South-East Asia study alliance guidelines

on the management of acne vulgaris in

South-East Asian patients

JOURNAL READING
Pembimbing: dr.Eko
Krisnarto, Sp.KK
Sarah
406161039
INTRODUCTION
Acne Vulgaris
chronic inammatory disease
of the pilosebaceous unit LESION
polymorphic manifestations comedos (pathonomonic
feature)
Chronic and recurrent
papules

pustules

nodules

cysts

itching or burning
 The South-East Asia Study Alliance (SASA) group, comprised of
13 leading dermatologists from 6 countries in SEA
(Indonesia, Malaysia, the Philippines, Singapore, Thailand and
Vietnam) The objectives of these guidelines are :
(i) the grading of acne vulgaris in SEA;
(ii) the most appropriate treatment for mild, moderate and
severe acne vulgaris in SEA, as well as maintenance therapy;
(iii) antibiotic resistance in the region and appropriate
antibiotic use;
(iv) recommended skin care for patients with acne.
METHODS
In 2014, the SASA group convened in Singapore discuss
and provide their insights on current practices and guidelines
regarding acne and its treatment in SEA.
Recent developments and evidence supporting these
practices shared and presented.
Discussions were then held to assess and determine which
practices to adopt and recommend based on evidence and the
groups collective experience and expertise
 RESULTS
Denition, diagnosis and grading of acne vulgaris
In practice, acne is commonly
classied by the clinical type of
manifestation or by disease severity.
Clinical types of manifestation
include :
comedonal, papular, pustular,
nodular, cystic, and inammatory or
non-inammatory lesions.
The classication by the Acne
Severity Global Alliance :
mild comedonal acne,
mild and moderate
papulopustular acne,
moderate nodular acne,
to severe nodular or conglobata
acne

Severity classication includes :

mild,
moderate,
severe
 Based on the number and types of lesions present
 Discussion
Prior to treatment initiation, it is
The SASA group adopts the recommended DD be ruled
ACC grading system for acne out :
severity (Table 1) A. cosmetic
Drug induced acneformis
recommends the treatment of
eruption
patients based on disease
Foliculitis
severity (table 5)
Maintenance treatment for acne
Important to prevent relapse.
Especially patients with severe acne, frequent relapses, acne
scars and a family history (parental) of acne scars, a
diminished quality of life and long-standing acne.
The most effective therapeutic agents : topical retinoids
Adapalene
Adapaline + BPO fixed dose combination
Adjuvant acne treatment
chemical peels.
Glycolic acids
salicylic acid in polyethylene glycol or salicylic acid in ethanol
trichloroacetic acid
Laser, energy-based devices and photodynamic therapies
(PDT)
Antibiotic resistance
a signicant international public health
P. acnes resistance to antibiotics may result in:
a reduced response,
absence of response or relapse during acne treatment.
who received long-term (2452 weeks) antibiotic therapy
compared with those who did not receive prior antibiotic
treatment (P = 0.015) and those who received shortterm
(618 weeks) treatment (P = 0.036).
Erythromycin and clindamycin high rates of resistance
Preventing the development of
antibiotic resistance
avoidance of antibiotic monotherapy or concurrent oral and
topical antibiotic use
limiting the duration
avoidance of the use of antibiotics as maintenance therapy.
Topical antibiotics should be used in combination with BPO
and a retinoid topical.
Recommended skin care for acne
CONCLUSION
The management of acne vulgaris in SEA is different from that
practiced elsewhere in the world, owing to local variation and the
differences between Asian and Caucasian skin.
Patients may be treated according to disease severity.
Mild acne topical medications including retinoids, BPO, a
combination of retinoid and BPO, or a combination of retinoids
and BPO with or without antibiotics.
Moderate acne a combination of topical retinoid, BPO and an
oral antibiotic.
Severe acne oral isotretinoin
if the patient fails a 68-week trial of combined oral antibiotics
and topical retinoids with BPO.
 CONCLUSION
Hormonal therapy female patients.
Maintenance treatment is recommended topical retinoids
with or without BPO.
To prevent the development of antibiotic resistance
topical antibiotics should not be used as monotherapy or used
concurrently with oral antibiotics.
Skin care during treatment is recommended cleansing,
moisturizing and sun protection.
education and communication is essential to improve
adherence and ensure successful treatment of acne.