Acne Vulgaris is a very common condition, affecting approximately 85% of youg people. It is an inflammation of the sebaceous units, and appears on face, trunk and back (rarely buttocks).
It is more severe in males than in females. Causes can be multifactorial, from genertic, family disposition and other genetic syndromes. Emotional stress can cause exacerbations/triggers. Cow´s milk may be associated with acne.
There are several types of acne depending on the appearance, and treatment will depend on this classification:
- Mild-inflammatory acne
- Mild comedonal acne
- Papulo-pustular acne
- Nodulo-cystic acne
- Moderate to severe scarring acne
Transmission of HIV would not be through non-visibly-bloodly saliva (during receptive oral sex). Hep B can be transmitted via saliva but CDC recommendations for a mucosal contact in this setting (outside healthcare setting, source not known to be HepB positive, exposed person fully vaccinated) are no prophylaxis. However, a booster of HepB vaccine that he received will not be harmful. Noted that there are other STIs that can be transmitted via oral-genital contact such as gonorrhea, chlamydia, syphilis, herpes. He states he plans to get full STI testing when he moves to where he will be living longer-term in a few weeks. Meantime he should monitor for any rash/lesions.
Treatment:
- Strong recommendations are made for topical benzoyl peroxide, retinoids, and/or antibiotics and their fixed-dose combinations, and for oral doxycycline. Oral isotretinoin is strongly recommended for severe acne, acne causing psychosocial burden or scarring, or acne failing standard treatment with oral or topical therapy.
- Conditional recommendations are made for the use of topical clascoterone, salicylic acid, azelaic acid, oral minocycline, sarecycline, combined oral contraceptives, and spironolactone.
- Using topical therapies combining multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with benzoyl peroxide and other topical therapies, and adjuvant intralesional corticosteroid injections are recommended as good clinical practices.
ISOTRETINOIN (DERCUTANE/ROACCUTANE)
Oral isotretinoin is highly effective, and in many cases a permanent treatment for severe acne. It is recommended as a first line treatment. At present, few GPs in Ireland initiate isotretinoin treatment.
Isotretinoin is a vitamin A derivative inducing oil glands to die via apoptosis, initially licensed in 1982. Duration of treatment is typically for four to six months. Side effects include dry skin and lips, rise in transaminase concentrations, teratogenic effects and rarely, severe mood disturbance. With patient education, monitoring and planned care, side effects can largely be prevented or mitigated.