Beauty Tips For Body Care
After the fucking awful not very good recent popular post, I'd like to share some treatment guidelines from the literature. They aren't pretty, but they're definitely more accurate than "treat moderate to severe nodulocystic acne with niacinamide, salicylic acid, and hyaluronic acid~"Since chunky charts & tables can be a bit difficult to parse, I've condensed that info into a text-based guideline as well. It's not as thorough, but it should be a bit easier to understand from a layperson perspective.Sources are listed down at the bottom, but let me know if you're looking for quotes about a specific statement! I have messy notes at the ready.And if you're looking for some in-depth overviews, you might enjoy:this video from OsmosisGuidelines of care for the management of acne vulgaris (2016)European Evidence‐based (S3) Guidelines for the Treatment of Acne (2012) & 2016 updateHormonal treatment of acne vulgaris: an update (2016) Acne TypesBrief overview of the different types of acne with image examples.Non-inflammatory (comedonal)Comedonal acne overviewOpen comedones (blackheads)open spots with a dark plugimage of open comedonesClosed comedonessmall, skin colored bumpsmay have a white headimage of closed comedones InflammatoryInflammatory acne overview & more info on nodulocystic acnePapulesred bumpsimage of papules & pustulesPustulesred bumps with a white or yellow headimage of papules & pustulesNodulocysticlarge, painful red lumpsnodulocystic acne on the face and back Treatment GuidelineThis is a greatly condensed guideline based on the available literature. Treatment options are highly dependent on severity, how long you've had acne, what other treatments you've tried, and other individual factors. Especially for moderate to severe acne, you should speak to a dermatologist. Mild acneLess than half the face is involved<20 comedones, <15 papules/pustules, no nodulocystic spotsMild acne exampleTreatmentsLikely able to treat OTC, although resistant cases may require the help of a dermatologist.Topical treatments include benzoyl peroxide, retinoids, azelaic acid, BHAs, and AHAs.It's noted that while BHAs don't have a ton of research backing them up, their long track record along with their accessibility makes them a common first choice for mild acne.Niacinamide and sulfur may be helpful as well, although they aren’t standard recommendations and don't have as much data backing them up as the other options.For both mild comedonal and mild papulopustular acne, topical retinoids, benzoyl peroxide, and azelaic acid are most often mentioned.Retinoids as a first choice for mostly comedonal acneBP as a first choice for mostly papulopustular acneAnecdotally, BHAs can be useful for open comedones (blackheads).For resistant acne, combotherapy may be required (i.e. BP + adapalene). Moderate acneMore than half the face is involvedMany comedones (20-100), many papules/pustules (15-50), maybe a nodulocystic spotModerate acne exampleTreatmentsMay be able to treat milder cases OTC, although resistant or more moderate-severe cases should be treated by a dermatologist.Topical therapy using some combination of: benzoyl peroxide, topical retinoids, topical antibiotics, and azelaic acid.Depending on the severity, may need additional systemic treatments such as oral antibiotics or, if applicable, hormonal therapies such as oral contraceptives or spironolactone. Severe acneAll of the face is involvedMany comedones (>100), many papules/pustules (>50), many nodulocystic spots (>5)Severe acne exampleTreatmentsAbsolutely should be treated by a dermatologist.Depending on the severity and individual factors, first line treatment may be an oral antibiotic + topical treatment (mono- or combo-therapy; benzoyl peroxide, retinoids, azelaic acid), or oral isotretinoin.If applicable, hormonal therapy (i.e. oral contraceptives, spironolactone) may also be used. Treatment AlgorithmsFun & accurate treatment algorithms! European evidence-based (S3) guideline for the treatment of acne – update 2016European evidence-based (S3) guideline for the treatment of acne – update 2016 – short version (Nast et al., 2016) Treatment recommendations from the European acne guidelinesEuropean evidence-based (S3) guidelines for the treatment of acne. (Nast et al., 2012)Table from Hormonal treatment of acne vulgaris: an update (Elsaie, 2016) Treatment algorithm for acneGuidelines for Treating Acne (Katsambas, Stefanaki, & Cunliffe, 2004) (full-text pdf) Mild acneModerate and severe acneAcne vulgaris (Williams, Dellaballe, & Garner, 2012) Comedonal acnePapulo-pustular acneNodular acneA consensus‐based practical and daily guide for the treatment of acne patients (Gollnick et al., 2016)Note: funded by Meda SourcesAADDermNet NZ Gollnick, H., Bettoli, V., Lambert, J., Araviiskaia, E., Binic, I., & Dessinioti, C. et al. (2016). A consensus-based practical and daily guide for the treatment of acne patients. Journal Of The European Academy Of Dermatology And Venereology, 30(9), 1480-1490. doi:10.1111/jdv.13675Katsambas, A., Stefanaki, C., & Cunliffe, W. (2004). Guidelines for treating acne. Clinics In Dermatology, 22(5), 439-444. doi:10.1016/j.clindermatol.2004.03.002Nast, A., Dréno, B., Bettoli, V., Bukvic Mokos, Z., Degitz, K., & Dressler, C. et al. (2016). European evidence-based (S3) guideline for the treatment of acne - update 2016 - short version. Journal Of The European Academy Of Dermatology And Venereology, 30(8), 1261-1268. doi:10.1111/jdv.13776Nast, A., Dréno, B., Bettoli, V., Degitz, K., Erdmann, R., & Finlay, A. et al. (2012). European Evidence-based (S3) Guidelines for the Treatment of Acne. Journal Of The European Academy Of Dermatology And Venereology, 26, 1-29. doi:10.1111/j.1468-3083.2011.04374.xWilliams, H., Dellavalle, R., & Garner, S. (2012). Acne vulgaris. The Lancet, 379(9813), 361-372. doi:10.1016/s0140-6736(11)60321-8Zaenglein, A. (2018). Acne Vulgaris. New England Journal Of Medicine, 379(14), 1343-1352. doi:10.1056/nejmcp1702493Zaenglein, A., Pathy, A., Schlosser, B., Alikhan, A., Baldwin, H., & Berson, D. et al. (2016). Guidelines of care for the management of acne vulgaris. Journal Of The American Academy Of Dermatology, 74(5), 945-973.e33. doi:10.1016/j.jaad.2015.12.037
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