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Feature Article

A clinically practical approach to acne. Part 2: treatment

John Sullivan, Veronica A Preda

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Abstract

There are many effective acne therapies but what works for one patient may not work for another. Topical and systemic acne therapies are discussed in this second of two articles on acne by these authors.

Key Points

  • Acne may be treated using either topical or systemic therapies, or combinations of these.
  • For mild to moderate acne, many topical treatments are at least as effective as monotherapy with oral antibiotics.
  • For more severe or widespread acne, using a topical therapy with another topical therapy or a systemic therapy achieves more rapid and greater control.
  • Agents with proven efficacy as topical acne therapies include benzoyl peroxide, salicylic acid microgel complex, topical antibiotics and topical retinoids.
  • Agents with proven efficacy as systemic acne therapies include systemic antibiotics and retinoids, certain combined oral contraceptives, spironolactone and metformin.
  • Retinoids, tetracyclines and spironolactone are not safe to use during pregnancy.
  • Poor adherence is a common reason for ‘treatment failure’, and is often due to side effects (such as irritation), incorrect product use and/or inconvenient regimens.

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