What is the management of acne vulgaris in adults?

From the Guidelines

The management of acne vulgaris in adults should involve a combination of topical and oral treatments tailored to acne severity, with strong recommendations for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline, as well as oral isotretinoin for severe cases. According to the guidelines of care for the management of acne vulgaris 1, the treatment approach should be based on the severity of the acne. For mild acne, topical retinoids like adapalene 0.1% gel or tretinoin 0.025% cream applied once daily at night, along with benzoyl peroxide 2.5-5% gel in the morning, are recommended.

Some key points to consider in the management of acne vulgaris in adults include:

• The use of multimodal therapy combining multiple mechanisms of action is recommended as a good practice statement 1
• Topical antibiotics should be used in combination with benzoyl peroxide to prevent the development of antibiotic resistance 1
• Oral doxycycline is strongly recommended for patients with acne, with a dosage of 100mg twice daily for 8-12 weeks 1
• Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy, with a dosage of 0.5-1mg/kg/day for 16-20 weeks 1
• Combined oral contraceptive pills and spironolactone are conditionally recommended for patients with acne, particularly for women with hormonal components 1

It is essential to note that treatment typically requires 8-12 weeks before significant improvement, and maintenance therapy with topical retinoids is often needed to prevent recurrence after clearing. Additionally, sun protection is crucial, especially when using retinoids, which increase photosensitivity. The guidelines also recommend limiting the use of systemic antibiotics when possible to reduce the development of antibiotic resistance and other antibiotic-associated complications 1.

From the FDA Drug Label

To get the best results with tretinoin therapy, it is necessary to use it properly. Use a mild, non-medicated soap Avoid frequent washings and harsh scrubbing. Wash your skin gently with a mild, bland soap. Two or three times a day should be sufficient. Pat skin dry with a towel Let the face dry 20 to 30 minutes before applying tretinoin. Apply tretinoin once daily before bedtime, or as directed by your physician It is recommended that you apply a moisturizer or a moisturizer with sunscreen that will not aggravate your acne (noncomedogenic) every morning after you wash

The management of acne vulgaris in adults using tretinoin involves:

• Using a mild, non-medicated soap
• Avoiding frequent washings and harsh scrubbing
• Washing the skin gently with a mild, bland soap 2-3 times a day
• Applying tretinoin once daily before bedtime, or as directed by the physician
• Applying a moisturizer or a moisturizer with sunscreen that will not aggravate acne every morning after washing 2

From the Research

Management of Acne Vulgaris in Adults

The management of acne vulgaris in adults involves a combination of topical and oral therapies. Some of the key treatment options include:

• Topical retinoids, such as adapalene, which help to prevent clogged pores and reduce inflammation 3, 4, 5, 6
• Benzoyl peroxide, which helps to kill bacteria that can cause acne and reduce inflammation 7, 3, 4, 5, 6
• Oral antibiotics, such as doxycycline, which help to reduce inflammation and kill bacteria that can cause acne 4, 5, 6
• Combination therapies, such as adapalene and benzoyl peroxide gel, which can provide enhanced efficacy and reduce the emergence of resistant strains of P. acnes 7, 3, 4, 5, 6

Treatment Regimens

Some studies have evaluated the efficacy and safety of different treatment regimens for acne vulgaris, including:

• Clindamycin/benzoyl peroxide gel, which was found to be as effective as clindamycin/benzoyl peroxide gel + tretinoin gel + clindamycin gel in reducing inflammatory lesions 7
• Adapalene/benzoyl peroxide gel, which was found to be safe and highly effective in the treatment of acne vulgaris, with superior efficacy, tolerability, and ease-of-use compared to other topical therapies 3
• Adapalene 0.3%/benzoyl peroxide 2.5% gel plus oral doxycycline, which was found to be an effective and safe treatment option for severe inflammatory acne 4
• Fixed-dose combination gel of adapalene and benzoyl peroxide plus doxycycline 100 mg, which was found to be a cost-effective alternative to oral isotretinoin for treating patients with severe acne vulgaris 5

Efficacy and Safety

The efficacy and safety of these treatment regimens have been evaluated in several studies, with results showing:

• Significant reductions in inflammatory lesion counts and improvements in global success and overall participant satisfaction 7, 4, 6
• Rapid reduction in Propionibacterium acnes, particularly within the first 4 weeks of treatment 6
• Good tolerability and safety profiles, with minimal adverse events reported 7, 3, 4, 5, 6