Neobook — clinical reference

ICD-10 code: L70

DESCRIPTION

An inflammatory condition of hair follicles leading to comedone formation; inflammatory papules and/or nodules that can cause scarring and post inflammation hyper-pigmentation, on healing.

DIAGNOSTIC CRITERIA

Black-heads or white-heads (comedones).

GENERAL AND SUPPORTIVE MEASURES

Avoid greasy and oily topical products.
Discourage excessive facial washing.

MEDICINE TREATMENT

For mild acne

Benzoyl peroxide 5%, gel, apply in the morning to affected areas as tolerated.
- Wash off in the evening.
- If ineffective and tolerated, increase application to 12 hourly.
- If ineffective after 4 months, move to topical retinoid therapy.

For comedonal acne
Topical retinoid, e.g.:

Tretinoin cream/gel 0.05%, topical, applied sparingly once daily at bedtime until substantial improvement.
- To limit skin irritation, introduce topical retinoid gradually – apply on alternate days (at night) for 1–2 weeks.
- Avoid contact with eyes and mucous membranes.
- To prevent irritation, limit exposure to sunlight, especially with concomitant use of doxycycline.

For inflammatory acne

Doxycycline, oral, 100 mg once daily for a maximum of 3 months.

AND
Topical retinoid, e.g.:

Tretinoin cream/gel 0.05%, topical, applied sparingly once daily at bedtime.

Tretinoin is teratogenic.
Do not use where pregnancy is a possibility. If used, ensure adequate contraception.
Teratogenic risk also applies to males

To avoid sun irritation:

Sunscreen, topical, applied daily.

REFERRAL

Ineffective treatment: referral for consideration of isotretinoin oral therapy.
Recalcitrant and/or fulminant acne.
Psychologically disturbed or depressed patient.
Young females with premenstrual flare or with clinical signs of hyperandrogenism for consideration of oral contraceptives.

Standard Treatment Guidelines And Essential Medicines List For South Africa, Hospital Level, Paediatrics, 2023 Edition

Chapter 5: Dermatology, 5.3 Macules And Papules, 5.3.2 Acne