From the Guidelines
Acne resolution is best achieved through a multi-faceted approach that targets the four main factors that cause acne: excess oil production, clogged pores, bacteria, and inflammation, with the most recent guidelines recommending benzoyl peroxide, topical retinoids, and topical antibiotics as first-line treatments 1.
Key Considerations
- For mild acne, over-the-counter treatments containing benzoyl peroxide (2.5-10%) or salicylic acid (0.5-2%) are effective when applied once or twice daily, as they kill acne-causing bacteria and help unclog pores.
- For moderate acne, topical retinoids like adapalene (0.1%) or tretinoin (0.025-0.1%) are recommended for nightly application, often combined with benzoyl peroxide in the morning, to normalize skin cell turnover and prevent clogged pores.
- Severe or persistent acne may require prescription oral antibiotics such as doxycycline (100mg twice daily) or minocycline (100mg daily) for 3-6 months, combined with topical treatments, with isotretinoin (0.5-1mg/kg/day for 4-6 months) reserved for severe, scarring acne resistant to other treatments 1.
Treatment Options
- Topical therapies, including topical retinoids, benzoyl peroxide, antibiotics, clascoterone, salicylic acid, and azelaic acid, are the mainstay of acne treatment and may be used for initial treatment and maintenance as monotherapy or in combination with other topical or oral agents.
- Multimodal therapy combining multiple mechanisms of actions is recommended as a good practice statement to optimize efficacy and reduce the risk of antibiotic resistance 1.
Supportive Measures
- Consistent gentle cleansing twice daily, avoiding picking or squeezing lesions, and maintaining a non-comedogenic skincare routine are essential supportive measures.
- Most acne treatments require 6-12 weeks to show significant improvement, and maintenance therapy is often needed to prevent recurrence.
From the FDA Drug Label
BY 3 TO 6 WEEKS, some patients notice an appearance of new blemishes (papules and pustules) At this stage it is important to continueusing tretinoin. If tretinoin is going to have a beneficial effect for you, you should notice a continued improvement in your appearance after 6 to 12 weeks of therapy. Don't be discouraged if you see no immediate improvement. Don't stop treatment at the first signs of improvement Once your acne is under control you should continue regular application of tretinoin until your physician instructs otherwise.
Acne resolution with tretinoin is expected to occur after 6 to 12 weeks of therapy, with some patients noticing an initial appearance of new blemishes between 3 to 6 weeks. It is essential to continue──treatments as directed by a physician and not stop at the first signs of improvement. The treatment should continue until the acne is under control, at which point the physician will provide further instructions 2.
From the Research
Acne Resolution Description
The resolution of acne can be achieved through various treatments, including topical retinoids, benzoyl peroxide, azelaic acid, and combinations of these agents 3, 4. Topical retinoids, such as tretinoin, adapalene, and tazarotene, are effective in treating mild to moderate acne by acting against comedones and microcomedones, and having direct anti-inflammatory effects 3, 5.
Treatment Options
- Topical retinoids, such as tretinoin and adapalene, are first-line treatments for acne 4, 6
- Combination therapy with a topical retinoid and antimicrobials is recommended for mild to moderate inflammatory acne 7
- Oral antibiotics, such as doxycycline and minocycline, and hormonal therapies, such as combination oral contraception, may be used for more severe disease 4
- Isotretinoin is approved for treating severe recalcitrant nodular acne, but may also be used for resistant or persistent moderate to severe acne 4
Efficacy of Treatments
- Tretinoin 0.025% gel reduced acne lesion counts by 63% compared to baseline in a randomized trial of 207 patients 4
- Adapalene 0.1% is equally effective to tretinoin 0.025% or tretinoin microsphere 0.1% gel or tretinoin 0.05% cream or isotretinoin 0.05% gel 3
- Combination oral contraception was associated with reductions in inflammatory lesions by 62% in a meta-analysis of 32 randomized clinical trials 4
Safety Profile
- Topical retinoids safety profile differs from their systemic counterparts and is related mainly to local adverse effects, such as erythema, dryness, itching, and stinging 3
- Adapalene 0.1% gel is significantly better tolerated than tazarotene 0.1% gel, tretinoin 0.025%, and tretinoin 0.05% gel, tretinoin 0.05% cream, tretinoin microsphere 0.1% gel or isotretinoin 0.05% gel 3