Acne vulgaris remains a common dermatological concern affecting individuals across various age groups. Management strategies depend on the severity of the condition and can range from over-the-counter (OTC) treatments to specialized interventions. Here, we discuss a stepwise approach to acne management based on its severity...
- Irrespective of acne severity, a good starting point is over-the-counter topical benzoyl peroxide. Benzoyl peroxide not only kills the bacteria that causes acne (Cutibacterium acnes) through the release of free oxygen radicals, but also functions as a comedolytic.
- If your patient’s acne is mild to moderate (defined as non-inflammatory lesions [comedones] or less than 5 inflammatory lesions [papulopustules]), you may consider prescribing a topical retinoid such as tretinoin 0.025%, adapalene 0.1%, or tazarotene 0.05% in combination with the benzoyl peroxide. These agents have been shown to have both comedolytic and anti-inflammatory effects, and are the cornerstone of topical therapy for all acne cases, save for the most mild.
- In moderate to severe acne (defined as multiple inflammatory lesions), you can consider prescribing an oral antibiotic in combination with the retinoid and benzoyl peroxide. The first-line therapy in this situation is often a tetracycline, such as daily doxycycline in the 1.7 to 2.4 mg/kg dose range.
- As with all medications, please familiarize yourself with contraindications and adverse side effects of these drugs before prescribing (e.g., doxycycline-related photosensitivity or adverse impact on GI flora, or avoiding tretinoin in pregnancy).
- For extremely severe acne (defined as widespread inflammatory lesions, nodules, and/or scarring), you should consider referral to a dermatologist for Roaccutane (isotretinoin) treatment. However, the aforementioned treatment options should be sufficient to control your patient’s symptoms until seen by a dermatologist!
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