II. Management: Options for women

  1. Change Oral Contraceptive if already taking one
    1. Increase Estrogen (50ug Ethinyl Estradiol minimum)
    2. Decrease to low androgenic Progestin
  2. Oral Contraceptive with low androgenic Progestin
    1. Norgestimate
      1. Ortho-Cyclen
      2. Ortho Tri-Cyclen
    2. Norethindrone
      1. Norlutin
      2. Aygestin
    3. Desogestrel
      1. Desogen
      2. Ortho-Cept
    4. Ethynodiol Diacetate
      1. Demulen
      2. Zovia
  3. Spironolactone
    1. Indications: Women with androgen hypersecretion
      1. Free Testosterone increased
      2. DHEA-S increased
    2. Dose: 50 to 200 mg orally daily

III. Management: Inflammatory Acne

  1. Visible Light Therapy decreases inflammatory acne
  2. Topical Corticosteroids
    1. Moderate to high potency agents (Triamcinolone or Clobetasol)
    2. Limit to short-term use (less than 14 days) only
  3. Inflammatory lesions needing quick cosmetic therapy
    1. Indications
      1. Photo or modeling session
      2. Wedding or other life-event
    2. Technique
      1. Dilute Triamcinolone 10 mg/ml to 2-3 mg/ml
      2. Inject 0.1 cc into inflammatory acne lesion
      3. May repeat in 3-4 weeks up to one month

IV. References

  1. Habif (2004) Dermatology, Mosby, p. 162-94
  2. Kaplan (2001) CMEA Medicine Lecture, San Diego
  3. Parker in Noble (2001) Primary Care p. 758-60
  4. Brown (1998) Lancet 351:1871-6 [PubMed]
  5. Feldman (2004) Am Fam Physician 69:2123-56 [PubMed]
  6. Gollnick (2003) J Am Acad Dermatol 49:S1-37 [PubMed]

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