From the Guidelines
The recommended treatment for acne is a combination approach, including topical benzoyl peroxide, retinoids, and/or antibiotics, as well as oral doxycycline for moderate to severe cases, as supported by the most recent guidelines 1.
Treatment Approach
The treatment of acne depends on the severity of the condition, but generally involves a combination of topical and oral medications.
- For mild acne, topical benzoyl peroxide (2.5-10%) or salicylic acid (0.5-2%) can be used, applied once or twice daily.
- For moderate acne, prescription topical retinoids like tretinoin (0.025-0.1%) or adapalene (0.1-0.3%) are effective, used nightly, along with topical antibiotics such as clindamycin 1% or erythromycin 2%.
- For severe or cystic acne, oral medications may be necessary, including antibiotics like doxycycline (100mg twice daily for 3-6 months), as strongly recommended by the guidelines 1.
Additional Considerations
It is also important to note that the guidelines recommend limiting the use of systemic antibiotics when possible to reduce the development of antibiotic resistance and other antibiotic-associated complications 1.
- Additionally, combining systemic antibiotics with benzoyl peroxide and other topical therapies is recommended as a good clinical practice 1.
- Intralesional corticosteroid injections can be used as an adjuvant therapy for larger acne papules or nodules, but should be used judiciously to minimize the risks of local corticosteroid adverse events 1.
Quality of Life
Maintaining a healthy diet, gentle cleansing twice daily, avoiding picking or squeezing lesions, using oil-free moisturizers and sunscreen can also help improve the quality of life for patients with acne.
- These treatments work by reducing excess oil production, preventing follicular plugging, decreasing inflammation, and controlling bacterial growth that contributes to acne formation.
- The guidelines provide evidence-based recommendations to guide the clinical management of acne vulgaris, aiming to improve patient outcomes and quality of life 1.
From the FDA Drug Label
Tretinoin works deep inside your skin and this takes time. You cannot make tretinoin work any faster by applying more than one dose each day, but an excess amount of tretinoin may irritate your skin. Tretinoin Cream or Tretinoin Gel should be applied once a day, before retiring, to the skin where acne lesions appear, using enough to cover the entire affected area lightly. The recommended treatment for acne is to apply tretinoin once daily, before bedtime, to the affected area, using a mild, non-medicated soap and avoiding harsh scrubbing. It is essential to follow the instructions carefully and be patient, as therapeutic results may take 2 to 3 weeks, but more than 6 weeks of therapy may be required before definite beneficial effects are seen 2 2.
- Key points to consider:
- Apply a small amount (about a half inch or less) to the fingertip and cover the entire affected area lightly.
- Avoid applying more than one dose per day, as this may irritate the skin.
- Use a moisturizer or a moisturizer with sunscreen that will not aggravate acne (noncomedogenic) every morning after washing.
- Minimize exposure to sunlight, including sunlamps, and use sunscreen products and protective clothing over treated areas when exposure cannot be avoided 2.
From the Research
Acne Treatment Options
- Topical therapies such as retinoids (eg, tretinoin, adapalene), benzoyl peroxide, azelaic acid, and/or combinations of topical agents are first-line treatments for acne 3
- Combination therapy is often used to address the multifactorial pathophysiology of acne, with the combination of clindamycin 1%-benzoyl peroxide 5% gel being efficacious and well-tolerated 4
- For more severe disease, oral antibiotics such as doxycycline and minocycline, hormonal therapies such as combination oral contraception or spironolactone, or isotretinoin are recommended 3
Recommended Treatment Regimens
- Adapalene-benzoyl peroxide fixed combination gel has been shown to be effective in controlling acne relapse after treatment with oral isotretinoin 5
- The combination of adapalene 0.1%-benzoyl peroxide 2.5% fixed-dose combination gel with doxycycline hyclate 100 mg has been demonstrated to be effective and safe for the treatment of severe acne vulgaris 6
- Adapalene/benzoyl peroxide gel is safe and highly effective in the treatment of acne vulgaris, with its efficacy, tolerability, and ease-of-use being superior to other topical acne therapies 7
Key Considerations
- Maintenance therapy with topical retinoids is important to prevent recurrences after discontinuing a successful treatment 5
- The cost of adapalene/benzoyl peroxide gel and lack of available generics may prohibit its use 7
- Digital UV fluorescence photography has demonstrated a rapid reduction in Propionibacterium acnes in the adapalene-benzoyl peroxide with doxycycline group, particularly within the first 4 weeks 6