Acne and its management

• Acne is a common and distressing disorder that can affect patients of all ages and may persist beyond adolescence. • Acne is a multifactorial disease in which follicular obstruction, androgens, inflammation, genetics, and bacteria all play a role. • Current evidence does not definitively support the role of diet in acne. At this time, the consensus of pediatric dermatologists is not to restrict the diet based on the presence of acne. This practice may change as more clinical trials directly evaluating the role of diet in acne are conducted. • Studies show that most patients with acne have normal hormone levels. Red flags that obligate an endocrine evaluation include treatment-resistant acne, acute acne onset or worsening, additional clinical indicators of androgen excess, and acne in patients 2 to 7 years old. • There are no universally accepted published guidelines for determination of the severity of acne. Clinical judgment, number of papulopustules, body areas affected, the presence or absence of scarring and cysts, and patient distress all contribute to categorization and subsequent management strategies. • Triple therapy, which consists of benzoyl peroxide, a topical retinoid, and an oral antibiotic, often is highly effective in treating moderate to severe acne. • Topical retinoids are central to acne management and are the preferred maintenance medication for all patients with acne.