From the Guidelines
The best treatment for acne vulgaris blemishes typically involves a combination of topical medications, such as benzoyl peroxide, topical retinoids, and topical antibiotics, along with good skincare practices, as strongly recommended by the most recent guidelines 1.
Key Recommendations
- For mild to moderate acne, start with benzoyl peroxide (2.5-5%) applied once daily, which kills acne-causing bacteria and removes excess oil and dead skin cells, as strongly recommended by the guidelines 1.
- Alternatively, use salicylic acid (0.5-2%) to unclog pores and reduce inflammation, although this is conditionally recommended due to lower certainty of evidence 1.
- Retinoids like adapalene (0.1% gel) are highly effective when applied thinly at night, as they prevent clogged pores and promote cell turnover, with strong recommendations for their use 1.
- For inflammatory acne, topical antibiotics such as clindamycin 1% may be combined with benzoyl peroxide to prevent bacterial resistance, with strong recommendations for fixed-dose combinations of topical antibiotics with benzoyl peroxide 1.
Additional Considerations
- Establish a gentle skincare routine using a mild cleanser twice daily, avoid picking at blemishes, and always use non-comedogenic moisturizers and sunscreen.
- For severe or cystic acne that doesn't respond to these treatments, consult a dermatologist who may prescribe oral medications like antibiotics (doxycycline 100mg daily for 3 months), hormonal treatments (for women), or isotretinoin, with strong recommendations for oral isotretinoin in cases of severe acne or acne causing psychosocial burden or scarring 1.
- Limiting systemic antibiotic use and combining systemic antibiotics with benzoyl peroxide and other topical therapies are recommended as good clinical practices to reduce antibiotic resistance and other complications 1.
From the FDA Drug Label
Purpose Acne treatment The best treatment for acne vulgaris blemishes is adapalene (TOP), as it is specifically stated to be for acne treatment 2.
- Key points:
- Apply once daily to the entire affected area
- Use a thin layer
- Do not use more than one time a day
- May cause skin irritation Alternatively, benzoyl peroxide (TOP) may also be used, but with caution due to potential skin irritation and sensitivity 3.
From the Research
Treatment Options for Acne Vulgaris
The treatment of acne vulgaris can vary depending on the severity of the condition. Some studies suggest the following options:
- Combination therapy with adapalene gel 0.1% and doxycycline for severe acne vulgaris 4
- Adapalene/benzoyl peroxide combination gel (0.1%/2.5% and 0.3%/2.5%) for the treatment of acne vulgaris 5
- Topical treatments such as benzoyl peroxide, salicylic acid, and a low-dose retinoid for mild acne 6
- Combination therapy comprising topical benzoyl peroxide, antibiotics, and/or retinoids, as well as oral antibiotics in refractory cases and oral contraceptive pills for female acne patients with moderate acne 6
- Oral isotretinoin therapy for severe nodulocystic acne vulgaris 6
Efficacy of Combination Therapies
Combination therapies have been shown to be effective in the treatment of acne vulgaris. For example:
- The combination of adapalene and doxycycline was significantly superior to doxycycline alone for change from baseline in total, inflammatory, and noninflammatory lesions 4
- Adapalene 0.1%/benzoyl peroxide 2.5% gel was more effective than adapalene 0.1% gel or benzoyl peroxide 2.5% gel alone in reducing total, inflammatory, and noninflammatory lesion counts 7
- The combination of oral lymecycline with adapalene 0·1%-BPO 2·5% fixed-dose gel was more effective than oral lymecycline with a vehicle gel in reducing total lesion counts and achieving success rate 8
Safety and Tolerability
The safety and tolerability of these treatments have also been evaluated:
- Adapalene 0.1%/benzoyl peroxide 2.5% gel was generally well tolerated in patients with acne, with the most commonly occurring treatment-related adverse events including erythema, scaling, dryness, and stinging/burning 7
- The combination of oral lymecycline with adapalene 0·1%-BPO 2·5% fixed-dose gel was well tolerated, with a similar proportion of satisfied and very satisfied subjects in both groups 8