Acne -- Any Alternatives to Isotretinoin and Antibiotics?

Désirée Lie, MD

Disclosures

January 21, 2011

Case

John is a 16-year-old boy with an oily complexion and moderately severe facial acne, with some involvement of the chest. He is also overweight with a body mass index in the 90th percentile for height and age. He is visiting his primary care physician with his mother, who would like him to have optimal treatment to control the acne. However, she is concerned about the potential for adverse psychological effects of isotretinoin treatment on adolescents, which she has read about, and prefers to avoid them. John has tried over-the-counter treatments, including benzoyl peroxide washes and gels, and found salicylic acid washes to be too harsh and drying. He was prescribed erythromycin topical gel, but the acne has not improved significantly over the past few months. He is open to changing his diet, using appropriate face washes, and trying alternative therapies such as tea tree oil or zinc to improve his skin before trying oral maintenance antibiotics or isotretinoins. Assessment of his acne severity suggests a severity of grade 3 for the face and back using the Leeds revised acne grading system.[1]

How would you guide this patient in his choice of alternative therapies?

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