From the Guidelines
For the management of acne, I strongly recommend using benzoyl peroxide, topical retinoids, and topical antibiotics, as well as oral doxycycline, as these treatments have been shown to be effective in reducing acne lesions and improving skin quality 1. When it comes to acne facials, a typical treatment includes cleansing, steam to open pores, gentle exfoliation, extractions of blackheads and whiteheads, application of salicylic acid or benzoyl peroxide treatments, and soothing masks with ingredients like sulfur or tea tree oil. Between professional treatments, maintaining results with a daily routine of gentle cleansing using products containing salicylic acid (1-2%), benzoyl peroxide (2.5-5%), or glycolic acid is crucial. Applying non-comedogenic moisturizers and using SPF 30+ sunscreen during the day is also essential, as many acne treatments increase sun sensitivity.
Some key points to consider when managing acne include:
- Using topical therapies that combine multiple mechanisms of action, such as benzoyl peroxide and topical retinoids, to reduce the development of antibiotic resistance and improve treatment outcomes 1
- Limiting systemic antibiotic use and combining systemic antibiotics with benzoyl peroxide and other topical therapies to minimize the risks of antibiotic resistance and other complications 1
- Considering alternative treatments, such as spironolactone, combined oral contraceptives, and oral isotretinoin, for patients with severe acne or those who have not responded to standard treatments 1
- Using intralesional corticosteroid injections as an adjuvant therapy for patients with larger acne papules or nodules to reduce inflammation and prevent scarring 1
It's also important to note that emerging topical therapies, dietary modification, and laser and light-based treatments may be effective alternatives to systemic antibiotics for the management of acne 1. However, more research is needed to fully understand the benefits and risks of these treatments. Overall, a comprehensive approach to acne management that incorporates a combination of topical and systemic treatments, as well as lifestyle modifications, is likely to yield the best outcomes for patients with acne. Regular treatments every 4-6 weeks, combined with consistent home care, typically yield the best outcomes for clearer skin 1.
From the FDA Drug Label
Use for the treatment of acne Purpose Acne treatment The treatment of acne can be done with benzoyl peroxide (TOP) 2 or adapalene (TOP) 3.
- Benzoyl peroxide (TOP) is used for the treatment of acne.
- Adapalene (TOP) is used for acne treatment.
From the Research
Acne Facial Treatment
- The central role of inflammation in acne is now more clearly understood, and treatments such as adapalene and benzoyl peroxide (BPO) act synergistically on inflammatory patterns through regulation of innate immunity 4.
- Adapalene, a third-generation topical retinoid, down-regulates toll-like receptor 2 expression and inhibits activator protein-1 activity, while BPO is a unique antimicrobial agent not shown to induce microbial resistance after more than 50 years of use 4.
- Combination topical therapy, such as clindamycin 1%-benzoyl peroxide 5% gel, is efficacious and well-tolerated in the treatment of acne, and may be used in conjunction with topical retinoids for a more targeted and complete treatment strategy 5.
Maintenance Therapy for Acne
- Maintenance therapy with topical retinoids, such as adapalene, is necessary to prevent recurrences after discontinuing a successful treatment, and the combination of adapalene and BPO has been shown to be effective in preventing relapse among patients with severe acne 6.
- A 12-month maintenance treatment with adapalene 0.1% and benzoyl peroxide (BPO) 2.5% fixed combination gel has been shown to control acne relapse after treatment with oral isotretinoin, with a relapse rate of only 2.94% 6.
Treatment of Severe Acne
- Anti-inflammatory dose doxycycline plus adapalene 0.3% and benzoyl peroxide 2.5% gel has been shown to be safe and effective for the management of severe acne, with significant reductions in inflammatory and non-inflammatory lesion counts and nodule counts 7.
- Combination treatment with anti-inflammatory dose doxycycline plus combination adapalene 0.3% and benzoyl peroxide 2.5% gel is a viable option for patients with severe acne who are not candidates for or refuse treatment with isotretinoin 7.
Adapalene and Benzoyl Peroxide Gel
- Adapalene/benzoyl peroxide gel is safe and highly effective in the treatment of acne vulgaris, with its efficacy, tolerability, and ease-of-use superior to other topical acne therapies 8.
- The use of adapalene/benzoyl peroxide gel does not contribute to antibiotic resistance, making it a desirable option for the treatment of acne 8.