From the Guidelines
The recommended treatment for Acne Vulgaris includes both topical and systemic options, with benzoyl peroxide, topical retinoids, and oral doxycycline being strongly recommended, as well as oral isotretinoin for severe cases, according to the most recent guidelines 1.
Treatment Options
- For mild acne, start with topical treatments like benzoyl peroxide (2.5-10%) applied once or twice daily, which works by killing bacteria and reducing inflammation.
- Topical retinoids such as adapalene (0.1-0.3%) or tretinoin (0.025-0.1%) applied nightly help normalize skin cell turnover and prevent clogged pores, though they may cause initial irritation.
- For moderate acne, combine these with topical antibiotics like clindamycin 1% or erythromycin 2%, typically applied twice daily.
- For moderate to severe acne, oral antibiotics such as doxycycline (100mg once or twice daily) or minocycline (50-100mg daily) for 3-6 months may be necessary.
- Hormonal treatments like combined oral contraceptives or spironolactone (25-200mg daily) can help women with hormonal acne.
- For severe, nodular acne, isotretinoin (0.5-1mg/kg/day for 4-6 months, cumulative dose 120-150mg/kg) is highly effective but requires close monitoring due to potential side effects including birth defects, so pregnancy prevention is mandatory.
Supportive Measures
- Consistent gentle skin cleansing twice daily
- Avoiding picking or squeezing lesions
- Using non-comedogenic products
Important Considerations
- Treatment response typically takes 6-8 weeks, and maintenance therapy is often needed to prevent recurrence.
- The use of topical therapies combining multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with benzoyl peroxide and other topical therapies, and adjuvant intralesional corticosteroid injections are recommended as good clinical practices 1.
- Oral isotretinoin is strongly recommended for severe acne, acne causing psychosocial burden or scarring, or acne failing standard treatment with oral or topical therapy 1.
From the FDA Drug Label
Tretinoin is indicated for topical application in the treatment of acne vulgaris. Tretinoin Cream and Tretinoin Gel are used for the topical treatment of acne vulgaris.
The recommended treatment for Acne Vulgaris is topical application of tretinoin. Key points to consider when using tretinoin for acne treatment include:
- Applying the medication once daily before bedtime, or as directed by a physician
- Starting with a lower frequency (e.g., every other night) if the skin is sensitive
- Using a mild, non-medicated soap and avoiding frequent washings and harsh scrubbing
- Avoiding excessive irritation, such as rubbing or using other medications not suggested by a physician
- Being patient, as improvement may be seen after 6 to 12 weeks of therapy 2, 2, 2
From the Research
Treatment Options for Acne Vulgaris
The treatment of Acne Vulgaris involves a combination of topical and oral therapies. Some of the recommended treatments include:
- Topical retinoids, such as tretinoin and adapalene, which are effective in reducing noninflammatory and inflammatory lesions 3, 4, 5
- Benzoyl peroxide, which has antibacterial properties and can be used in combination with topical retinoids 3, 4, 6
- Azelaic acid, which has antibacterial and anti-inflammatory properties 4
- Oral antibiotics, such as doxycycline and minocycline, which are effective in reducing inflammatory lesions 4, 7
- Hormonal therapies, such as combination oral contraception and spironolactone, which can be effective in treating acne in women 4
- Isotretinoin, which is a powerful oral retinoid that is effective in treating severe acne, but can have serious side effects 3, 4, 7
Combination Therapies
Combination therapies, which involve the use of multiple topical and/or oral agents, are often recommended for the treatment of Acne Vulgaris. These therapies can be more effective than single-agent therapies and can help to reduce the risk of antibiotic resistance 3, 4, 5, 7. Some examples of combination therapies include:
- Topical retinoids and benzoyl peroxide 3, 4, 6
- Topical retinoids and oral antibiotics 3, 4, 7
- Oral antibiotics and hormonal therapies 4
Severity-Based Treatment
The treatment of Acne Vulgaris should be based on the severity of the disease. Mild to moderate acne can be treated with topical therapies, while more severe acne may require oral antibiotics or isotretinoin 3, 4, 7. Some of the factors that should be considered when determining the severity of acne include: