From the Guidelines
Acne can be effectively treated with a combination of topical and oral medications, with benzoyl peroxide, topical retinoids, and oral doxycycline being strongly recommended options 1.
Treatment Options
The treatment of acne should prioritize a combination of topical and oral medications to target the four main causes of acne: excess oil production, clogged pores, bacteria, and inflammation.
- For mild acne, start with benzoyl peroxide (2.5-5%) applied once daily, which kills bacteria and reduces inflammation.
- Add a topical retinoid like adapalene (0.1%) at night to prevent clogged pores and promote skin cell turnover.
- Wash your face twice daily with a gentle cleanser containing salicylic acid to exfoliate and clear pores.
Moderate to Severe Acne
For moderate to severe acne, see a dermatologist who may prescribe:
- Oral antibiotics like doxycycline (100mg twice daily for 3 months)
- Isotretinoin (0.5-1mg/kg/day for 4-6 months) for severe cases, especially those with psychosocial burden or scarring 1.
Hormonal Acne
Hormonal acne in women might respond to:
- Spironolactone (50-100mg daily)
- Combined oral contraceptives, although the recommendation is conditional due to variability in patient values and preferences related to contraception and hormonal medications 1.
Additional Recommendations
- Consistency is crucial—most treatments take 6-12 weeks to show significant improvement.
- Avoid picking at acne, which can cause scarring, and use oil-free, non-comedogenic moisturizers and sunscreen.
- Diet modifications like reducing dairy and high-glycemic foods may help some individuals, though evidence varies.
- Multimodal therapy combining multiple mechanisms of actions is recommended as a good practice statement to optimize efficacy and to reduce the risk of antibiotic resistance 1.
From the FDA Drug Label
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. Therapeutic results should be noticed after 2 to 3 weeks but more than 6 weeks of therapy may be required before definite beneficial effects are seen Once the acne lesions have responded satisfactorily, it may be possible to maintain the improvement with less frequent applications, or other dosage forms.
The treatment options for acne include applying tretinoin cream or gel once a day to the affected area.
- Tretinoin can be used to treat acne lesions, with noticeable results after 2-3 weeks and significant improvement after 6 weeks of therapy.
- Dosage frequency can be adjusted based on the patient's response to treatment, with the option to reduce applications or switch to other dosage forms once the acne has responded satisfactorily 2.
From the Research
Treatment Options for Acne
The treatment options for acne include a variety of topical and oral medications. Some of the available treatments are:
- Topical retinoids (e.g., tretinoin, adapalene, tazarotene) which act against comedones and microcomedones and have direct anti-inflammatory effects 3, 4, 5
- Antimicrobial and antibacterial agents (e.g., benzoyl peroxide, clindamycin, erythromycin, sulfacetamide with or without sulfur) 6, 5, 7
- Oral antibiotics (e.g., doxycycline, minocycline, tetracycline) 6, 5
- Hormonal agents (e.g., oral contraceptives, spironolactone) 6, 5
- Systemic retinoids (e.g., isotretinoin) which is approved for treating severe recalcitrant nodular acne 6, 5
Combination Therapy
Acne is usually treated with combination therapy to address its multifactorial pathophysiology. The combination of clindamycin 1%-benzoyl peroxide 5% gel is efficacious and well-tolerated 6. Topical retinoids can be used in combination with other topical agents, such as benzoyl peroxide or topical antibiotics, for more effective treatment 3, 4, 7.
First-Line Treatments
First-line treatments for acne include topical retinoids, benzoyl peroxide, azelaic acid, or combinations of these topical agents 5, 7. For mild comedonal acne, monotherapy with topical retinoids is the treatment of choice 7. For moderate comedonal and mild to moderate papulopustular acne, combination therapy with either benzoyl peroxide or topical retinoids plus topical antibiotics is proven most effective 7.