Systemic

Therapy

Tetracycline

Macrolides

MOA

P.acnescolonization

P.acnes
Antiinflammatory

Indication

Moderatetosevere
inflamm.Acne
1stline
Rosacea:pustular,
popular

Usedifptcannot
toleratetetras

Dose

Tetracycline250
500mgTID
Doxycycline50100
BID
Minocycline100
200mgBID
Cramps,Diarrhea,
photosensitivity
Tetra:teeth
discoloration
Minocycline:skin
pigmentation

Erythromycin250
500TID
Azithromycin500mg
TID

SMXTMP
800/160mgBID

1st4weeks:0.5mg/kg
Weeks516/20:1mg/kg

Abdominalcramps,
diarrhea

SignificantGI
Bonemarrow
suppression

Drynessofskinandmucous
TG,Chol,LFTs
Depression
Acneflareatthestartoftx
Alopecia
Photosensitivity

ADRs

PtEduc.

Pregnancy

Avoiddairy,space1
2hours
Usesunscreen,
protectiveclothing,
limitsun
Skindiscoloration
canbepermanent

CategoryD

SMXTMP
Sulfamethoxazole
/Trimethoprim
Bactrim
P.acnes

Isotretinoin

Suppressabn.Keratinization,
sebum,proliferationP.acness,
Inflamm.
3rdlineifunableto Moderate,severe
toleratetetraor
Recalcitrantacne
macrolides
SevereRosacea
Limitedusedueto
ADRs

Depressionnocausalrelat
iPledgeMonitoring:
Pregnancytests&2formsof
contraception
Lipids&LFTs
Educateabouthowtomanage
dryeyes,mouth,nose,skin,lips,
andmusclepain
Ptsmust:understandbirthrisks,
reliable,signconsent,fillRx
within7days,notdonateblood,
notsharemed,waitatleast1
monbeforeDQing
contraceptives
CategoryX

CombinationOral
ContraceptivesCOC

Spironolactone
Aldactone

Androgen(
sebum)

Antiandrogen
(inhibits5alpha
reductase)
Lastoption

Inflamm.Papules,
nodules
Femalesnmlor
Andros
Androgenicalopecia
Lateonsetacne
Needestrogen
contenttocombat
androgens
Preferlow
androgenic
progesterone
N/V,HA,breast
tenderness,
spotting/breakthro
ugh,
thromboembolism,
edema,libido,
appetite,wtgain
Takes36months
forresults
Dontsmoke
bloodclots

50200mgBID

Hyperkalemia
Irregularmenses
HA
Fatigue
Gynecomastia

MonitorPotassium

CategoryC(non
childbearing&
thosethatareCIfor
COCs)

TypicalFrequencyofLesionType
Acne
Severity

Closed
Comedones

Open
Comedones

Papules

Pustules

Nodules

Scarring

Mild

Fewtomany

Fewtomany

+/

+/

Common1stLineTreatments
MildComedonal:TOPretinoid,+/TOPbenzoylper
MildPapular/Pustular:POabxw/TOPretinoid,Benz.P

Moderate

Fewtomany

Fewtomany

++

++

+/

Moderaterequirescombotherapy
Mod.Papular/Pustular:POabx,TOPretinoid,Benz.P
Modnodularw/scar:POabx,TOPretinoid,BenzP.

Severe

Fewtomany

Fewtomany

+++

+++

+++

+++

ForrefractorysevereacneNotfirstline
Severenodular:isotretinoin
Severehormonal(pust.&nod,nocysts):antiandrogen
Scarring,keloids:isotretinoin

Formulation
Gels
Creams

Oilyskin

Normalskin

AVOID

Dryskin
AVOID

x
x

Lotions

Solutions

AVOID