From the Guidelines
For the management of acne, benzoyl peroxide, topical retinoids, and oral doxycycline are strongly recommended, while oral isotretinoin is reserved for severe cases or those causing psychosocial burden or scarring, as per the most recent guidelines 1. The treatment of acne should be tailored to the individual's severity and type of acne, with a focus on combining topical therapies with multiple mechanisms of action to minimize the development of antibiotic resistance 1. Some key recommendations include:
- Using benzoyl peroxide, topical retinoids, and topical antibiotics for patients with acne, with a strong recommendation for fixed-dose combination topical antibiotic with benzoyl peroxide or topical retinoid 1.
- Limiting the use of systemic antibiotics when possible and using them concomitantly with benzoyl peroxide and other topical therapy to reduce the development of antibiotic resistance and other complications 1.
- Considering oral isotretinoin for severe cases or those causing psychosocial burden or scarring, as it has been shown to be effective in reducing acne severity and improving quality of life 1.
- For women, hormonal treatments like spironolactone or combined oral contraceptive pills may be conditionally recommended, with careful consideration of potential side effects and monitoring of potassium levels 1. It is essential to note that acne treatment should be individualized, and patients should be educated on the importance of consistent treatment, avoiding picking at acne, and the potential risks and benefits of different therapies 1.
From the FDA Drug Label
Purpose Acne treatment Active ingredient Benzoyl peroxide 5% Benzoyl peroxide 10% Purpose Acne treatment
Acne treatment options include:
- Adapalene (TOP) 2
- Benzoyl peroxide (TOP) 3
- Isotretinoin (PO) is used for severe recalcitrant nodular acne 4
From the Research
Acne Treatment Options
- Topical antimicrobial agents, such as benzoyl peroxide and clindamycin, are commonly used to manage mild to moderate acne vulgaris 5
- Combination therapy with topical retinoids and antibiotics is a rational and effective approach for treating acne vulgaris 6
- For mild acne, topical treatments such as benzoyl peroxide, salicylic acid, and low-dose retinoids are effective 7
- Moderate acne responds well to combination therapy comprising topical benzoyl peroxide, antibiotics, and/or retinoids, as well as oral antibiotics in refractory cases 7
- Severe nodulocystic acne vulgaris responds best to oral isotretinoin therapy 7, 8
Treatment Guidelines
- The American Academy of Dermatology, European Academy of Dermatology and Venereology, and Italian Society of Dermatology and Venereology guidelines provide recommendations for treating mild-to-moderate acne 9
- Treatment selection is based on disease severity, patient preference, and tolerability 8
- Topical retinoids are indicated for acne of any severity and for maintenance therapy 8
- Systemic and topical antibiotics should be used only in combination with benzoyl peroxide and retinoids and for a maximum of 12 weeks 8