Management of Acne Vulgaris : Guideline Summary

 

Reference : Management of Acne Vulgaris 2nd Edition 2021 (MOH)

1. Why acne appears?

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• during adolescence period, sebum production increased on face

• this can block the pilosebaceous unit, and causing colonisation of bacteria, Cutibacterium acnes

• other factors that contribute to acne include

• family history

• high glycemic index diet

• unhealthy fat intake

2. How to classify acne severity?

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• acne can be classified into 

• non inflammatory : open and closed comedones

• inflammatory : papules, pustules, nodules, cyst

• using Comprehensive Acne Severity Scale (CASS)

• grade 0 : CLEAR 

• no lesion / barely visible

• grade 1 : ALMOST CLEAR 

• few scattered comedones, small papules, pustules

• grade 2 : MILD 

• comedones, papules and pustules, less than half of area

• grade 3 : MODERATE 

• comedones, papules and pustules, more than half of area

• grade 4 : SEVERE 

• comedones, papules, pustules, nodules and cyst

• grade 5 : VERY SEVERE 

• inflammatory acne with nodules and cyst

3. How to treat acne?

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• based on severity

• mild
• non inflammatory  
• topical retinoid
• inflammatory 
• topical benzoyl peroxide  2.5% OD to 10% OD
• reassess after 3 months of treatment
• if no improvement, to escalate treatment  / refer

• moderate : 
• combination of any 2 topical agents
• benzoyl peroxide 
• retinoid
• topical antibiotic
• azelaic acid
• salicylic acid
• reassess after 3 months
• if no improvement : add oral antibiotic (stop topical antibiotic if any)
• doxycycline : 100 - 200mg OD
• tetracycline : 250 - 500mg BD 
• erythromycin (EES) : 400 - 800mg BD
• reassess at 6-8 weeks
• recommended duration of oral antibiotic : 3-4 months
• severe
• refer dermatology for physical therapy / oral isoretinoin
• physical therapy (chemical peels) include
• salicyclic acid
• glycolic acid

4. Any extra precautions with topical treatment?

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• skin irritation may develop with topical benzoyl peroxide

• withhold treatment, and start every alternated days

• use moisturiser to reduce skin irritation

• topical retinoid can cause photosensitivity (causing skin burn)

• apply at night to reduce side effect 

• use sunscreen / umbrella / hat

• use moisturiser