From the Guidelines
For a patient whose acne is not improving with Biacna, I strongly recommend adding oral doxycycline 100mg daily for 3 months, as it is a strong recommendation with moderate certainty of evidence 1.
Key Considerations
- Before changing treatment, ensure the patient has been using Biacna correctly for at least 8-12 weeks, as retinoids often require time to show results and may cause initial worsening.
- Alternative topical options include benzoyl peroxide 2.5-5% to address potential antibiotic resistance, or adapalene 0.1% gel if tretinoin irritation is an issue.
- For female patients with hormonal acne patterns, combined oral contraceptives or spironolactone 50-100mg daily may be beneficial, with conditional recommendations and moderate certainty of evidence 1.
Adjunctive Treatments
- Adjunctive treatments like salicylic acid cleansers can help, while lifestyle modifications including gentle skin care and avoiding comedogenic products should be reinforced.
- Intralesional corticosteroid injections can be considered as an adjuvant therapy for patients with larger acne papules or nodules, as a good practice statement 1.
Underlying Conditions
- Treatment resistance may indicate underlying conditions such as polycystic ovary syndrome or folliculitis that require specific evaluation.
- It is essential to limit the use of systemic antibiotics when possible to reduce the development of antibiotic resistance and other antibiotic-associated complications, as a good practice statement 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Options for Acne Not Improving with Biacna
- The patient's acne not improving with Biacna may require a combination of topical therapies, such as retinoids, benzoyl peroxide, and antimicrobial agents 2.
- Topical retinoids, such as tretinoin, can be used in combination with other topical agents to address the multifactorial pathophysiology of acne 3.
- For more severe disease, oral antibiotics, such as doxycycline or minocycline, hormonal therapies, such as combination oral contraceptives or spironolactone, or isotretinoin may be recommended 3, 4.
- Isotretinoin is approved for treating severe recalcitrant nodular acne, but is often used to treat resistant or persistent moderate to severe acne, as well as acne that produces scarring or significant psychosocial distress 3, 4.
- The combination of clindamycin 1%-benzoyl peroxide 5% gel may be a well-tolerated and efficacious treatment option for acne, and can be used in combination with topical retinoids 2.
Considerations for Treatment Selection
- Treatment selection should be based on disease severity, patient preference, and tolerability 4.
- Topical retinoids are indicated for acne of any severity and for maintenance therapy, while systemic and topical antibiotics should be used only in combination with benzoyl peroxide and retinoids and for a maximum of 12 weeks 4.
- Patients with skin of color may require special consideration, as they are more prone to post-inflammatory hyperpigmentation, and topical retinoids may be beneficial in reducing hyperpigmentation 5.