A 16-year-old presents with this. You start doxycycline 100 mg po BID, clindamycin solution every morning and tretinoin 0.025% cream at night.

ACNE

Acne is one of the most common skin conditions. It affects nearly every teenager as well as many young women. It begins in the prepubertal years (e.g., 8-13 years), peaks around age 16, and for males, usually remits by age 20.

• Unfortunately for women, the acne may persist well into the 20's and even 30's. Furthermore, some women who had very little to no acne before age 20 may develop acne in adulthood. See acne in women.
• Onset is earlier now. Acne may be the first sign of onset of puberty in children 7 to 11 years of age.
• Acne is caused by a combination of clogged pores and an infection of the follicles by the bacteria Propionibacterium acnes (P. acnes)--not dirt!
• Acne often leaves a bit of color change as it heals. Many patients think these are scars, but luckily they are not. If the acne is controlled, these color spots will fade. Acne scars, in contrast, are raised, depressed or pitted, with an uneven texture that can be felt.
  
• Truncal acne is often more resistant to treatment and usually requires oral antibiotics and/or isotretinoin.

Diet and Acne

A healthy diet is important in the treatment of acne. All of the following have been associated with acne flares and should be minimized: milk (especially skim milk), ice cream, chocolate, sugary drinks, all sweets (anything high glycemic) and whey protein.

Comedonal acne (blackheads and whiteheads). Retinoids (e.g. adapalene, tretinoin, tazorotene) are key here to unclogging the pores.

Inflammatory Acne. Benzoyl peroxide alone or in combination with clindamycin is excellent for the inflammatory papules and pustules of acne (along with a retinoid).

More severe acne. This type of acne usually requires pils as well (e.g. doxycycline) and if needed isotretinion.

Acne on the back. Acne of the trunk is usually more resistant to therapy. Isotretinoin (Accutane) is indicated here.

RegionalDerm

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