What is the treatment for small red and white pimples on the face, also known as acne?

Treatment for Small Red and White Pimples on the Face (Acne Vulgaris)

For small red and white pimples on the face (acne vulgaris), a combination of topical retinoids with benzoyl peroxide is recommended as first-line therapy, with additional agents selected based on acne severity. 1, 2

Treatment Based on Acne Severity

Mild Acne

• Topical retinoids (tretinoin 0.025-0.1%, adapalene 0.1-0.3%, or tazarotene 0.05-0.1%) are recommended as monotherapy or in combination with benzoyl peroxide for primarily comedonal acne 1, 2
• Benzoyl peroxide 2.5-5% is effective as an antimicrobial agent with mild comedolytic properties and no reported bacterial resistance 3, 4
• Azelaic acid is useful for patients with post-inflammatory dyspigmentation 1, 2
• Topical dapsone 5% gel is particularly effective for inflammatory acne in adult females 1, 2

Moderate Acne

• Combination therapy with topical retinoid + benzoyl peroxide is recommended as first-line treatment 2
• Fixed-combination products (erythromycin 3%/BP 5%, clindamycin 1%/BP 5%, clindamycin 1%/BP 3.75%) enhance treatment compliance 1
• Topical antibiotics (clindamycin or erythromycin) should always be used with benzoyl peroxide to prevent bacterial resistance 1, 5
• Never use topical antibiotics as monotherapy due to risk of bacterial resistance 1, 6

Moderate to Severe Acne

• Oral antibiotics + topical retinoid + benzoyl peroxide is the recommended first-line treatment 1, 2
• Doxycycline and minocycline are more effective than tetracycline for systemic antibiotic therapy 1
• Limit systemic antibiotic use to 3-4 months to minimize bacterial resistance 1
• For females with hormonal component, combined oral contraceptives or spironolactone may be beneficial 1, 2

Mechanism of Action of Key Treatments

• Topical retinoids work by being comedolytic, resolving microcomedones, and providing anti-inflammatory effects 1
• Benzoyl peroxide kills C. acnes through release of free oxygen radicals and has mild comedolytic properties 4, 7
• Topical antibiotics suppress P. acnes and provide anti-inflammatory effects 6
• Combination therapy targets different aspects of acne pathogenesis for better results 1

Important Considerations

• Topical retinoids may cause photosensitivity; daily sunscreen use is recommended 2
• Benzoyl peroxide can bleach clothing and bedding 8
• Start with lower concentrations of active ingredients to minimize irritation 7
• Maintenance therapy with topical retinoids is crucial after clearing to prevent recurrence 2
• Re-evaluate treatment after 6-8 weeks; if no improvement is observed, consider adjusting treatment 6

Common Pitfalls to Avoid

• Using topical antibiotics as monotherapy increases bacterial resistance risk 1, 6
• Stopping treatment once acne clears often leads to relapse 2
• Combining topical and oral antibiotics may increase bacterial resistance risk 6
• Underestimating the psychological impact of acne, especially with scarring 2