If the active topical agent such as BPO is used at night an oil free

If the active topical agent such as bpo is used at

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free) moisturisers to combat these adverse effects. If the active topical agent such as BPO is used at night, an oil-free moisturiser can be used in the morning after washing or showering. Lifestyle factors affecting acne Diet One factor that has attracted a great deal of attention in acne is diet. In a recent survey of acne sufferers, 92% believed diet could affect their condition. Moreover, 71% mentioned fried, greasy foods, 53% chocolate and 47% dairy products as factors that aggravated their acne.[ 11] In recent years, there has been much speculation on the influence of diet in acne, especially as studies of native non- westernised populations in Papua New Guinea and Paraguay reveal a virtual absence of the condition. This has led to the idea that the Western diet with a high glycaemic load (highly refined carbohydrates such as white bread and cakes) leads to an increased production of androgens, which then worsens acne. In fact, a randomised, controlled, low glycaemic index dietary trial, emphasising fresh fruits and vegetables and avoiding refined carbohydrates, did show a significant reduction in acne lesions after three months.[ 12] But the role of diet in managing acne remains controversial and if anything, patients should be advised to adopt a healthy diet. Hygiene and sunlight Poor hygiene (lack of washing) as a causative agent and lack of exposure to sunlight are often cited as lifestyle factors in acne. However, there is little evidence that either has a noticeable effect. [ 13] Patients also like to use facial washes that contain particulates (exfoliants) and believe that these unclog the pores. However, vigorous scrubbing is more likely to irritate the skin and worsen acne. Make-up People with acne who wish to use make-up should look for the term non-comedogenic (oil free) on the label. Heavy make-up products can block pilosebaceous follicles, exacerbating acne. Other factors that appear to aggravate acne include emotional stress, smoking and picking at lesions. Talking to patients According to a recent survey by the British Skin Foundation of more than 2,000 people with acne, 95% said it had an impact on their daily lives and 63% reported a drop in self-confidence because of their acne.[ 14] If a patient is browsing facial washes, approaching them and inviting them into the consultation room for a private discussion should signal that you are sensitive to their possible embarrassment. It is also important not to undermine their perception of acne severity. While your perception might be that their acne is mild, the effect on them might be profound. Pharmacists should discuss the treatment options available in the pharmacy and how each therapy should be used. The importance of perseverance should be emphasised because treatments are slow to work. Likely side-effects, such as dryness and irritation, and how these can be managed should also be explained to the patient.
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The algorithm in FIGURE 1 summarizes the pharmacologic management of acne vulgaris.
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  • Winter '19
  • Professor Robert
  • acne scarring, acne fulminans

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