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(BQ) Part 2 book “Family medicine - Ambulatory care & prevention” has contents: Diabetes mellitus, inflammatory bowel disease, ischemic heart disease and acute coronary syndromes, peptic ulcer disease, premenstrual syndrom, renal failure, seizure disorders, thyroid disease, and other contents. | SECTION II. Chronic Illness 66 Acne Vulgaris and Acne Rosacea Paul C. Walker, PharmD, FASHP, Mindy A. Smith, MD, MS, Brooke E. Farley, PharmD, BCPS, & Julie A. Murphy, PharmD, BCPS KEY POINTS • Accurate diagnosis of a patient’s severity level of acne will ensure optimal medication regimen selection. (SOR C) • Topical agents are often sufficient for mild-to-moderate acne vulgaris (SOR A) and mild forms of acne rosacea. (SOR B) • For more extensive involvement in patients with acne rosacea, oral doxycycline, tetracycline, and metronidazole are effective. (SOR A) Systemic antibiotics are effective in patients with moderate acne, but it is not clear that they are more effective than topical agents. (SOR C) • Oral isotretinoin (Accutane) is used for severe acne vulgaris or acne rosacea, (SOR A) but requires registration with the iPledge program to ensure safe use. • Education of patients about the disease and the importance of compliance will improve outcomes. (SOR C) • Assessment of patient progress at regular intervals will enhance the success rate of medication regimens. (SOR C) ACNE VULGARIS I. Introduction A. Definitions 1. Acne vulgaris is a common, chronic, polymorphic skin disease of pilosebaceous units, consisting of a hair follicle and sebaceous gland, located on the face, chest, and back. It is generally a self-limited condition that begins during adolescence; however, acne can persist into adulthood. In general, acne is not a high mortality disease state; however, morbidity can be high as the disease can adversely affect self-esteem and can cause scarring and disfigurement. 2. Noninflammatory (obstructive) lesions (Figure 66–1). a. Open comedones, or “blackheads”, are wide openings on the skin surface capped with a melanin-containing blackened mass of epithelial debris. b. Closed comedones, or “whiteheads”, have a narrow or obstructed opening on the skin surface; these may rupture, producing a low-grade dermal inflammatory reaction. FIGURE 66–1. .
