What is the recommended treatment for acne?

From the Guidelines

The recommended treatment for acne is a combination approach, including benzoyl peroxide, topical retinoids, and oral antibiotics, with isotretinoin reserved for severe cases. According to the most recent guidelines 1, benzoyl peroxide, topical retinoids, and topical antibiotics are strongly recommended for the treatment of acne. For mild acne, over-the-counter products containing benzoyl peroxide (2.5-10%) or salicylic acid (0.5-2%) can be used, applied once or twice daily.

Treatment Options

• For moderate acne, prescription topical treatments like adapalene 0.1% gel, tretinoin 0.025-0.1% cream, or clindamycin 1% solution are effective, applied thinly at night.
• Oral antibiotics such as doxycycline (100mg twice daily) or minocycline (50-100mg daily) for 3-6 months may be added for inflammatory acne.
• For severe or cystic acne, isotretinoin (0.5-1mg/kg/day for 4-6 months) is highly effective but requires medical supervision due to potential side effects, as supported by recent studies 1.
• Women may benefit from hormonal treatments like combined oral contraceptives or spironolactone (50-200mg daily), as conditionally recommended by guidelines 1.

Additional Recommendations

• Alongside medication, using a gentle cleanser twice daily, applying oil-free moisturizers, avoiding picking at lesions, and maintaining a consistent skincare routine are crucial.
• These treatments work by reducing excess oil production, preventing follicular plugging, decreasing inflammation, or targeting acne-causing bacteria, addressing the four main factors in acne development.
• The use of systemic antibiotics should be limited to the shortest possible duration, and concomitant topical therapy with benzoyl peroxide or a retinoid should be used with systemic antibiotics and for maintenance after completion of systemic antibiotic therapy, as recommended by guidelines 1.

From the FDA Drug Label

To get the best results with tretinoin therapy, it is necessary to use it properly. Apply tretinoin once daily before bedtime, or as directed by your physician Your physician may advise, especially if your skin is sensitive, that you start your therapy by applying tretinoin every other night. It is recommended that you apply a moisturizer or a moisturizer with sunscreen that will not aggravate your acne (noncomedogenic) every morning after you wash Tretinoin works deep inside your skin and this takes time. If tretinoin is going to have a beneficial effect for you, you should notice a continued improvement in your appearance after 6 to 12 weeks of therapy.

The recommended treatment for acne with tretinoin is to apply it once daily before bedtime, or as directed by a physician. It's essential to use it properly and be patient, as it may take 6 to 12 weeks to see improvement. Additionally, using a noncomedogenic moisturizer or moisturizer with sunscreen every morning can help. It's crucial to follow the instructions carefully and consult a doctor if questions arise 2.

From the Research

Acne Treatment Overview

• Acne vulgaris is a common skin condition that affects approximately 9% of the population worldwide, with the majority of cases occurring in individuals aged 12-24 years 3.
• The condition can cause permanent physical scarring, negatively impact quality of life and self-image, and is associated with increased rates of anxiety, depression, and suicidal ideation 3.

Recommended Treatments

• First-line treatments for acne include topical therapies such as retinoids (e.g., tretinoin, adapalene), benzoyl peroxide, azelaic acid, and combinations of topical agents 3, 4, 5, 6, 7.
• Topical retinoids are effective in reducing acne lesion counts and have anti-inflammatory effects, with adapalene 0.1% gel being well-tolerated and equally effective to tretinoin 0.025% or 0.1% microsphere gel 4.
• Combination topical therapy, such as clindamycin 1%-benzoyl peroxide 5% gel, is also efficacious and well-tolerated, and can be used in conjunction with topical retinoids 5.
• Adapalene/benzoyl peroxide combination gel (0.1%/2.5% and 0.3%/2.5%) is a safe and highly effective treatment option for acne vulgaris, with superior efficacy, tolerability, and ease-of-use compared to other topical therapies 6.

Treatment Considerations

• The choice of treatment depends on the severity and type of acne, as well as individual patient factors such as skin type and potential side effects 3, 4, 5, 6, 7.
• Topical retinoids have a favorable safety profile, with local adverse effects such as erythema, dryness, itching, and stinging being the most common side effects 4, 7.
• Combination therapy, including oral antibiotics and hormonal agents, may be necessary for more severe cases of acne 3.