Drug-induced acne

  • Etiology
    • Drug reaction
      • Androgénios em ginásio ou mudança de sexo
      • Corticoides (tópicos, orais)
      • Análogos ACTH
      • Anticonvulsivantes: carbamazepina
      • Antidepressivos: litio, risperidona
      • Vitamina B12 e outras do complexo B
      • Hormona do crescimento
      • EGFR inhibiors - EGFR has a crucial role in epidermal and pilosebaceous homeostasis - amivantamab, lazertinib
      • MEK inhibitors
      • Immune checkpoint inhibitors (PD1, CTLA4)
      • JAK inhibitors
          • notion image
          notion image
  • Mechanism
    • Only the inflammatory component of acne: neutrophilic folliculitis
  • Clinical presentation
    • 1st month of treatment: within the first days to weeks after the initiation
    • Mostly on the face, scalp and upper chest and back (V shape)
    • Lesions can have painful localizations (eg. scalp)
    • Monomorphic - because the drug
  • Tratamento
    • Ácido azelaico
    • Clindamicina
    • Doxiciclina
    • Ácido Glicolico ou retinoide sistémico e muito irritante numa pele sensível
      • Prevention
      • For all patients
        • Appropriate patient education: avoid hot water, skin irritants, solvents, skin manipulation
        • Warking with lubeworm water and nonirritating soap-free cleansing products
        • Fragrance-free topical moisturizers
        • No excessive UV exposure
        • Treat any underlying skin condition
        • Screening for S. aureus colonization
      • For selected patients
        • If history of severe acneiform rash
        • Or antineoplastic +/- anti-EGFR, ITK
        • Or combination with radiotherapy/chemotherapy
        • Or no dermatologic follow-up
        • Prophylatic treatment with antibacterials for systemic use
      S. aureus superinfection
      • 20% of patients have S. aureus positive cultures sometimes resistant to tetrcyclines
      • Onset after 12 weeks of treatment
      • Possibly favorise by the impaired skin barrier alteration and/or anti-EGFR later the expression of skin anti-microbial peptides
Grade 1
Grade 2
Grade 3
SS<10%
>10% or associated with symptoms impacting QoL
Severe, oedema, necrosis, ulceration or severe symptoms
Topical antibiotics (metronidazol, clindamycin, erythromycin)
Moderate to high potency topical steroids
Add per os docycycline or minocycline
Double the antibiotic dose
Discuss with the oncologist treatment interruption or adaptation
Screening for S. aureus superinfection