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Synchronizing pharmacotherapy in acne with review of clinical care
Sarvajnamurthy Aradhya Sacchidanand1, Koushik Lahiri2, Kiran Godse3, Narendra Gajanan Patwardhan4, Anil Ganjoo5, Rajendra Kharkar6, Varsha Narayanan7, Dhammraj Borade7, Lyndon D'souza7
1 Consultant Dermatologist, Sujala Polyclinic and Laboratory, Bengaluru, Karnataka, India
2 Consultant Dermatologist, Wizderm Speciality Skin and Hair Clinic, Kolkata, West Bengal, India
3 Shree Skin Centre and Pathology Laboratory, Navi Mumbai, Maharashtra, India
4 Consultant Dermatologist, Shreeyash Hospital, Pune, Maharashtra, India
5 Dr. Ganjoo's Skin and Cosmetology Centre, New Delhi, India
6 Consultant Dermatologist, Dr. Kharkar's Skin Clinic, Mumbai, Maharashtra, India
7 Department of Medical Affairs, Wockhardt Limited, Mumbai, Maharashtra, India
Correspondence Address:
Sarvajnamurthy Aradhya Sacchidanand
Sujala Polyclinic and Laboratory, 64, Bheema Jyothi LIC Colony, West of Chord Road, Opposite Shankar Matt, Doctor MC Modi Road, Basaveshwara Nagar, Bengaluru - 560 079, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/ijd.IJD_41_17
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Acne is a chronic inflammatory skin disease that involves the pathogenesis of four major factors, such as androgen-induced increased sebum secretion, altered keratinization, colonization of Propionibacterium acnes, and inflammation. Several acne mono-treatment and combination treatment regimens are available and prescribed in the Indian market, ranging from retinoids, benzoyl peroxide (BPO), anti-infectives, and other miscellaneous agents. Although standard guidelines and recommendations overview the management of mild, moderate, and severe acne, relevance and positioning of each category of pharmacotherapy available in Indian market are still unexplained. The present article discusses the available topical and oral acne therapies and the challenges associated with the overall management of acne in India and suggestions and recommendations by the Indian dermatologists. The experts opined that among topical therapies, the combination therapies are preferred over monotherapy due to associated lower efficacy, poor tolerability, safety issues, adverse effects, and emerging bacterial resistance. Retinoids are preferred in comedonal acne and as maintenance therapy. In case of poor response, combination therapies BPO-retinoid or retinoid-antibacterials in papulopustular acne and retinoid-BPO or BPO-antibacterials in pustular-nodular acne are recommended. Oral agents are generally recommended for severe acne. Low-dose retinoids are economical and have better patient acceptance. Antibiotics should be prescribed till the inflammation is clinically visible. Antiandrogen therapy should be given to women with high androgen levels and are added to regimen to regularize the menstrual cycle. In late-onset hyperandrogenism, oral corticosteroids should be used. The experts recommended that an early initiation of therapy is directly proportional to effective therapeutic outcomes and prevent complications. |
