Recognizing and treating truncal lesions important in acne patient management

The possibility of truncal involvement should not be overlooked in patients who present for treatment of facial acne vulgaris, said James Q. Del Rosso, D.O.

"There is a conspicuous absence of published literature on the epidemiology, grading, and treatment of truncal acne vulgaris, and acne patients who present with a chief complaint of facial disease may not even mention truncal lesions if they are not directly asked. Nevertheless, most patients are interested in treatment for truncal acne, and providing effective intervention is important because these lesions can lead to follicular macular atrophic scarring for which there is no good therapy," explains Dr. Del Rosso, clinical assistant professor of dermatology, University of Nevada School of Medicine.

The need for application of topical medication to a large body surface area poses one challenge in treating truncal acne. To enable diffuse and confluent coverage, Dr. Del Rosso recommends patients be instructed to apply the medication in multiple "fingertip units" over the entire affected region and then spread the dots over the skin to achieve diffuse and confluent coverage.

If topical clindamycin is used, the need for widespread application may also raise safety concerns relating to the risk of pseudomembranous colitis. However, results of a clinical trial in which patients applied topical products containing 1 percent clindamycin phosphate to the face and other body sites in a regimen of 4 gm daily for 5 days demonstrated that plasma concentrations were negligible.

"Regardless of whether patients applied a foam or gel formulation, the level of clindamycin in plasma was only about 2 ng/ml. In contrast, the concentration achieved after ingestion of a 150 mg oral dose ranges from 2,000 to 3,000 ng/ml," Dr. Del Rosso reports.