What are the management options for acne?

From the Guidelines

Effective acne management requires a consistent skincare routine and appropriate treatments based on severity, with strong recommendations for benzoyl peroxide, topical retinoids, and oral doxycycline, as well as oral isotretinoin for severe cases 1. For mild acne, start with over-the-counter products containing benzoyl peroxide (2.5-5%) to kill bacteria and reduce inflammation, or salicylic acid (0.5-2%) to exfoliate and unclog pores. Some key points to consider in acne management include:

• Applying these products once or twice daily after gentle cleansing
• Considering prescription topical retinoids like tretinoin (0.025-0.1%) applied nightly for moderate acne, which normalize skin cell turnover and prevent clogged pores
• Adding topical antibiotics such as clindamycin 1% to reduce bacteria
• Using oral medications like doxycycline (100mg twice daily for 3-6 months) or hormonal treatments like combined oral contraceptives or spironolactone (50-200mg daily) for severe or cystic acne
• Isotretinoin (0.5-1mg/kg/day for 4-6 months) is highly effective for severe, resistant acne but requires medical supervision due to potential side effects, as supported by guidelines 1 Regardless of treatment, maintaining a gentle skincare routine with non-comedogenic products, avoiding picking at lesions, and being patient as most treatments take 6-8 weeks to show significant improvement are crucial. Additionally, diet modifications, particularly reducing high-glycemic foods and dairy, may help some individuals, though evidence varies 1, and stress management can also play a role in controlling acne flares. It is essential to follow the guidelines of care for the management of acne vulgaris, which include 18 evidence-based recommendations and 5 good practice statements, to ensure effective treatment and minimize potential side effects 1.

From the FDA Drug Label

Dosage and Administration Tretinoin Cream or Tretinoin Gel should be applied once a day, before retiring, to the skin where acne lesions appear, using enough to cover the entire affected area lightly. Apply tretinoin once daily before bedtime, or as directed by your physician 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. The treatment plan for acne management using tretinoin involves:

• Applying the medication once daily before bedtime
• Using a mild, non-medicated soap
• Avoiding frequent washings and harsh scrubbing
• Washing the skin gently with a mild, bland soap two or three times a day It is essential to follow the instructions carefully and be patient, as improvement may be seen after 12 weeks of therapy 2, 2, 2.

From the Research

Acne Management Overview

• Acne vulgaris is a common inflammatory skin disease that affects approximately 9% of the population worldwide, with the majority of cases occurring in individuals aged 12-24 years 3.
• The disease can cause permanent physical scarring, negatively impact quality of life and self-image, and is associated with increased rates of anxiety, depression, and suicidal ideation 3.

Treatment Options

• First-line treatments for acne include topical therapies such as retinoids, benzoyl peroxide, azelaic acid, and combinations of these agents 3, 4.
• For more severe disease, oral antibiotics, hormonal therapies, and isotretinoin may be recommended 3, 4.
• Topical retinoids, such as tretinoin, have been shown to be effective in reducing acne lesion counts, with a 63% reduction in lesion counts at 12 weeks compared to baseline 3.
• Combination oral contraception has been associated with reductions in inflammatory lesions by 62% at 6-month follow-up, while oral antibiotics have been associated with a 58% reduction 3.

Treatment Guidelines

• The American Academy of Dermatology, European Academy of Dermatology and Venereology, and Italian Society of Dermatology and Venereology have published guidelines for the treatment of mild-to-moderate acne, which recommend a combination of topical, systemic, and physical therapeutic approaches 5.
• The treatment of acne should be individualized based on disease severity, patient preference, and tolerability, with topical retinoids indicated for acne of any severity and for maintenance therapy 6.

Specific Treatment Options

• Adapalene and benzoyl peroxide once-daily topical gel has been shown to be a safe and effective therapeutic option for acne, with superior efficacy, tolerability, and ease-of-use compared to other topical therapies 7.
• Isotretinoin is approved for the treatment of severe recalcitrant nodular acne, but is often used to treat resistant or persistent moderate to severe acne, as well as acne that produces scarring or significant psychosocial distress 3, 6.