Therapy for acne

Mild acne

Comedonal acne is especially responsive to topical retinoids. Salicylic acid is not as effective a comedolytic as retinoids.

For inflammatory acne, combination therapy is the mainstay of treatment. Topical retinoids (tretinoin Evidence , adapalene Evidence and tazarotene) are prescribed in combination with benzoyl peroxide Evidence and/or topical antibiotics (clindamycin Evidence or erythromycin Evidence).

Moderate acne

Moderate comedonal acne with minimal inflammation may respond to topical retinoids alone. Inflammatory acne is best treated by a combination of systemic antibiotic with topical retinoid. If this does not make acne better in 8-10 weeks, benzoyl peroxide should be considered. This is mainly to reduce production of antibiotic resistant strains but also increase the efficacy of the treatment.

Severe nodulocystic acne

For severe or nonresponsive acne, oral isotretinoin for 6 months should be considered. Systemic steroids can be used as an adjunct.