Acne treatments should be selected according to age, gender, ethnicity

MIAMI — Understanding the effects of age, gender and ethnicity when treating a patient for acne can inform the best approach to treatment, according to a speaker here.

“When you sit down with an acne patient, I do believe you need to spend a lot of time with these patients and it’s not just a little trite condition,” Diane S. Berson, MD, said at South Beach Symposium 2017. “The first thing I do discuss with them is skincare; it’s really important to know what they’re using for their skincare and make sure they use the appropriate products.”

Diane S. Berson

Berson advised that mineral-based cosmetics can be useful in the management of acne as they deflect light and minimize the appearance of pores. Cosmeceuticals can be used in both adolescents and adults, especially adults with photo damage, and the focus is to improve the barrier with products that include ingredients such as glycerin and lipids.

Topical treatments consisting of combined benzoyl peroxide with a retinoid are the most useful, according to Berson, as they will affect all pathogenic factors other than sebum.

Oral treatments, such as antibiotics, can be used in cases where inflammation has not been resolved by topical treatments. However, Berson advocated the practice of antibiotic stewardship: Limit use by 6 months and use in conjunction with the combined topical treatments to minimize the development of resistance.

For adult women who either have acne that has continued since adolescence or is new-onset acne, especially those who have flares pre- and peri-menstrually, hormonal therapy can be used. Berson’s first line of choice is birth control pills, which decrease the available testosterone. Alternative birth control methods, though not FDA-approved for acne, have been shown to have similar affects.

For patients with skin of color, the four pathogenic factors are nearly the same, but these patients are more prone to developing possible hyperpigmentation or scarring. Physicians should be careful with topical selection to avoid exacerbating pigmentary issues. Berson recommended anti-inflammatory and anti-microbial or even oral solutions.

“What you want to avoid for all patients with acne is harsh cleansers, scrubs, picking at the lesions — that’s something you want to discuss with certainly your teenagers who try to get rid of it by squeezing at them,” Berson concluded. “Try to dissuade thick camouflage cosmetics and maybe oily hair products which can contribute to comedones around the scalp line.” – by Talitha Bennett

References: Berson DS. Acne in Children, Older Adults, Skin of Color. Presented at: South Beach Symposium 2017; Feb. 9-12; Miami Beach, Florida.

Disclosure: Healio.com was unable to determine whether Dr. Berson has a direct financial interest in the products discussed in this article or if he is a paid consultant for any companies mentioned.