The Full Package: Adding Procedures to the Acne Armamentarium
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Increasingly, dermatologists recognize that acne often persists beyond the teen years. Adult acne affects both men and women. These patients are often motivated to participate in treatment and are interested in optimized approaches that offer the best likelihood of rapid, long-term clearance. Combination approaches may be the answer.
Treatment begins with topical medications. An assessment of the type of acne and the patient’s skin type directs treatment selection. My preference is a treatment approach that includes a topical prescription regimen for use at home as well as in-office procedures.
Topical antimicrobials, such as benzoyl peroxide or minocycline, are foundational for my treatment approach. Also essential to topical acne treatment is a topical retinoid. The selection of a retinoid can be tailored to the patient, and therapy can be titrated, if necessary, for optimum tolerability.
For adult women, with acne, where there is a hormonal component to the disease, adjunctive treatments, such as oral contraceptive pills or spironolactone, may be beneficial.
All patients with acne must use sunscreen daily. Because acne patients may tend to perceive certain formulations as “oily,” dermatologists must be prepared to work with patients to find a formulation they like and will use. I find that acne patients tend to prefer mineral sunscreens. A dimethicone base may offer a balance of moisture without oiliness. I like to recommend sunscreens with supportive ingredients, such as niacinamide, in the base. Niacinamide may help to reduce inflammation, which is part of the acne pathogenesis.
In terms of procedures for the acne patient, I generally recommend light chemical peels or light laser treatments. The targeted energy from an Nd:YAG laser, for example, may gently heat the skin to reduce inflammation. Combination red and blue light therapy is both effective and popular, as there is no downtime. I recommend that patients return to the office once per month for procedures for fastest remission.