Is Fucibet (betamethasone + fusidic acid) or Dapsone (dapsone) gel 5% more effective for treating papulopustular acne on the back in a 37-year-old male?

Treatment Recommendation for Papulopustular Acne on the Back

For papulopustular acne on the back in a 37-year-old male, neither Fucibet (betamethasone + fusidic acid) nor dapsone gel 5% alone represents optimal first-line therapy, but if choosing between these two options, topical dapsone 5% gel is the better choice as it has established efficacy for inflammatory acne with a 58.2% reduction in inflammatory lesions, while topical corticosteroids like those in Fucibet are not generally recommended for acne treatment. 1, 2

Why Dapsone is the Better Choice Between These Two Options

Dapsone gel 5% has proven efficacy specifically for inflammatory acne:

• Dapsone gel 5% demonstrates a treatment success rate of 40.1-69.4% when used for 12-16 weeks, with inflammatory lesions decreasing by a larger percentage than noninflammatory lesions 3
• At 12 months, dapsone gel produces a mean reduction of 58.2% in inflammatory lesion counts, with rapid onset showing 30.6% reduction at just one month 2
• The topical formulation results in systemic exposures approximately 100-fold less than oral dapsone, avoiding hematological adverse effects while maintaining efficacy 4, 5

Fucibet (corticosteroid + antibiotic combination) is problematic for acne:

• Topical corticosteroids are not generally recommended for acne treatment, though they may have limited benefit in combination regimens in specific contexts (primarily EGFR-inhibitor-induced acneiform rash, not acne vulgaris) 6
• The fusidic acid component as a topical antibiotic monotherapy increases bacterial resistance risk 1

The Actual Optimal Treatment Approach

However, both options fall short of guideline-recommended first-line therapy for back acne:

First-line treatment should be:

• Topical retinoid (adapalene 0.1-0.3% or tretinoin 0.025-0.1%) combined with benzoyl peroxide 2.5-5% 1
• The American Academy of Dermatology specifically states that treatment for back acne follows the same severity-based approach as facial acne 1

For moderate papulopustular acne on the back, the complete regimen should include:

• Topical retinoid + benzoyl peroxide as the foundation 1
• Add oral antibiotics (doxycycline 100 mg once daily or minocycline 100 mg once daily) for moderate-to-severe inflammatory acne 1
• Always combine any antibiotic use with benzoyl peroxide to prevent bacterial resistance 1
• Limit systemic antibiotics to 3-4 months maximum 1

If Dapsone is Selected as an Alternative Agent

Dapsone gel 5% can serve as an alternative topical agent:

• Apply twice daily to affected areas 2
• Particularly effective for inflammatory acne, though it works better on inflammatory lesions than noninflammatory ones 3
• No glucose-6-phosphate dehydrogenase testing required before starting topical dapsone 1
• Common adverse effects include mild to moderate application site reactions (8.2% of patients), primarily skin irritation 2, 3
• Should ideally be combined with a topical retinoid and benzoyl peroxide for comprehensive acne treatment 1

Critical Pitfalls to Avoid

Never use topical antibiotics (like the fusidic acid in Fucibet) as monotherapy:

• This rapidly develops bacterial resistance without concurrent benzoyl peroxide 1
• The American Academy of Dermatology explicitly advises against topical antibiotic monotherapy 1

Avoid prolonged topical corticosteroid use for acne:

• Topical corticosteroids are not standard acne therapy and can potentially worsen acne long-term 6

Do not underestimate back acne severity:

• Back acne often requires the same aggressive approach as facial acne, particularly if there is risk of scarring 1