Jerry Tan MD FRCPC
Adjunct Professor, Western University, Windsor campus; Medical Director, Healthy Image Center, Windsor Ontario
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Acne has a worldwide prevalence – but intriguingly does not affect certain populations including some tribal groups and those with Laron’s syndrome. The search for underlying reasons has revolved around hormonal abnormalities as well as dietary differences.
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New research demonstrates that Propionibacterium acnes consists of different phyllotypes with different pro-inflammatory potential. Furthermore, there is differential association for inflammatory acne and no acne. This infers that targeting all Propionibacterium acnes during acne treatment is unreasonable. Should we be modifying the concept of treating acne with antibiotics? Is the efficacy of antibiotics due to non-antibiotic effects?
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There is an increasing focus on reducing antibiotic usage to mitigate the development of further antibiotic resistant bacteria.
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For oral isotretinoin, the standard of treatment for recalcitrant and severe acne, the cumulative threshold dosing concept has been shown to be outdated and inappropriate in the current era. Furthermore, there are concerns about the adequacy of implementation of pregnancy prevention program for oral isotretinoin in Canada.
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Recent studies demonstrate the evolution of primary acne lesions to scars including some which may be temporary. Two topical treatment options have been shown effective in reducing inflammatory acne as well as in mitigating and improving post acne scarring.
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For those with acne, there are 2 new developments:
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A new survey instrument has been developed to identify those at greatest risk of acne scarring.
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A patient decision-aid for acne including management options based on individual values and preferences has been developed as a free online resource informed-decisions.org
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