From the Guidelines
The most effective treatment for acne is a combination of topical benzoyl peroxide, topical retinoids, and oral doxycycline, with oral isotretinoin reserved for severe cases or those that have failed standard treatment, as recommended by the most recent guidelines 1. When managing acne, it is essential to consider the severity and type of acne, as well as the patient's medical history and potential contraindications.
- For mild acne, start with benzoyl peroxide 2.5-5% applied once daily, increasing to twice daily as tolerated.
- For moderate acne, add topical retinoids like adapalene 0.1% gel applied thinly at bedtime, starting every other night and gradually increasing to nightly use.
- For inflammatory acne, consider topical clindamycin 1% or oral antibiotics like doxycycline 100mg twice daily for 8-12 weeks. Some key points to consider when treating acne include:
- Limiting systemic antibiotic use to reduce the development of antibiotic resistance and other antibiotic-associated complications 1.
- Combining systemic antibiotics with benzoyl peroxide and other topical therapies to enhance efficacy and minimize resistance.
- Using intralesional corticosteroid injections as an adjuvant therapy for larger acne papules or nodules. It is crucial to educate patients on gentle face washing twice daily, avoiding picking or squeezing lesions, using non-comedogenic products, and expecting 6-8 weeks before significant improvement. Additionally, document any medication allergies, contraindications, and for females of childbearing age, pregnancy status and contraception use, especially if considering isotretinoin. Schedule follow-up in 4-6 weeks to assess treatment response and adjust therapy as needed. The guidelines also recommend conditional use of topical clascoterone, salicylic acid, azelaic acid, oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone, depending on the specific patient circumstances and acne severity 1.
From the FDA Drug Label
In a clinical study of 217 pediatric patients (12 to 17 years) with severe recalcitrant nodular acne, isotretinoin was given in two divided doses. The appropriate treatment for acne is isotretinoin for severe recalcitrant nodular acne, given at the recommended doses for no longer than the recommended duration 2.
- Dosage: approximately 1 mg/kg/day of isotretinoin given in two divided doses.
- Patient population: pediatric patients (12 to 17 years) with severe recalcitrant nodular acne.
From the Research
Treatment Options for Acne
The treatment for acne depends on the severity of the condition and may involve a combination of topical and oral medications, as well as procedural therapies 3, 4, 5, 6, 7.
- Topical retinoids are indicated for acne of any severity and for maintenance therapy 3, 5, 6, 7.
- Benzoyl peroxide is an over-the-counter bactericidal agent that can be used in combination with topical retinoids and antibiotics 3, 4, 7.
- Systemic and topical antibiotics should be used only in combination with benzoyl peroxide and retinoids and for a maximum of 12 weeks 3.
- Oral isotretinoin is used for severe, recalcitrant acne, and is also often used in moderate cases where scarring is evident, acne-related psychosocial distress is significant, or other treatment modalities have failed 3, 4, 5, 6, 7.
- Hormonal treatments, such as oral contraceptives and spironolactone, are useful for many women with acne 4, 5, 6.
Treatment Selection
Treatment selection is based on disease severity, patient preference, and tolerability 3.
- For mild to moderate acne, topical agents are the first-line treatment and can be used as combination therapy for more severe acne 5, 6.
- For moderate to severe acne, systemic therapies are usually prescribed for the initial treatment, as well as for acne that is refractory to topical therapies 5, 6.
- Oral antibiotics are an important therapy for inflammatory acne unresponsive to topical therapy, but should not be used as monotherapy 5, 6.
Maintenance Therapy
After treatment goals are reached, maintenance therapy should be initiated to prevent recurrence of acne lesions 7.