Abstract
Truncal acne is present in approximately half of all patients with facial acne but is also occasionally seen in isolation. Important considerations when selecting treatment options for adult female acne, whether on the face, back, chest, or shoulders, include patient compliance, treatment response time, tolerability of the treatment, and psychosocial impact of the disease. Oral antibiotics are widely prescribed for truncal acne due to the challenges of applying topical therapy to such an extensive body surface area. In cases of severe inflammatory and nodular acne vulgaris, this may be a reasonable consideration; however, oral antibiotics should only be used for short durations. Overprescription contributes to microbial resistance and may cause disruption of the gastrointestinal microbiome. In many cases of mild, moderate, or even severe truncal acne, combinations of topical therapies may be valid alternatives. The introduction of foam formulations with enhanced percutaneous absorption and tretinoin lotion formulations that incorporate moisturizing/hydrating agents challenges the previously held idea that effective and tolerable treatment of truncal acne requires oral treatment. This case series describes four female African-American patients with truncal acne successfully treated with a combination of tretinoin lotion 0.05% and azelaic acid 15% foam.
Highlights
Acne vulgaris (AV) is characterized by lesions resulting from inflammation of pilosebaceous units [1]
AV is principally a disorder of adolescence, research suggests that the prevalence of adult acne is increasing, especially in females [10]
Important considerations when selecting a treatment for adult female acne, whether on the face or trunk, are the slower response to treatment, increased likelihood of skin irritation, and greater psychosocial impact of the disease [11]
Summary
Acne vulgaris (AV) is characterized by lesions resulting from inflammation of pilosebaceous units [1]. Truncal acne refers to AV affecting the chest and/or back and is present in approximately 50% of patients with facial acne [4]. Truncal acne is expected to respond to therapy in a similar manner as acne on the face, the challenges of topical application, to the back, are obvious, making patient compliance a challenge. Dermatologists have frequently resorted to prescribing oral antibiotics for these large and hard-to-reach body areas in contravention of the American Academy of Dermatology guidelines [8] and potentially increasing the growing. It is currently estimated that more than 50% of C. acnes strains are resistant to topical macrolide antibiotics [9]; physicians have a duty to evaluate and prescribe appropriate alternative treatments
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