Acne treatment

January 2017

Acne, a disease of the pilosebaceous follicle, affects adolescents more particularly. With a prevalence in France of more than 70%, it is important to find the adequate treatment, more especially as acne can have a strong psychosocial repercussion.

In November 2007, the Afssaps issued recommendations on the treatment of acne by local and general way.

Let us focus on these recommendations.


Medicinal treatments for acne which have a marketing authorisation since 2007


Afssaps publishes the following list of medicinal treatments for acne which have a marketing authorisation since 2007.

Local application

  • Tretinoin:
    • Alone
    • Associated (+ erythromycin)
    • Isotretinoin
    • associated Isotretinoin (+ erythromycin)
    • Adapalene
  • Benzoyl peroxide
  • Local antibacterial:
    • Clindamycin
    • Erythromycin
    • Sulfacetamide
    • Azelaic acid
  • Sulfur, copper and zinc sulfate

General

  • Antibiotics:
    • Cyclins (doxycycline, lymecycline, metacycline, minocycline)
    • Macrolides (erythromycin)
  • Hormonal therapies (oestrogen/progestogen)
  • Retinoids (Isotretinoin)
  • Others (zinc gluconate)

Acne


There exist several forms of acne:
  • Acne with retentional lesions
  • Acne with inflammatory lesions
    • Papules-pustules
    • Nodular Acne

Treatment

Generalities


Afssaps recommends, in all cases, adapted hygiene (daily toilet with dermatological soap-free gel or bar and daily application of a moisturiser for acned skin). It is necessary for the patient to be aware that the medicinal treatment is long and that it alternates between an attack phase and a maintenance therapy.

The attack treatment lasts generally at least 3 months.

The attack treatment


The treatment varies according to the form of the acne. Afssaps recommends:
  • Acne with retentional prevalence: adapalene at 0,1% or tretinoin with 0,025% in application once per day.
  • Acne with Papules-pustules prevalence
    • Localised Form
      • Benzoyl peroxide at 5% 1 X/day
      • If intolerance with benzoyl peroxide: adapalene at 0,1% 1 X/day or a local antibiotic associated with a local retinoid
    • Wide form or prolonged evolution
      • Cyclins
      • If cyclin is contraindicated: erythromycin


Afssaps recommends to associate a local treatment with a general antibiotherapy and not to associate a general antibiotherapy with a local antibiotherapy.
  • Nodular acne: oral Isotretinoin.

Maintenance therapy

  • Local retinoids (adapalene at 0,1% + possibly oral zinc gluconate).
  • Also for women wishing contraception: non-androgenic hormonotharapy.

Source


Treatment de l'acné par voie générale, Afssaps, 2007.

Photo Copyright© Michelle Robek | Dreamstime.com

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