Acne

SOME TOPICAL TREATMENT REGIMENS

Mild (comedonal ± papulopustular)

Principle: treat comedones with a topical comedolytic (e.g. salicylic acid, retinoids) and pustules with an antibacterial (e.g. benzoyl peroxide, azelaic acid).

First line—start with:

• use tretinoin 0.025% cream or adapalene 0.1% cream or gel, apply each night

• if slow response after 6 weeks, add benzoyl peroxide 2.5% or 5% gel or cream once daily (in the morning)

• maintain for 3 months and review

Alternative or add-on regimens, if persistent: clindamycin HCL 600 mg in 60 mL of 70% isopropyl alcohol (e.g. ClindaTech). Apply with fingertips twice daily.

Moderate (± trunk involvement)

• Topical retinoid ± benzoyl peroxide plus

• Oral antibiotics

ORAL ANTIBIOTICS

Use if acne is resistant to topical agents or for inflammatory acne (moderate to severe papulopustular) ± trunk involvement. Doxycycline 100 mg/d or minocycline 50–100 mg bd for 12 wks then reduce according to response (e.g. doxycycline 50 mg for at least 6 mths to achieve maximal response). Use erythromycin 250–500 mg (o) bd if above not tolerated or contraindicated.

OTHER THERAPIES

Severe cystic acne (specialist care)

• isotretinoin (Roaccutane)

• spironolactone

Females not responding to first-line treatment:

• combined low-dose oral contraceptive pill (e.g. ethinyloestradiol/cyproterone acetate [Diane-35 ED})