From the Guidelines
Acne vulgaris treatment should typically follow a stepwise approach based on severity, starting with topical treatments including benzoyl peroxide and topical retinoids for mild acne, and progressing to oral antibiotics like doxycycline for moderate acne, and isotretinoin for severe or cystic acne, as recommended by the most recent guidelines 1.
Treatment Approach
The treatment approach for acne vulgaris depends on the severity of the condition. For mild acne, topical treatments are usually sufficient, while moderate to severe acne may require a combination of topical and oral therapies.
- Topical treatments:
- Benzoyl peroxide (2.5-10%) applied once or twice daily to reduce bacteria and inflammation
- Topical retinoids like adapalene 0.1% gel applied nightly to prevent comedones and enhance skin cell turnover
- Oral antibiotics:
- Doxycycline 100mg daily for 3 months for moderate acne
- Isotretinoin (0.5-1mg/kg/day for 4-6 months) for severe or cystic acne, which requires medical supervision due to potential side effects including teratogenicity, requiring pregnancy prevention in women of childbearing age
Additional Considerations
- Hormonal therapy with combined oral contraceptives or spironolactone 50-100mg daily can help women with hormonal acne patterns 1.
- Treatment should continue for at least 6-8 weeks before assessing effectiveness, as skin turnover takes time.
- Sun protection is crucial, especially with retinoids which increase photosensitivity.
- Avoid picking or squeezing lesions to prevent scarring, and maintain treatment even after improvement to prevent recurrence.
Guideline Recommendations
The guidelines recommend strong consideration for topical benzoyl peroxide, retinoids, and/or antibiotics and their fixed-dose combinations, and for oral doxycycline 1. Oral isotretinoin is strongly recommended for severe acne, acne causing psychosocial burden or scarring, or acne failing standard treatment with oral or topical therapy 1. Conditional recommendations are made for the use of topical clascoterone, salicylic acid, azelaic acid, oral minocycline, sarecycline, combined oral contraceptives, and spironolactone 1.
From the FDA Drug Label
Tretinoin is indicated for topical application in the treatment of acne vulgaris. Tretinoin Cream and Tretinoin Gel are used for the topical treatment of acne vulgaris.
Tretinoin is used for the treatment of acne vulgaris. The medication should be applied topically, and it is available in different forms, including cream and gel. To use tretinoin properly, it is necessary to follow the instructions provided by a physician, and to be patient as it may take 6 to 12 weeks to see improvement 2, 2, 2.
- Apply tretinoin once daily before bedtime, or as directed by a physician.
- Wash the skin with a mild soap and dry it gently before applying the medication.
- Wait 20 to 30 minutes before applying tretinoin to allow the skin to dry completely.
- Use a moisturizer or a moisturizer with sunscreen that will not aggravate acne in the morning after washing.
From the Research
Acne Vulgaris Treatment Options
- Topical retinoids, such as adapalene and tretinoin, are effective in treating acne vulgaris by addressing early lesions and having anti-inflammatory effects 3, 4
- Adapalene is a stable molecule that can be used in combination with benzoyl peroxide products, making it a useful treatment option 3
- Topical therapies, including retinoids, benzoyl peroxide, and azelaic acid, are first-line treatments for acne vulgaris 5
- Combination therapies, such as adapalene and benzoyl peroxide gel, have been shown to be safe and effective in treating acne vulgaris 6
Comparison of Treatment Options
- Adapalene 0.1% gel has been shown to be equally effective to tretinoin 0.025% or 0.1% microsphere gel in treating mild to moderate acne 4
- Tazarotene 0.1% is more effective than tretinoin 0.025% or 0.1% microsphere gel, but has a lower tolerability profile 4
- Adapalene 0.1%-benzoyl peroxide 2.5% gel has been shown to be comparable to clindamycin 1%-benzoyl peroxide 5% gel in treating comedonal acne 7
Treatment Considerations
- The choice of treatment should be based on the severity and type of acne, as well as the patient's individual needs and preferences 5
- Topical retinoids, such as adapalene, can be irritating, but are generally well-tolerated 3, 4
- Combination therapies, such as adapalene and benzoyl peroxide gel, may be more effective than single-agent therapies, but may also be more expensive 6