• The adolescent acne is called polymorphic because it combines several elementary lesions: comedones (blackheads or) microcysts (or closed comedones), papules (aseptic inflammation microcysts), follicular pustules.
• It affects 80% of adolescents but only 10% of them require medical treatment.
• The lesions are secondary to a functional disorder of the follicle pilosebaceous (seborrhea, retention, inflammation).
• The spontaneous evolution is towards healing but times vary greatly (from 6 months to 20 years).
• The choice of treatment depends on the type of acne (retentional, inflammatory), intensity, extent.
• Severe acne is characterized by the presence of abscess, or suppurative macrocysts follicular nodules. They are the responsibility of the specialist.
• In case of acne in a person of age wall, eliminate secondary cause (corticosteroids, barbiturates, vitamin B12, halogenated, occupational exposure to hydrocarbons and chlorine).
• The oral isotretinoin (Curacné) should be reserved for severe acne or resistant properly conducted local treatment. The association of oral and Curacné cyclins is against inappropriate.
• Avoid: sulfur soaps or acidic cleaners (acne is not an infectious disease), comedogenic cosmetics, sun, automanipulation lesions, diets.
• AFSSAPS published recommendations in 2008 for the treatment of acne. This document is available at: http://www.sfdermato.com/doc/ACNE_RECO.pdf
Order No. 1: retentional acne (blackheads, microcysts)
– To face washing morning and evening, dermatological bread or SEBIUM foaming gel.
– The morning after cleansing, apply cream or TOLERIANE HYSEKE emulsion.
– In the evening, 10 minutes after the toilet on a very dry skin, apply to all areas of acne: RETACNYL 0.025[Tretinoin] or Differin [adapalene]. If irritation, space applications.
Treatment for 3 months.
If irritation, space applications (one application every 2 or 3 days) and then gradually return to the original frequency.
A pustular pressure may occur in the first 15 days.
We will not judge the effectiveness of the treatment after a month of regular applications.
Ordinance No. 2: inflammatory acne (papules, pustules)
– Same Order No. 1 for soaps and anti-irritant creams.
– Every evening, 10 minutes after washing and drying, apply without rub on acne areas: EFFACNECUTACNYL 5 or 5 or 5 ECLARAN [benzoyl peroxide].
Treatment for 3 months.
The risk of skin irritation are the same as Order No. 1. If poor tolerance, space applications.
No.3: moderate acne in young women desiring contraception
– Ordinance No. 1 or No. 2.
– Add: DIANE 35 or Lumalia [cyproterone ethinyl estradiol] or TRIAFEMI [norgestinate, ethinyl estradiol].
The improvement is noticeable from the 3rd or 4th menstrual cycle. The management of this oral contraception is no different from other COCs (clinical, biological, gynecological consultation). Note the absence of marketing authorization as a contraceptive and for DIANE Lumalia and lack of reimbursement by social security.
Ordinance No. 4: acne face significant or resistant to previous treatments, profuse inflammatory acne and back
– TETRALYSAL [lymecycline] 1 capsule 2 times daily for 3 months without food or TOLEXINE 100[doxycycline] 1 capsule per day for 3 months, during meals and at least one hour before bedtime.
– Local treatment: same order 1.
Sun exposure should be avoided for the duration of this treatment (phototoxicity cyclin).
Against: pregnancy, lactation, children under 8 years.
An evaluation of treatment should be made in the third month. If the improvement is clear, local treatment is to continue spacing applications, otherwise, a therapeutic enhancement is possible as an association of different therapeutic cited.