SAN FRANCISCO — Lack of treatment efficacy is only one of the reasons that acne therapy often fails in teenagers, Lee T. Zane, M.D., reported at a meeting on clinical pediatrics sponsored by the University of California, San Francisco.
Poor adherence is also a factor, said Dr. Zane of the university. And poor adherence can stem from several things. The treatment regimen may be too complex, or patients may stop treatment prematurely when they don't see quick results. Adverse effects of therapy often lead to poor adherence too. In some cases, the patient may have conceptual opposition to certain modes of therapy.
Dr. Zane offered these tips to optimize adherence:
▸ Simplify the treatment regimen. Use fewer agents or combination agents. Combinations of clindamycin and benzoyl peroxide are available now. Coming soon there may be retinoids plus antibiotics and retinoids plus benzoyl peroxide.
▸ Minimize the adverse effects. Because benzoyl peroxide can be especially irritating, maximize retinoid therapy before maximizing benzoyl peroxide.
With retinoids and benzoyl peroxide, advise patients that a pea-sized dollop should be enough to cover the face. Using more will not improve the result, but will increase irritation.
Advise them to apply topical agents to dry skin, waiting 20–30 minutes after washing.
▸ Set realistic expectations. Tell patients to try a therapy for at least 2 full months before deciding whether it's effective.
“I'm going for a slow and steady course of therapy followed by long-term maintenance,” Dr. Zane said. “It's not a quick cure. It's really about management of a chronic condition and prevention.
▸ Remember that your clinical assessment of disease severity may differ dramatically from the patient's assessment. A single pustule on otherwise porcelain skin may be more damaging psychologically than widespread disease.
▸ Peer opinion is often far more compelling than scientific data. The physician may be focusing on the patient's face, but if his friends are making fun of the acne on his back, he'll be more concerned about that.
▸ Warn patients about behaviors that worsen acne. Physicians have long advised against picking or squeezing, but they also should point out that scrubbing or exfoliating can promote the formation of comedones. Rubbing the skin during sports or other activities also can promote acne.
Finally, some medications can exacerbate symptoms. These include lithium, topical and oral corticosteroids, and androgenic steroids.