This document discusses the classification, severity, treatment, and management of acne. It describes acne as comedonal, inflammatory, or nodulocystic. Severity is classified as mild, moderate, or severe based on the number and size of lesions and presence of scarring. Treatment involves reducing bacteria, excess skin cells, sebum production, and hormones. For mild-moderate acne, topical retinoids and benzoyl peroxide are recommended. Moderate-severe acne is treated with oral antibiotics like doxycycline combined with topical treatments. Patients are advised on proper skin care and risks of certain medications aggravating acne. Referral to a dermatologist is suggested for un

1. Prepared by : Dr. Ahmed Ibrahim Eldesouky Abouelela
Family Medicine Registrar
MBBch, Msc, MRCGP.int

2.  Comedonal acne – open (blackheads) and
closed comedones (whiteheads)
 Inflammatory acne – papules and pustules
 Nodulocytic acne – nodules and cysts

10.  Mild acne – characterized by papules and
pustules but no nodules
 Moderate acne – characterized by many
papules and several nodules
 Severe acne – characterized by extensive
papules and many nodules

11.  The presence of atrophic or hypertrophic
acne scarring is a separate indicator of
severity
 Scarring can occur with mild acne, but is
more common with severe acne

14.  Mild: Comedones (open/closed) with no
erythema
 Moderate: Comedones + Papules + Pustules +
Erythema
 Severe: Nodules and Cysts + Severe
inflammation + Scaring

15.  Reduce excess cells (hyperkeratinisation):
Topical retinoids, azelaic acid
 Reduce bacteria (propioniobacterium acnes):
Benzoyl peroxide, strength according to skin
type / Topical antibiotics (combine with
Benzoyl peroxide to reduce antibiotic
resistance) / Oral antibiotics
 Rebalance hormones (reduce androgen
excess) Oral contraceptives containing an
anti-androgen
 Reduce sebum hypersecretion: Oral
isotretinoin-high risk of teratogenicity

16.  Mild to moderate acne: start regimen is a
combination of a topical retinoid
(comedolytic) + a benzoyl peroxide (anti-
bacterial)
 Treatment takes 4-8 weeks to be effective

17.  Moderate to severe: First-line is oral
antibiotic therapy, doxycycline 50–100 mg
daily combined with a topical antiseptic (eg
benzoyl peroxide) to reduce the risk of
development of antibiotic-resistant acne for
a period of 12 weeks.

18.  Doxycycline is contraindicated in less than 10
years and women who are pregnant or
breastfeeding.
 Patients should also be warned of
gastrointestinal side effects, including
epigastric pain, nausea and vomiting, as well
as a risk of photosensitivity, dizziness, ataxia
and vaginal candidiasis in women. The
antibiotics should be taken with a full glass
of water to avoid gastrointestinal side effects

19.  It is not a dietary or infectious disorder
 Reassure it becomes less after age of 25 years
 Special soaps and over scrubbing are unhelpful
 Use a normal soap and wash gently
 Excessive facial wash may dry out the skin
especially when combined with benzol
peroxide treatment
 Avoid oily or creamy cosmetics and all
moisturizers
 Drugs aggravate acne: corticosteroids / lithium
/ anti-epileptics (e.g. phenytoin) / OCP

20.  Patients whose acne is unresponsive to oral
antibiotic therapy after 12 weeks, or have
the presence of scarring, should be referred
to a dermatologist

21. Thank you