From the Guidelines
The recommended treatment for acne depends on severity but typically includes a combination approach, with benzoyl peroxide, topical retinoids, and oral doxycycline being strongly recommended, as stated in the guidelines of care for the management of acne vulgaris 1. For mild acne, start with over-the-counter products containing benzoyl peroxide (2.5-10%) or salicylic acid (0.5-2%), applied once or twice daily. Establish a gentle skincare routine using a mild cleanser twice daily, avoiding harsh scrubbing. Some key points to consider when treating acne include:
- For moderate acne, prescription topical retinoids like tretinoin (0.025-0.1%) or adapalene (0.1-0.3%) are effective, applied thinly at night, as supported by the guidelines 1.
- These may be combined with topical antibiotics such as clindamycin 1% or erythromycin 2%.
- For severe or cystic acne, oral medications are often necessary, including antibiotics like doxycycline (100mg twice daily for 3-6 months), or for females, hormonal treatments like combined oral contraceptives or spironolactone (25-200mg daily) 1.
- Isotretinoin (0.5-1mg/kg/day for 4-6 months) is reserved for severe, resistant cases, as recommended in the guidelines 1. These treatments work by reducing oil production, preventing follicular plugging, decreasing inflammation, or targeting acne-causing bacteria. Consistency is crucial, and improvement typically takes 6-12 weeks. Sun protection is essential, especially with retinoids, as many acne treatments increase sun sensitivity. It's also important to note that limiting systemic antibiotic use is recommended, and alternative treatments such as spironolactone, combined oral contraceptives, and oral isotretinoin can be effective in reducing antibiotic use 1.
From the FDA Drug Label
In an open-label clinical trial (N = 217) of a single course of therapy with isotretinoin for severe recalcitrant nodular acne, bone density measurements at several skeletal sites were not significantly decreased (lumbar spine change > -4% and total hip change > -5%) or were increased in the majority of patients Use of isotretinoin in this age group for severe recalcitrant nodular acne is supported by evidence from a clinical study comparing 103 pediatric patients (13 to 17 years) to 197 adult patients (≥18 years) Results from this study demonstrated that isotretinoin, at a dose of 1 mg/kg/day given in two divided doses, was equally effective in treating severe recalcitrant nodular acne in both pediatric and adult patients
The recommended treatment for severe recalcitrant nodular acne is isotretinoin at a dose of 1 mg/kg/day given in two divided doses. This is supported by evidence from clinical studies, including an open-label clinical trial of 217 patients and a comparative study of 103 pediatric patients and 197 adult patients 2. Isotretinoin has been shown to be equally effective in treating severe recalcitrant nodular acne in both pediatric and adult patients. Key points to consider when prescribing isotretinoin include:
- Bone density measurements: should be monitored, as some patients may experience decreases in bone mineral density
- Pediatric use: should be given careful consideration, especially for patients with known metabolic or structural bone disease
- Dosing: 1 mg/kg/day given in two divided doses
- Efficacy: equally effective in treating severe recalcitrant nodular acne in both pediatric and adult patients
From the Research
Treatment Options for Acne
The recommended treatment for acne often involves a combination of therapies to address its multifactorial pathophysiology. Some key treatment options include:
- Topical retinoids, such as adapalene, tretinoin, and tazarotene, which are effective against comedones and microcomedones and have direct anti-inflammatory effects 3, 4
- Antibiotics, including doxycycline, which can be used orally or topically to reduce inflammation and prevent bacterial growth 5, 6
- Benzoyl peroxide, which has antibacterial properties and can be used in combination with other treatments 7, 6
Combination Therapies
Combination therapies are often more effective than single-agent treatments for acne. For example:
- The combination of adapalene gel 0.1% and doxycycline has been shown to be significantly superior to doxycycline alone for the treatment of severe acne 5
- The combination of clindamycin 1%-benzoyl peroxide 5% gel is efficacious and well-tolerated for the treatment of acne 7
- The combination of anti-inflammatory dose doxycycline plus adapalene 0.3% and benzoyl peroxide 2.5% gel has been shown to be safe and effective for the management of severe acne 6
Key Considerations
When selecting a treatment for acne, it's essential to consider the individual's specific needs and the potential benefits and risks of each treatment option. For example: