eMedicine Specialties > Dermatology > Diseases of the Adnexa

Acne Vulgaris: Follow-up

Author: James Fulton Jr, MD, PhD, Center for Cosmetic Dermatology; Consultant, Vivant Pharmaceuticals, LLC
Contributor Information and Disclosures

Updated: Aug 6, 2009

Follow-up

Further Outpatient Care

  • Appropriate laboratory examinations (electrolyte evaluation, with particular attention to potassium levels and, when appropriate, pregnancy tests) may be considered when spironolactone is prescribed.
  • Baseline assessment of antinuclear antibody levels and hepatic transaminase levels has been recommended by some authors for patients expected to be on minocycline for more than 1 year.35

Complications

  • Acne lesions may lead to permanent scarring.

Prognosis

  • In male patients, acne generally clears by early adulthood.
    Five percent of men still have acne at age 25 years.
  • Female patients frequently have adult acne. Twelve percent of women still have acne at age 25 years. Five percent of women still have acne at age 45 years.
  • The overall prognosis for persons with acne is good. However, acne can result in long-lasting psychosocial impairment and physical scarring.

Patient Education

  • Patients should be instructed on their morning and evening treatment programs. Retinoid dermatitis may develop at approximately day 10 of therapy. Patients must be informed of this in advance so they will not consider this exfoliation an allergy. By skipping a day or 2 and restarting the program slowly, the skin can adapt  to this irritation.
  • Prescriptions should be accompanied by a discussion of the potential adverse effects.
  • For excellent patient education resources, visit eMedicine's Skin, Hair, and Nails Center and Teen Health Center. Also, see eMedicine's patient education articles Acne. Also see the Medscape Acne Resource Center.

Miscellaneous

Medicolegal Pitfalls

  • Careful prescribing of isotretinoin is mandatory. Aggressive pregnancy prevention in female patients and monthly follow up of all patients on isotretinoin therapy are necessary. Some patients develop a significant flare of acne at the outset of isotretinoin therapy, resulting in scar formation. This potential risk may be lessened by starting therapy at 0.5 mg/kg/d or less and by the coadministration of systemic steroids.

Special Concerns

  • Treating acne during pregnancy is a challenge. Many of the most commonly prescribed acne medications are not safe during pregnancy.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous author, Julie C. Harper, MD, to the development and writing of this article.



More on Acne Vulgaris

Overview: Acne Vulgaris
Differential Diagnoses & Workup: Acne Vulgaris
Treatment & Medication: Acne Vulgaris
Follow-up: Acne Vulgaris
Multimedia: Acne Vulgaris
References
Further Reading
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References

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  32. Papageorgiou P, Katsambas A, Chu A. Phototherapy with blue (415 nm) and red (660 nm) light in the treatment of acne vulgaris. Br J Dermatol. May 2000;142(5):973-8. [Medline].

  33. Smith RN, Mann NJ, Braue A, Mäkeläinen H, Varigos GA. The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: a randomized, investigator-masked, controlled trial. J Am Acad Dermatol. Aug 2007;57(2):247-56. [Medline].

  34. Agatston A. The South Beach Diet. Emmaus, Pa: Rodale Press; 2003.

  35. Knowles SR, Shapiro L, Shear NH. Serious adverse reactions induced by minocycline. Report of 13 patients and review of the literature. Arch Dermatol. Aug 1996;132(8):934-9. [Medline].

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Further Reading

An excellent reference textbook is Plewig G, Kligman AM; Acne and Rosacea, New York, NY: Springer-Verlag, 1993.

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Keywords

acne vulgaris, acne lesion, follicular papules, comedones, inflammatory papules, inflammatory pustules, inflammatory nodules, follicular epidermal hyperproliferation and hyperkeratinization, excess sebum, Propionibacterium acnes, P acnes, microcomedo, microcomedone, acne fulminans, comedonal acne, nodulocystic acne, congenital adrenal hyperplasia, polycystic ovary syndrome

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Contributor Information and Disclosures

Author

James Fulton Jr, MD, PhD, Center for Cosmetic Dermatology; Consultant, Vivant Pharmaceuticals, LLC
James Fulton Jr, MD, PhD is a member of the following medical societies: American Academy of Cosmetic Surgery, American Academy of Dermatology, American Society for Laser Medicine and Surgery, Dermatology Foundation, International Society of Cosmetic and Laser Surgeons, and Skin Cancer Foundation
Disclosure: vivant pharmaceuticals Ownership interest Consulting

Medical Editor

Alexa F Boer Kimball, MD, MPH, Associate Professor of Dermatology, Harvard University School of Medicine; Vice Chair, Department of Dermatology, Massachusetts General Hospital; Director of Clinical Unit for Research Trials in Skin (CURTIS), Department of Dermatology, Massachusetts General Hospital
Alexa F Boer Kimball, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, and Society for Investigative Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Chair, Department of Dermatology, Director, Dermatology Residency Training Program, Scott and White Clinic, Northside Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: Nothing to disclose.

Managing Editor

Jeffrey Meffert, MD, Assistant Clinical Professor of Dermatology, University of Texas Health Science Center-San Antonio
Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

Dirk M Elston, MD, Director, Department of Dermatology, Geisinger Medical Center
Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

 
 
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