Dermatology Protocol • ICD-10 L70.0
Acne Vulgaris & Extrinsic Cutaneous Photoaging
Pilosebaceous follicular hyperkeratinization and Cutibacterium acnes inflammation alongside UV-induced dermal collagenase upregulation and epidermal dysplasia.
Medically Reviewed by Dr. Priya Nair, MD, FAAD (NPI #1295730425)
Acne Vulgaris & Extrinsic Cutaneous Photoaging Optimal Biomarker & Diagnostic Fact Matrix
| Metric | Verified Benchmark | Source |
|---|---|---|
| ICD-10-CM Diagnostic Classification | L70.0 | WHO / CMS ICD-10-CM Clinical Modification |
| Biomarker: ALT / AST & Fasting Triglycerides | Baseline & q8w if systemic retinoid | DotMD Preventive Optimal Target Range |
| Biomarker: Free Androgen Index (Female Adult Acne) | < 4.5 | DotMD Preventive Optimal Target Range |
Pathophysiology & Clinical Presentation
Androgen-stimulated sebum lipogenesis and TLR-2 inflammatory signaling obstruct follicles, while solar ultraviolet radiation activates AP-1 and MMP-1 metalloproteinases that fragment type I and III dermal procollagen.
Hallmark Clinical Signs & Biomarker Triggers
- Open and closed comedones with inflammatory papulopustules
- Post-inflammatory hyperpigmentation and boxcar scarring
- Solar lentigines, fine periorbital rhytids, and elastosis
Evidence-Based Medications & Cash Arbitrage for Acne Vulgaris & Extrinsic Cutaneous Photoaging
| Medication | Mechanism Class | Worth-It Score | Retail Avg | Lowest Cash |
|---|---|---|---|---|
| Valacyclovir Hydrochloride Valtrex | L-Valyl Ester Nucleoside Viral DNA Polymerase Chain Terminator | 95.20% (38) | $64.00 | $7.90/mo |
| Tretinoin (All-Trans Retinoic Acid Cream/Gel) Retin-A, Altreno, Renova | Pan-Agonist Nuclear Retinoic Acid Receptor (RAR-Alpha/Beta/Gamma) Retinoid | 94.80% (59) | $112.00 | $24.50/mo |
| Isotretinoin (13-Cis-Retinoic Acid) Accutane, Absorica, Claravis | Systemic Sebocyte Apoptosis & Pilosebaceous Remodeling Retinoid | 94.50% (37) | $345.00 | $135.00/mo |
| Ivermectin 1% Topical Cream Soolantra | Avermectin Glutamate-Gated Chloride Channel & Demodex Neurotoxin | 92.50% (21) | $348.00 | $42.80/mo |
| Glycopyrrolate (Quaternary Non-CNS Antimuscarinic) Robinul | Charged Quaternary Ammonium Peripheral Eccrine M3 Muscarinic Blocker | 92.30% (26) | $62.00 | $8.90/mo |
| Azelaic Acid 15% Gel / 20% Cream Finacea, Azelex | Dicarboxylic Acid Tyrosinase, Kallikrein-5 & C. acnes Inhibitor | 91.90% (33) | $178.00 | $26.40/mo |
| Spironolactone Aldactone | Sebocyte Androgen Receptor Antagonist & Aldosterone Blocker | 90.80% (43) | $24.00 | $5.30/mo |
| Tranexamic Acid (Cyclic Menorrhagia & Melasma Micro-Protocol) Lysteda | Synthetic Lysine-Binding Antifibrinolytic & Keratinocyte Plasmin Inhibitor | 90.70% (22) | $136.00 | $18.20/mo |
| Tacrolimus 0.1% Topical Ointment Protopic | Non-Steroidal Macrolide Calcineurin / NFAT T-Cell Inhibitor | 90.40% (17) | $162.00 | $29.80/mo |
| Tazarotene Cream / Lotion Tazorac, Arazlo | Acetylenic Prodrug Selective RAR-Beta/Gamma High-Potency Retinoid | 90.10% (22) | $285.00 | $39.60/mo |
| Adapalene 0.3% Prescription Gel Differin Rx 0.3% | Third-Generation Naphthoic Acid Selective RAR-Beta/Gamma Retinoid | 89.60% (26) | $146.00 | $21.80/mo |
| Terbinafine Hydrochloride Lamisil | Allylamine Fungal Squalene Epoxidase Fungicidal Inhibitor | 89.30% (20) | $54.00 | $7.40/mo |
| Pimecrolimus 1% Topical Cream Elidel | Lipophilic Ascomycin Cutaneous Calcineurin Inhibitor | 87.60% (13) | $214.00 | $36.90/mo |
| Clascoterone 1% Cream (Cortexolone 17-Alpha-Propionate) Winlevi | First-in-Class Topical Sebocyte Androgen Receptor Antagonist | 83.20% (15) | $568.00 | $95.00/mo |
| Clindamycin Phosphate 1% Topical Gel / Lotion Cleocin-T | Lincosamide 50S Ribosomal Subunit Cutaneous Antibacterial | 82.70% (18) | $68.00 | $12.20/mo |
| Metronidazole 0.75% / 1% Topical Gel MetroGel, Noritate | Nitroimidazole Cutaneous Antioxidant & Neutrophil ROS Scavenger | 81.80% (16) | $114.00 | $15.80/mo |
| Doxycycline Hyclate / Monohydrate Vibramycin, Oracea (40 mg sub-antimicrobial) | Tetracycline 30S Ribosomal & Sub-Antimicrobial MMP-9/Collagenase Inhibitor | 81.50% (29) | $52.00 | $7.80/mo |
| Minocycline Hydrochloride Minocin, Solodyn | Lipophilic Sebum-Concentrating Tetracycline Derivative | 77.90% (16) | $78.00 | $10.60/mo |
INSTANT PRESCRIPTION & CASH ROUTING
DotMD Club Members get $29 flat-rate script renewals →
Verified Online Prescribers & Wholesale Pharmacies for Acne Vulgaris & Extrinsic Cutaneous Photoaging
Mark Cuban Cost Plus Drugs (Wholesale Pharmacy)
Requires an existing doctor prescription. Need a script? Pair with a $29 DotMD Club TeleMed consult.
$7.90/mo
Wholesale Cash Price
Hims & Hers Direct Cash Pharmacy (Online Doctor Consult + Delivery)
Asynchronous physician review included • Ships in ~2 days
• Rx included in monthly tier
$
49.00
All-In Monthly
Sesame Direct Cash-Pay Prescriber Network (Online Doctor Consult + Delivery)
Asynchronous physician review included • Ships in ~1 days
$
29.00
Consult / Starting Tier
Board-Certified Teledermatology Compounding (Online Doctor Consult + Delivery)
Asynchronous physician review included • Ships in ~3 days
$
20.00
Consult / Starting Tier