From the Guidelines
Treatment for truncal acne should involve a combination of topical and systemic therapies, with benzoyl peroxide, topical retinoids, and oral doxycycline being strongly recommended. For mild to moderate truncal acne, start with benzoyl peroxide washes (5-10%) used daily in the shower, allowing the product to remain on the skin for 2-3 minutes before rinsing, as recommended by the guidelines of care for the management of acne vulgaris 1. Topical retinoids like adapalene 0.1% gel or tretinoin 0.025-0.05% cream should be applied nightly to dry skin, as they have been shown to be effective in the treatment of acne 1.
For more extensive or moderate truncal acne, oral antibiotics such as doxycycline (100mg twice daily) or minocycline (100mg daily) for 8-12 weeks can be added to the topical regimen, with doxycycline being strongly recommended 1. For females with hormonal influences, combined oral contraceptives or spironolactone (50-100mg daily) may be beneficial, although their use is conditionally recommended 1. In severe or resistant cases, oral isotretinoin (0.5-1mg/kg/day for 16-20 weeks) is highly effective and strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy 1.
Some key points to consider when treating truncal acne include:
- Using multimodal therapy combining multiple mechanisms of action, as recommended by the guidelines 1
- Limiting systemic antibiotic use to reduce the development of antibiotic resistance and other antibiotic-associated complications 1
- Combining systemic antibiotics with topical therapies, such as benzoyl peroxide, to enhance efficacy and prevent resistance 1
- Adding intralesional corticosteroid injections for larger acne lesions as an adjuvant therapy, although this should be used judiciously 1
- Recommending loose-fitting, breathable clothing to reduce friction and sweating, which can exacerbate truncal acne. Treatment should continue for at least 6-8 weeks before assessing efficacy, as acne therapies work by preventing new lesions rather than clearing existing ones. Truncal acne often requires more aggressive and longer treatment than facial acne due to thicker skin and larger sebaceous glands in these areas.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Treatment Guidelines for Truncal Acne
- Truncal acne is a common condition that can be challenging to treat due to its extensive body surface area 2.
- Important considerations when selecting treatment options for truncal acne include patient compliance, treatment response time, tolerability of the treatment, and psychosocial impact of the disease 2.
- Topical therapies such as retinoids (e.g., tretinoin, adapalene), benzoyl peroxide, azelaic acid, and/or combinations of topical agents are first-line treatments for truncal acne 3.
- Combinations of topical therapies may be valid alternatives to oral antibiotics for mild, moderate, or even severe truncal acne 2.
- Oral antibiotics such as doxycycline and minocycline, hormonal therapies such as combination oral contraception or spironolactone, or isotretinoin are recommended for more severe disease 3.
Topical Therapies for Truncal Acne
- Tretinoin lotion 0.05% and azelaic acid 15% foam have been shown to be effective in treating truncal acne in female African-American patients 2.
- Adapalene/benzoyl peroxide combination gel (0.1%/2.5% and 0.3%/2.5%) is safe and highly effective in the treatment of acne vulgaris, including truncal acne 4.
- The combination of clindamycin 1%-benzoyl peroxide 5% gel is efficacious and well-tolerated for the treatment of acne, including truncal acne 5.
Maintenance Therapy for Truncal Acne
- Maintenance therapy with topical retinoids such as adapalene 0.1% and benzoyl peroxide 2.5% fixed combination gel can help prevent recurrences after discontinuing a successful treatment for truncal acne 6.
- A 12-month maintenance treatment with adapalene-benzoyl peroxide fixed combination gel has been shown to be effective in controlling acne relapse after treatment with oral isotretinoin 6.