From the Guidelines
Acne vulgaris should be diagnosed and treated with a multimodal approach, combining topical medications such as benzoyl peroxide, retinoids, and antibiotics, as well as oral antibiotics like doxycycline, to reduce morbidity, mortality, and improve quality of life. The diagnosis of acne vulgaris involves identifying the presence of comedones, papules, pustules, and nodules on the skin, particularly on the face, chest, and back [ 1 ].
Treatment Options
- For mild acne, over-the-counter treatments containing benzoyl peroxide (2.5-10%) or salicylic acid (0.5-2%) can be effective [ 1 ].
- For moderate to severe acne, prescription treatments such as topical retinoids like tretinoin (0.025-0.1%), adapalene (0.1-0.3%), or oral antibiotics like doxycycline (100mg daily for 3-4 months) may be necessary [ 1 ].
- Hormonal acne in women may respond to combined oral contraceptives or spironolactone (25-100mg daily) [ 1 ].
- Severe, cystic acne may require isotretinoin (0.5-1mg/kg/day for 4-6 months) [ 1 ].
Skincare Routine
Regardless of treatment, it is essential to maintain a consistent skincare routine, including:
- Gently washing the face with a mild cleanser
- Avoiding picking at pimples
- Using non-comedogenic products
- Changing pillowcases regularly
- Being patient, as most treatments take 6-8 weeks to show significant improvement [ 1 ].
Additional Considerations
Diet modifications, such as reducing dairy and high-glycemic foods, may help some individuals, although evidence is limited [ 1 ]. Intralesional corticosteroid injections can be used as an adjuvant therapy for larger acne papules or nodules [ 1 ]. It is crucial to limit the use of systemic antibiotics to reduce the development of antibiotic resistance and other complications [ 1 ]. Combining systemic antibiotics with benzoyl peroxide and other topical therapies is recommended as a good clinical practice [ 1 ].
From the FDA Drug Label
Use for the treatment of acne Purpose Acne treatment
The diagnosis of acne (acne vulgaris) is not explicitly stated in the provided drug labels. The treatment for acne (acne vulgaris) includes topical medications such as:
- Benzoyl peroxide 2
- Adapalene 3 For severe recalcitrant nodular acne, isotretinoin (oral) may be used 4
From the Research
Diagnosis of Acne
- Acne vulgaris is the most common skin disease that can lead to disfigurement and psychological distress 5
- The diagnosis of acne is typically based on clinical presentation, and the severity of acne can be classified as mild, moderate, or severe 5
Treatment of Acne
- Topical agents are the first-line treatment for mild-to-moderate acne and can be used as combination therapy for more severe acne 5
- Topical retinoids are the drugs of choice for the treatment and maintenance therapy of patients with mild-to-moderate acne vulgaris 5
- Topical antibiotics and benzoyl peroxide are effective against inflammatory acne vulgaris 6
- Oral antibiotics are an important therapy for inflammatory acne unresponsive to topical therapy 5
- Oral isotretinoin is the drug of choice for severe, extensive, nodular acne vulgaris 5
- Combination therapy, such as clindamycin 1%-benzoyl peroxide 5% gel, is efficacious and well-tolerated 7
- Adapalene/benzoyl peroxide gel is safe and highly effective in the treatment of acne vulgaris 8
Treatment Considerations
- Topical and oral antibacterials should not be used in combination for the treatment of acne vulgaris, since this association may increase the risk of bacterial resistance 6
- Neither topical nor oral antibiotics should be used as monotherapy 5
- Oral contraceptives and/or spironolactone are useful for many women with acne 5
- The cost of adapalene/benzoyl peroxide gel and lack of available generics may prohibit its use 8