Acne Tool Kit

HKC Bottom Line

• Take patient concerns about acne seriously. Treatment is more effective than with many other diseases and typically takes 4-6 weeks. Many clinicians prefer a "step-down" approach, (i.e. antibiotic and topical therapy) where results are seen faster and then the regimen can often be simplified.

HKC Recommended Article

• ICES Informed.The Management of Acne Vulgaris (Sept 2000).
  Includes Q & A's, drug table, and recommendations.
  

Disease Overview

• BMJ Clinical Review. Acne Vulgaris (Aug 2002).
  Good concise overview.
  

Management and Prescribing Advice

  General

• ICES Informed. The Management of Acne Vulgaris (Sept 2000).
  Includes Q & A's, drug table, and recommendations.
  
  
• Prodigy. Acne Vulgaris (Feb 2003).
  A very comprehensive website that provides disease assessment and management. Clinical scenarios (e.g. mild – severe acne) may help you with managing your patient with acne.
  
  
• Archives of Family Medicine. New Treatment and Therapy Strategies for Acne (Feb 2000).
  Extensive review on acne management. Includes a comprehensive table on drug therapy.

  Drug Specific

• RxFiles. OTC Products (Jun 2003).
  See 'acne' section at the top of page 3. Good overview on OTC preparations.
  
  
• ICES Informed. Costs of common acne medications in Ontario (Sept 2000).
  
  
• AAFP. Topical Therapy for Acne (Jan 2000).
  Good article, the only downfall is that it doesn't give exact drugs for treatment, just classes.

• Diane 35^®
  Rx Files. Diane 35^® Q&A Summary (Mar 2000).
  Good answers to common questions and for determining the place for Diane 35^® in therapy compared to other OC's.
  
  HKC Bottom Line: There appears to be a controversy on whether the 3rd generation progestin, cyproterone, in Diane 35^® results in an increased risk for VTE. Remember, all OC's carry an increased risk of VTE and this risk should be communicated to patients. Use the following table to help communicate the relative risk to your patients:

(Adapted from Diane 35^® (Cyproterone Acetate): Safety Concerns, CMAJ Feb 18, 2003 168 (4): 455-56)

• Inform patients of the potential risk
• Consider alternative OC's without a third-generation progestin (Alesse, Cyclen, Tri-Cyclen) as they have also shown to be beneficial in acne
• Do not prescribe in high-risk patients (e.g. history of VTE, history of coagulopathies)
• Prescribe for short-term only and discontinue 3-4 menstrual cycles after resolution of symptoms

Listed below is a collection of statements/opinions on the Diane 35^® controversy:

• Diane 35^® (cyproterone acetate): safety concerns, CMAJ Feb 18, 2003 168 (4): 455-56
• Health Canada Public Advisory of Diane 35^® and the Risk of Thromboembolism (April 2003).
  

Algorithm

• AAFP. Management of Acne (Jan 2000).

Guideline

• Institute for Clinical Systems Improvement. Acne Management (May 2006).

Patient Resources

  Printable Patient Resources

• CFPC. Acne, ways to control it.
  Great 2 page patient brochure. Good, especially because it can be printed as a handout.
  
  
• AFP. What can I do about pimples?
  1 page patient information brochure.
  
  
• HealthyOntario.com. Accutane-Patient drug information.

  Web-Based Patient Resources

• American Academy of Dermatology. ACNENET (2002).
  An excellent educational web resource for the educated consumer.