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| ACNE IN INDIA: GUIDELINES FOR MANAGEMENT - IAA CONSENSUS DOCUMENT |
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| Year : 2009 | Volume
: 75
| Issue : 7 | Page : 60 |
Diffificult acne
Raj Kubba, AK Bajaj, DM Thappa, Rajeev Sharma, Maya Vedamurthy, Sandipan Dhar, S Criton, Rui Fernandez, AJ Kanwar, Uday Khopkar, Malavika Kohli, VP Kuriyipe, Koushik Lahiri, Nina Madnani, Deepak Parikh, Sudhir Pujara, KK Rajababu, S Sacchidanand, VK Sharma, Jayakar Thomas
members Indian Acne Alliance, India
Correspondence Address:
Raj Kubba
Consultant Dermatologist, Kubba Clinic,10, Aradhana Enclave, Ring Road, New Delhi - 110066
India
 Source of Support: Production and publication of this supplement is made possible by an educational grant from Galderma India Pvt. Ltd., Conflict of Interest: Indian Acne Alliance (IAA) meetings logistics to formulate IAA consensus document DQAcne in India: Guidelines for managementDQ were supported by Galderma India Pvt. Ltd.  | Check |
PMID: 19282601 
How to cite this article:
Kubba R, Bajaj A K, Thappa D M, Sharma R, Vedamurthy M, Dhar S, Criton S, Fernandez R, Kanwar A J, Khopkar U, Kohli M, Kuriyipe V P, Lahiri K, Madnani N, Parikh D, Pujara S, Rajababu K K, Sacchidanand S, Sharma V K, Thomas J. Diffificult acne. Indian J Dermatol Venereol Leprol 2009;75, Suppl S1:60 |
How to cite this URL:
Kubba R, Bajaj A K, Thappa D M, Sharma R, Vedamurthy M, Dhar S, Criton S, Fernandez R, Kanwar A J, Khopkar U, Kohli M, Kuriyipe V P, Lahiri K, Madnani N, Parikh D, Pujara S, Rajababu K K, Sacchidanand S, Sharma V K, Thomas J. Diffificult acne. Indian J Dermatol Venereol Leprol [serial online] 2009 [cited 2021 Jan 20];75, Suppl S1:60. Available from: https://www.ijdvl.com/text.asp?2009/75/7/60/45492 |
Difficult acne may be defined as "Acne that fails to respond to elected treatment approach, or acne that presents with constraints and/or challenging clinical features."
Failure to respond, that is, under-responsiveness, may arise from a variety of reasons. Failure to address the pathogenesis; inappropriate selection of treatment modalities; lack of patient compliance (adherence); improper methodology; drug interactions; antibiotic resistance; overlooked concomitant pityrosporum folliculitis; and high glycemic load diet. There are clinical features which by their presence add to the difficulty in treating acne. Some of these features include: macrocomedones, cysts, sinus tracts, keloids, scarring, and hyperandrogenism.
The following clinical subtypes of acne are more difficult to treat: acne in preteens, adult acne, scarring acne, nodulocystic acne, acne corporis, acne conglobata, acne fulminans, pyoderma faciale, and SAPHO syndrome.
Acne with constraints includes: acne patient attempting to conceive; acne in pregnancy; difficult personality - patient averse to taking oral medications; patient averse to topical medication; allergy/intolerance to medications; patients with cynical attitude and phobias; cost considerations/inability to afford prescribed medications; and acne treatment against a deadline! It is also difficult to manage acne in the setting of an underlying chronic systemic disease such as tuberculosis, cirrhosis, or chronic renal failure.
Successful management of difficult acne requires greater effort by the patient and the treating dermatologist. It requires climbing the therapeutic ladder. It requires mastering the use of oral retinoids and antiandrogens. It pays to employ drug combinations, and to create innovative, customized, treatment programs.
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