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AcneVulgarisMx
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<<forEachTiddler where 'tiddler.tags.contains(context.inTiddler.title)' sortBy tiddler.title ascending write '"*[["+tiddler.title+"]]\n"'>> <<tiddler AutoRefresh with: force>> ''simple step-up scheme'' 6/52 at each level, alt days to start with //Mild// single topical therapy (retinoids (comedones) or benzyl peroxide (pustules)) then topical combination therapy (2 of - antibiotic, benzoyl peroxide, retinoid) //Moderate// Consider COCP, then add in oral antibiotics with BP or topical reinoids try two different oral abs for 8/52 each before referral //Severe// oral isotretinoin: only under specialist supervision therapy – 3-6/52 to help, 3-6/12 for max effect lifestyle – diet no difference, smoking inc, skin cleansers help with mild topical antibiotics – erythro, clinda (as good as oral), Oral antibiotics - oxytet (od most cost effective), doxy, erythro, for larger area – 12/52 at most and use with retinoid or BP to dec resistance, Beware – tetracyclines for children, young women – need contraceptive Azelaic acid – limited benefit COCP (Dianette not shown to be better than any other but POP may make skin worse) Retinoids – teratogenic, specialist prescribe oral, 16-24/52 course, beware suicide Minocycline - possible irreversible pigmentation - AVOID Gram negative folliculitis may occur with long-term antibiotic use - high-dose oral trimethoprim is effective if this occurs but may depress haematopoiesis - specialist to start Erythromycin - inhibits P450 so affects hepatic metabolism of other drugs
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