Acne treatment guidelines at a glance

The AAD suggests using topical retinoids as first-line therapy when managing teens, adults with mild and severe acne. Topical retinoids attack the hyperkeratinization, which decreases inflammation and sequelae, especially in patients with skin of color. (viiwee - stock.adobe.com)

Dermatologist should consider topical therapies such as using benzoyl peroxide or Combinations with erythromycin or clindamycin. These can be used as a monotherapy for mild acne, or in combination with topical retinoids or systemic antibiotic therapy for moderate-to-severe acne. Dapsone 5% or 7.5% gel can also be used for inflammatory acne, particularly in adult women. (viiwee - stock.adobe.com)

Oral antibiotics have shown success in treating moderate-to-severe acne and inflammatory acne in patients resistant to topical treatment, but can lead to antibiotic resistance. AAD suggests limiting antibiotic use to three months. Doxycycline and minocycline are similar in efficacy, more effective than tetracycline. According to recent study, sarecycline is also effective for severe acne. (viiwee - stock.adobe.com)

Isotretinoin is considered the go-to treatment for severe nodular acne. Recommendations for lab testing include: baseline liver function, serum cholesterol and triglycerides, follow up tests in 2-3 months, and at end of therapy (6 months), and monthly pregnancy test in women of child bearing age. (viiwee - stock.adobe.com)

Estrogen-containing oral contraceptives are recommended for inflammatory acne in women. The following are approved by the FDA: Ortho Tri-Cyclen (norgestimate/ethinyl estradiol, Janssen Pharmaceuticals), Estrostep (ethinyl estradiol and norethindrone, Allergan), and Yaz (drospirenone/ethinyl estradiol, Bayer). (viiwee - stock.adobe.com)

Spironolactone Can reduce acne levels just as effectively as antibiotics, according to research. It is not suitable for male patients as it blocks the function of male hormones. The drug is well-tolerated overall, but side effect can include: fatigue, increased urination, irregular periods, breast tenderness, muscle pain, irregular heartbeat and hyperkalemia. Spironolactone can be used in combination with oral contraceptives to regulate menses. (viiwee - stock.adobe.com)

1. Hilton, Lisette. Acne Treatment alternatives to know. https://www.dermatologytimes.com/acne/acne-treatment-alternatives-know. Published July 3, 2019.
2. Hilton, Lisette. A paradigm shift in the treatment of acne. https://www.dermatologytimes.com/acne/paradigm-shift-treatment-acne. Published May 2, 2019.