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Acne: Clinic, diagnosis and treatment
Acne: Clinic, diagnosis and treatment
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Medical editor: Dr Marina ALEXANDRE, Dermatologist, Avicenne Hospital, France.
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Dr. Marina Alexandre
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There are several determining factors in the development of acne:
The different forms of acne are classified into three categories: common forms, severe forms and specific forms2:
There are 6 levels of acne severity2,6. They are described according to a global severity assessment tool: Global Acne Evaluation (GEA)6.
The different lesions found in acne have been classified as such2,6:
Two types: closed comedones and open comedones:
The French Society of Dermatology has established an algorithm7 for the management of acne according to the patient's symptoms. It is described below:
Oral isotretinoin, topical retinoids and cyclins are strictly contraindicated. Topical antibiotic treatment may be used: benzoyl peroxide or azelaic acid. Oral zinc can be used from the second trimester onwards1,12.
Reassure about the always temporary and spontaneously regressive nature of the flare-ups. Advise usual non-irritating hygiene care, no topical antiseptics. Possibly an erythromycin cream in 4% preparation in case of request for treatment.
As a first-line treatment, either a copper IUD or a second-generation estrogen-progestin is recommended. As a second-line treatment, norgestimate is recommended. If the acne persists after 3 months, consult a gynecologist.
Infant acne is due to persistent exposure to maternal hormones.
The copper IUD has no influence on acne, while estrogen-progestogens have a positive or negative influence, depending on whether they are anti or pro-androgenic.
In 10 to 15% of cases, it can cause or worsen acne13,14.
A papule is an erythematous lesion that is slightly infiltrated. A pustule has a white tip (cellular debris or pus). A comedo is an open cyst, whereas a microcyst has no opening to the skin.
Propionibacterium acnes is the former name of Cutibacterium acnes. It is a bacterium that contributes to the pathophysiology of acne.
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