From the Guidelines
To effectively treat adult acne, a combination of topical and oral medications, as well as lifestyle modifications, should be considered, with benzoyl peroxide, topical retinoids, and oral doxycycline being strongly recommended, as evidenced by the most recent guidelines from the Journal of the American Academy of Dermatology 1.
Treatment Options
- Topical treatments:
- Benzoyl peroxide (2.5-5%)
- Topical retinoids (e.g., adapalene, tretinoin)
- Topical antibiotics (e.g., clindamycin)
- Oral medications:
- Doxycycline (100mg daily for 8-12 weeks)
- Hormonal treatments for women (e.g., spironolactone, combined oral contraceptives)
- Isotretinoin (0.5-1mg/kg/day for 4-6 months) for severe, resistant cases
Lifestyle Modifications
- Gentle skincare routine with salicylic acid or benzoyl peroxide cleansers
- Low-glycemic diet
- Stress management
- Avoiding pore-clogging products
Important Considerations
- Combining topical therapies with multiple mechanisms of action is recommended as a good practice statement 1.
- Limiting systemic antibiotic use and combining systemic antibiotics with topical therapies are also recommended as good practice statements 1.
- Intralesional corticosteroid injections may be considered as an adjuvant therapy for larger acne papules or nodules 1. It is essential to consult a dermatologist for personalized treatment if over-the-counter treatments do not work after 2-3 months or if the acne is severe, as they can provide guidance on the most effective treatment options and help minimize the risk of scarring and other complications.
From the FDA Drug Label
Tretinoin works deep inside your skin and this takes time. The relatively high level of spontaneous pheochromocytomas occurring in the male Fischer 344 rat makes it an equivocal model for study of this tumor; therefore, the relevance of this tumor to the human population is uncertain. In studies with isotretinoin, adverse reactions reported in pediatric patients were similar to those described in adults except for the increased incidence of back pain and arthralgia (both of which were sometimes severe) and myalgia in pediatric patients
The treatments for adult acne include tretinoin (TOP) and isotretinoin (PO).
- Tretinoin (TOP) should be applied once a day, before retiring, to the skin where acne lesions appear, using enough to cover the entire affected area lightly 2.
- Isotretinoin (PO), 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 3.
From the Research
Treatment Options for Adult Acne
- Fixed-dose retinoid/antimicrobial combinations are effective against both inflammatory and non-inflammatory lesions in adult female acne patients 4
- Oral hormonal treatment or isotretinoin may be required in patients with severe acne or disease that is refractory to other treatments 4
- Adapalene/benzoyl peroxide gel is a safe and highly effective treatment for acne vulgaris, with efficacy, tolerability, and ease-of-use superior to other topical acne therapies 5
- Combination therapy using adapalene 0.1%-benzoyl peroxide 2.5% fixed-dose combination gel with doxycycline hyclate 100 mg is effective in treating severe acne vulgaris 6
Role of Skin Care in Managing Adult Acne
- Epidermal barrier dysfunction plays a vital role in acne pathogenesis, particularly in adult female acne 7
- Improving patient knowledge of comprehensive acne treatments, including quality adjunctive cleansers and moisturizers, may maximize regimen efficacy and provide patients with personalized and successful acne treatment and maintenance tools 7
- Hormonal treatment is a safe and effective therapeutic option for acne in adult female patients, especially when other systemic therapies have failed 8
Considerations for Treatment
- Adult female acne may require a different treatment approach due to its unique clinical presentation and pathogenesis 4
- Genetic and hormonal factors play key roles in the pathogenesis of adult female acne, and the disease is characterized by a chronic evolution with frequent relapses requiring long-term maintenance therapy 4
- The high likelihood of antibiotic-resistant P. acnes and poor adherence of patients to other long-term therapies should be considered when selecting a treatment option 4