From the Guidelines
For recurring acne on the cheeks that persists despite using salicylic acid and benzoyl peroxide, consider consulting a dermatologist for prescription-strength treatments, such as topical retinoids or oral antibiotics, as recommended by the most recent guidelines 1. The management of recurring acne requires a multifaceted approach, targeting different causes of acne, including excess oil production, bacterial growth, inflammation, and hormonal factors.
Key Considerations
- Topical retinoids, such as tretinoin (0.025% to 0.1%) applied nightly, can promote cell turnover and prevent clogged pores, as supported by moderate certainty evidence from 20 studies 1.
- Oral antibiotics, like doxycycline (100mg once or twice daily for 8-12 weeks), may help if inflammation is significant, with strong recommendations made for their use 1.
- For women, hormonal treatments, such as spironolactone (starting at 25-50mg daily) or combined oral contracebores, can address hormonal causes, with conditional recommendations made for their use 1.
Skincare Routine Adjustments
- Using a gentle cleanser twice daily
- Applying treatments on dry skin
- Moisturizing with a non-comedogenic product
- Using sunscreen daily
Additional Recommendations
- Diet modifications, such as reducing dairy and high-glycemic foods, may help some individuals
- Consistency is crucial, with any new treatment given at least 8-12 weeks before evaluating effectiveness These approaches, as outlined in the guidelines 1, can help target different acne causes and improve treatment outcomes.
From the Research
Management of Recurring Acne
The management of recurring acne, particularly on the cheeks, can be challenging even after using salicylic acid and benzoyl peroxide. Several studies have investigated the effectiveness of different treatments for acne vulgaris.
Treatment Options
- Topical therapies such as retinoids, benzoyl peroxide, azelaic acid, and combinations of topical agents are first-line treatments for acne vulgaris 2.
- For more severe disease, combinations of topical agents with systemic agents (oral antibiotics, hormonal therapies, or isotretinoin) are recommended 2.
- Adapalene/benzoyl peroxide gel is safe and highly effective in the treatment of acne vulgaris, with its efficacy, tolerability, and ease-of-use being superior to other topical acne therapies 3.
- A combination of salicylic acid-based products has been shown to be effective in the treatment of mild comedonal-papular acne, with significant improvement in acne lesions and reduction of personal discomfort related to acne 4.
Comparison of Treatments
- A study comparing the efficacy and safety of 2% supramolecular salicylic acid with 5% benzoyl peroxide/0.1% adapalene found similar effects in reducing papules/pustules, non-inflammatory lesions, and total lesions 5.
- Guidelines advise topical treatments as first-line, with oral antibiotics having a role when coprescribed with a non-antibiotic topical treatment, and hormonal treatments being effective for women with persistent acne 6.
Considerations for Treatment
- Treatment acceptability and tolerability are important considerations, with adapalene/benzoyl peroxide gel being well-tolerated and having good acceptability 3, 4.
- The cost of treatments, such as adapalene/benzoyl peroxide gel, and the lack of available generics may prohibit their use 3.
- The potential risks of mental health problems and sexual dysfunction associated with isotretinoin should be considered, with recent guidance from the Medicines and Healthcare products Regulatory Agency having implications for specialist prescribing and monitoring 6.