From the Guidelines
Topical retinoids are recommended as the initial treatment for acne, prior to the use of antibiotics, due to their ability to address the underlying causes of acne formation and reduce the risk of antibiotic resistance. According to the guidelines of care for the management of acne vulgaris 1, topical retinoids are strongly recommended for patients with acne, with a moderate level of certainty of evidence. Retinoids like tretinoin, adapalene, or tazarotene normalize skin cell turnover, prevent follicular plugging, and reduce inflammation, which are key factors in acne development.
The use of topical antibiotics, on the other hand, is recommended when inflammatory lesions persist despite retinoid therapy, as they primarily target P. acnes bacteria but do not address the underlying causes of acne 1. Moreover, using antibiotics alone increases the risk of bacterial resistance, which is a growing concern in the treatment of acne 1. The guidelines also recommend concomitant use of benzoyl peroxide with topical antibiotics to prevent the development of antibiotic resistance 1.
Some key points to consider when using topical retinoids for acne treatment include:
- Starting with lower concentrations and using every other day if irritation occurs
- Applying the medication once daily, usually in the evening, to clean, dry skin
- Using a pea-sized amount for the entire face
- Continuing retinoid use even after acne improves to maintain clear skin
Overall, the use of topical retinoids as the initial treatment for acne, prior to the use of antibiotics, is supported by the most recent and highest quality evidence 1, and is recommended to reduce the risk of antibiotic resistance and provide long-term benefits in preventing new acne formation.
From the Research
Topical Retinoids in Acne Treatment
- Topical retinoids are used as a first-line treatment for acne due to their ability to expel mature comedones, reduce microcomedone formation, and exert anti-inflammatory effects 2, 3, 4.
- They have a favorable safety profile, with local adverse effects such as erythema, dryness, itching, and stinging being the most common side effects 2, 3.
Combination Therapy with Antibiotics
- Combination therapy with a topical retinoid and an antibiotic is recognized as a rational and effective approach for the treatment of acne vulgaris 5, 6.
- The combination of adapalene and doxycycline has been shown to deliver a superior and faster response than an antibiotic alone 5.
- Topical retinoids can be used in combination with oral antibiotics, such as doxycycline, to provide a more targeted and complete treatment strategy 5, 6.
Rationale for Using Topical Retinoids Before Antibiotics
- Topical retinoids are used before antibiotics because they can help reduce the formation of microcomedones and prevent the development of inflammatory lesions, making it easier for antibiotics to target the remaining bacteria 2, 3, 4.
- Additionally, topical retinoids do not induce bacterial resistance, making them a suitable long-term treatment option for maintenance of remission after cessation of initial combination therapy 2.