Acne Vulgaris

Skin Lesion: Polymorphic presentation including comedones (open/blackheads or closed/whiteheads), papules, pustules, and in severe cases, nodules and cysts.

Severity Grading:

• Mild: Many comedones, papules and pustules.
• Moderate: Numerous comedones, papules and pustules.
• Severe: Covered with comedones, numerous pustules and papules, a few nodules and cyst.

Acne Rosacea

• The Clue: Facial flushing, persistent erythema, and telangiectasia. Triggers include spicy food, heat, and alcohol.
• Vs Acne: Rosacea lacks comedones. It primarily affects the central face (nose, cheeks, forehead) in adults aged 30-50.

Perioral Dermatitis

• The Clue: Small, inflammatory papules around the mouth with a characteristic clear zone (sparing) at the lip margin (vermilion border).
• Vs Acne: Often triggered by the use of topical steroids on the face. Does not feature comedones.

Mild Acne:

• Benzoyl Peroxide 5%: Apply daily.
• Topical Retinoids (Adapalene 0.1%): Apply at night. Contraindicated in pregnancy!
• Step up to moderate acne management if no improvement after 3 months

Moderate Acne:

• Choose 2 from these: Benzoyl peroxide | Retinoid | Topical antibiotic | Azelaic acid | Salicylic acid
• ADD ON ONE ORAL ANTIBIOTIC IF NO IMPROVEMENT AFTER 3 MONTHS. Response to oral antibiotics should be assessed at 6 - 8 weeks. Recommended duration of oral antibiotics is 3 - 4 months.
• Doxycycline: 100mg OD for 12 weeks.
• Erythromycin: 400mg BD for 12 weeks. (Safe in pregnancy).

Severe Acne:

• Refer dermatology

⚠️ Clinical Pearl: To avoid antibiotic resistance, never use oral antibiotics as monotherapy; always combine with a topical agent like Benzoyl Peroxide or Adapalene.

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