Recognizing and treating truncal lesions important in acne patient management

Speaking at the American Academy of Dermatology Summer Meeting in July in San Diego, James Q. Del Rosso, DO, advised physicians not to overlook the possibility of truncal involvement in patients who come in for treatment of facial acne vulgaris.

"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," explained Dr. Del Rosso, clinical assistant professor of dermatology, University of Nevada School of Medicine. "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."

The need to apply 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 that you instruct patients 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 you are prescribing topical clindamycin, the need for widespread application may also raise safety concerns relating to the risk of pseudomembranous colitis. Results of a clinical trial, however, in which patients applied topical products containing 1% clindamycin phosphate to the face and other body sites in a regimen of 4 g/d for five days, demonstrated that plasma concentrations of the drug 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 to3,000 ng/mL."