Teenagers and Acne: The Role of the Pharmacist

Joshua J. Pray, Pharm.D. Candidate, W.Steven Pray, Ph.D., R.Ph.

US Pharmacist. 2003;28(6) 

In This Article

Treatment of Acne

Patients should be told that acne symptoms improve gradually, perhaps taking as long as six to eight weeks. Further, patients should not be discouraged if their acne seems to worsen for two to three weeks after treatment begins.[8] This common flare often presages a period of slow improvement.

Patients need other advice, too. They should keep their hair away from the face, because oils can spread from the hair to the face and worsen acne. Adolescents who tan to hide acne must be informed that tanning is counterproductive due to long-term damage from sun exposure.

Numerous approaches exist for treating acne.[14] Patients with type 1 acne may choose from several relatively mild nonprescription medications, such as benzoyl peroxide, sulfur, and salicylic acid.[15] Patients with moderate to severe acne (types 2 to 4) or with scars already present should be referred.[16]

In one treatment taxonomy, dermatologists suggest a treatment approach based on the acne grade at presentation. For instance, a patient with type 2 acne might be prescribed topical antibiotics (eg, tetracyclines, erythromycin). For type 3 acne, physicians might choose an eight- to 12-week course of oral antibiotics with anti-inflammatory actions (eg, oxytetracycline, tetracycline, doxycycline, minocycline) or erythromycin/azithromycin, possibly in addition to topical products.[16,17] However, the use of some antibiotics may be limited due to resistance (eg, erythromycin) and may require shorter courses of therapy.[18] Type 4 acne does not respond to topical therapy; rather, physicians may prescribe systemic hormones or isotretinoin.[8]

Pharmacists may be confronted with patients whose skin has broken out as a result of several nonacne conditions, all of which require referral.[8] Rosacea is found on the cheeks, nose, forehead, and chin, and may produce papules and pustules, but it is mostly found in middle-aged patients and never produces comedones. Patients taking oral antibiotics for acne may notice a sudden onset of small pustules around the nose, chin, and cheeks that may be due to the development of Gram-negative folliculitis. After two to five weeks of therapy with topical corticosteroids, some patients develop uniformly sized flesh-colored lesions. This steroid-induced acne requires steroid discontinuation, followed by topical products (eg, benzoyl peroxide). Female patients with acne, scanty menses, and hirsutism may have polycystic ovary syndrome and need to see an endocrinologist.

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