Acne, the infamous mark of entering adolescence, is a dermatologic condition caused by the complex interactions of genetics, hormones, innate and acquired immunity, and a host of other environmental factors. Acne affects nearly 85% of young people ages 12-24 years and peaks in incidence around 18 years.1 Often called zits or pimples, acne presents itself in various forms, ranging from comedones, papules, and pustules, to cysts and scars.

In an attempt to manage the disease, acne treatments will target as many pathogenic factors as possible. Such factors include:

  • Hormonal influences on sebum production and composition—Androgens (produced locally in the sebaceous glands) and androgen receptors (found in the basal layer and sheath of the follicle) are responsive to testosterone and DHT. Increases in serum DHEAS levels in prepubescent children are associated with an increase in sebum production, leading to oily skin.2
  • Colonization with the bacterium Propionibacterium acnes— acnes is typically not considered a pathogen, but can still illicit an inflammatory response in the skin. It is a gram-positive, anaerobic rod found within the sebaceous follicle; although it is found in increased numbers in acne patients, its density on the skin does not correlate with clinical severity.3
  • Local release of inflammatory mediators (e.g. cytokines, prostaglandins)—Inflammation is seen early in acne lesion formation as indicated by the increased number of CD4+ T cell and and IL-1.4 Acne lesions contain keratin, sebum, P. acnes, and cellular debris, which significantly intensify inflammation.
  • Micro-anatomical changes in the pilosebaceous unit (e.g. ductal hyperkeratosis)—A hyper-keratotic plug and bottleneck structure, often called a microcomedo and later comedo, are formed when corneocytes accumulate due to an increase in proliferation and cohesiveness of follicular cells. These skin changes further exacerbate the inflammatory and sebaceous accumulation process and result in the telltale bumps seen with acne.

In addition to targeting pathogenic factors, a successful therapy regimen will involve properly educating patients. Here are some helpful tips for topical acne therapy:

  • A simple medication regimen—Adolescents with busy lifestyles show an increased rate of noncompliance, which can contribute to the failure of a treatment plan. To make a regimen simpler and easier to follow, a combined product can be used instead of relying on 2 or more separate products. It is important to know that it may take anywhere from 6-8 weeks to see improvement, so medication use must continue daily, even if improvement is not immediately visible to the eye.
  • Proper use of medication—Instead of using “spot” therapy, patients should apply the medication to the entire affected area and surrounding areas to ensure that all areas are getting treated. Typically, a “thin layer” should be applied and hands washed thoroughly afterward. Because many medications used on the skin can cause photosensitivity, the patient will need to apply sunscreen in the morning and when exposed to sun. Using too much of the medication or too frequently can also cause irritation.
  • Know their skin type and minimize irritants—For patients with sensitive skin, begin with a gentler formulation or request a lower strength for the medication. Alcohol-free preparations and single-agent medications should be used in these cases. Azelaic acid and Sulfacetamide are best for sensitive skin. Avoid harsh scrubs or irritating agents such as toners and acne products that are not part of the regimen. Discontinue the use of over the counter topical agents, which may interact or be duplications. Non-comedogenic moisturizers can be used if the skin becomes dry.
  • Avoid exacerbation—Picking and squeezing lesions will not help correct or speed up the healing process.

At Innovation Compounding, we formulate medication regimens that target the causative factors of acne specific to patients’ needs using unique combinations of the following ingredients: benzoyl peroxide, clindamycin phosphate, erythromycin, alpha lipoic acid, sodium sulfacetamide, niacinamide, retinoic acid, azelaic acid, zinc, hyaluronic acid, metronidazole, spironolactone.

Our Derm line includes acne rosacea and acne vulgaris regimens, which are pH-balanced, dye-free preparations compounded using the most appropriate bases and non-comedogenic ingredients.

We know how precious your skin is and you should feel good in it! Ask us how our acne products can work for you or your patients!

 

References:

  1. Ghodsi SZ, Orawa H, Zouboulis CC. Prevalence, severity, and severity risk factors of acne in high school pupils: a community-based study. J Invest Dermatol 2009;129:2136–41.
  2. Lucky AW, Biro FM, Huster GA, et al. Acne vulgaris in premenarchal girls. An early sign of puberty associated with rising levels of dehydroepiandrosterone. Arch Dermatol 1994;130:308–14.
  3. Leyden JJ, McGinley KJ, Mills OH, Kligman AM. Propionibacterium levels in patients with and without acne vulgaris. J Invest Dermatol 1975;65:382–4.
  4. Jeremy AHT, Holland DB, Roberts SG, et al. Inflammatory events are involved in acne lesion initiation. J Invest Dermatol 2003;121:20–7.

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