concentration, optimized formulations aimed at reducing dryness and irritation without compromising efficacy. In the absence of direct comparative clinical trials, this review provides timely guidance for clinicians on the use of these agents.

Fixed-combination products in the management of acne vulgaris.

Acne is a common disease of the pilosebaceous units of the skin and topical therapy is recommended for the management of acne with comedolytic, anti-inflammatory agents, along with antimicrobials. However, topical application of these drugs leads to frequent adverse effects and also, there is an emergence of antibiotic resistance by Propionibacterium acnes. Furthermore, systemic antimicrobial usage has been causally associated with various adverse events. Clarina cream is a polyherbal formulation and contains extracts of Aloe barbadensis, Prunus amygdalus, Alternanthera sessilis and Rubia cordifolia, and the present study was planned to evaluate the efficacy and safety of Clarina cream in management of acne vulgaris. This study was an open, non-comparative clinical trial conducted at the Department of Dermatology of V. S. Medical College, Ahmedabad, from January to April 2002. Twenty eight patients of both sexes were included in the study. Children below 18 years of age, patients with preexisting systemic disease necessitating long-term medications, genetic and endocrinal disorders and those who refused to give informed consent were excluded from the study. Pregnant and lactating women were also excluded from the study. A baseline history was obtained in order to determine the patient’s eligibility for enrolment in the trial. Thereafter all patients underwent a clinical examination and thorough skin examination was done. All patients were advised to apply Clarina cream topically over the lesions, twice a day for a period of 6 weeks. All patients were followed up every two weeks and during each follow-up visit, local skin examination was done. The predefined primary outcome measures were reduction in number of blackheads, whiteheads, inflamed pustules and overall inflammation along with increase in exfoliation, overall moisturizing and soothing effects and healing without scar formation. The predefined secondary outcome measures were incidence of adverse events and compliance to the treatment. Statistical analysis was done according to intention-to-treat principles. This study observed significant improvement in the mean scores for reduction in number of blackheads, whiteheads, inflamed pustules and overall inflammation. In addition, there was significantly better exfoliation, moisturizing and soothing effects, along with significant improvement in healing without scar formation. The overall response to the treatment also recorded a significant improvement from the second week onwards. There were no clinically significant short- and long-term adverse reactions (either reported or observed) , during the entire period of study and excellent patient compliance to Clarina cream was also observed. Based on these observations, it may be concluded that Clarina cream is clinically effective and safe for short- and long-term usage in acne vulgaris.

Acne and rosacea

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Acne and rosacea