Modern protocols for the management of patients with acne: recommendations from a specialist

In the practice of every dermatologist, patients with such a pathology as acne are much more common than others, because this dermatological disease is the most common among patients of different sex and age. That is why the issue of acne treatment is very relevant, and the protocols for managing such patients are being supplemented and improved every year.

Irina Dasyuk, a dermatovenereologist, cosmetologist, certified lecturer of the Allergan company, Member of the European Academy of Dermatovenereology EADV, spoke about the most relevant and effective protocols for managing patients with various forms of acne especially for estet-portal.com.

What are the most relevant acne management protocols today?

The latest acne protocols were approved in 2016. Many countries approve their own protocols, but the most common ones today are American, Canadian, British and European protocols for the management of patients with acne. They are, for the most part, similar, but there are changes made from previous protocols.

In the new acne protocols, systemic antibiotics have taken a back seat, and systemic isotretinoins have been elevated.

In addition, the new protocols draw attention to insulin resistance, as well as the need to examine the patient by a gynecologist, endocrinologist and other specialists.

Which of the current acne management protocols do you like best?

I really liked one of the guidelines because it was written for a practicing doctor. That is, it minimizes scientific data, and focuses on everyday clinical practice, data that a practicing doctor can use in his daily work and which will make it easier for him to work with patients. These protocols focus less on what to prescribe because we already know it, and more on what to do if something goes wrong or the therapy does not bring the desired results.

What are the highlights of this acne management protocol that you would highlight?

If we are talking about topical therapy, then the priority is the appointment of topical retinoids for comedonal forms of acne. Moreover, the drug with the highest strength of recommendations (level of evidence A), that is, the best drug for the treatment of comedonal acne does not exist at all. It is also forbidden to prescribe monotherapy with an antibacterial drug for comedonal acne, but fixed combinations can be used, which have great strength of recommendations for both comedonal and moderate acne. Antibiotic monotherapy is prohibited because, to date, there is an incredibly high resistance of bacteria to antibacterial drugs. And when an antibiotic is used in a fixed combination, that is, in combination with an additional drug – the risk of developing resistance to it is sharply reduced.<

What's new in the protocols for managing moderate acne?

As for the moderate forms, the protocols for prescribing systemic isotretinoin have expanded more. To date, with the help of this drug, it is possible to treat not only severe forms of acne, but also moderate, and even mild forms, especially & nbsp; when patients have a tendency to scarring, because then it can be extremely difficult to remove it. The tendency to prescribe systemic antibiotic therapy has slightly decreased, attention is paid to insulin resistance, metformin and antiandrogens, in particular spironaloctone, are prescribed more often.

Do you frequently prescribe isotretinoin for acne treatment to your patients?

I love systemic isotretinoin and as a doctor I find it easier to treat severe acne than mild acne. Because in this case, I can prescribe systemic isotretinoin, the patient takes his course, and the problem, most often, is solved. And with milder forms, it is initially necessary to recommend to patients a different treatment regimen, which does not always work. Systemic isotretinoin has its own characteristics and contraindications. One of them is photosensitization, that is, an increase in the sensitivity of the skin to ultraviolet radiation. With extreme caution, you need to take the drug in the summer, or even refuse to take it during the sunny period. Based on this, there are special restrictions on trips to the sea, to a picnic, and so on. Therefore, if a patient, for example, with mild acne comes to me in May – I follow the protocols (topical therapy, systemic antibiotics, antiandrogens), and if the treatment regimen does not help him –  we are switching to systemic retinoids. If the patient comes in October – I can safely prescribe isotretinoin to him right away. Also, the most severe contraindication for taking isotretinoin in women is pregnancy, since retinoids can provoke fetal malformations. It is necessary to start taking the drug after menstruation, plus reliable methods of contraception are additionally negotiated with the patient. FAQ: When can I get pregnant after taking systemic isotretinoin? Absolutely safe – in 2 months.

I can safely prescribe isotretinoin to him right away. Also, the most severe contraindication for taking isotretinoin in women is pregnancy, since retinoids can provoke fetal malformations. It is necessary to start taking the drug after menstruation, plus reliable methods of contraception are additionally negotiated with the patient. FAQ: When can I get pregnant after taking systemic isotretinoin? Absolutely safe – in 2 months.

I can safely prescribe isotretinoin to him right away. Also, the most severe contraindication for taking isotretinoin in women is pregnancy, since retinoids can provoke fetal malformations. It is necessary to start taking the drug after menstruation, plus reliable methods of contraception are additionally negotiated with the patient. FAQ: When can I get pregnant after taking systemic isotretinoin? Absolutely safe – in 2 months.

What can be the reason why acne management protocols are not working?

There can be many reasons why an acne treatment protocol doesn't work. First, it is necessary to check whether the patient is being treated at all. In such situations, I ask my patients to tell me how often they used the prescribed remedies, and even better – show the tube with the drug. Because if a patient was prescribed a drug where there is 15 grams in a tube, and he has been treated for 2 months, and he still has 2/3 of the package left, it is clear that he did not use the drug properly.

Isotretinoin can cause side effects such as dry skin, irritation, retinol dermatitis and other unpleasant conditions that make the patient unwilling to use the drug.

Furthermore, acne management protocols may not work if the patient has Malassezia folliculitis or Gram-negative folliculitis, which may be caused by Pseudomonas or Klebsiella, if the patient does not take the drug with food and simply does not absorbed if he additionally takes antiepileptic drugs, anabolic steroids and other drugs that are acne-producing. In all of these and some other cases, acne management protocols may indeed be ineffective.

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