When to Initiate Referral

  • Comedonal or inflammatory acne resistant to treatment after 3 months
  • Nodulocystic acne with or without scarring
  • Acne associated with signs of androgen excess or part of a systemic disease

Treatment Basics

  • EDUCATION: Medications often take weeks to work and the patient’s skin may get “worse” (dry and red) before it gets better. Patients should use oil-free, non- comedogenic hair and skin care products.
  • COMPLIANCE: Make sure patients are using the medications as prescribed before switching to another regimen.

Basic Skin Care

  • Wash skin gently 1-2 times per day
  • Apply oil-free moisturizer to skin as needed for dryness
  • Apply oil-free sunscreen every morning
  • When using moisturizer and/or sunscreen, medications should be applied first

How to Apply Topical Medications

  • Skin should be clean and dry
  • A pea-sized amount of medication should be used to cover the entire face
  • Consider gels for oily skin and creams for dry/sensitive skin
  • Gentle cleansers and moisturizers are often recommended to avoid excessive irritation from topical acne treatments

Mild Comedonal Acne (Mainly Comedones)

  • Mild topical retinoid at night AND an otc benzoyl peroxide wash in the morning
    • Adapalene 0.1% lotion or cream (0.1% gel if skin is very oily)
    • Tretinoin 0.025% gel or cream

Mild Mixed Acne (Comedones and a few Inflammatory Lesions)

  • Mild topical retinoid at night
    • Adapalene 0.1% lotion or cream (0.1% or 0.3% gel if skin is very oily)
    • Tretinoin 0.025% or 0.05% cream

AND

  • Clindamycin-Benzoyl Peroxide  1%-5%  gel  in  the  morning  OR  clindamycin gel/solution/cream in morning in addition to using an otc benzoyl peroxide wash in the morning.

Moderate to Early Severe Mixed Acne (Many Comedones and Inflammatory Lesions)

  • Stronger topical retinoid at night:
    • Tretinoin 0.05% or 0.1% cream/gelTazarotene 0.05% or 0.1% cream (0.05% or 0.1% gel if skin is very oily)

AND

  • Clindamycin-Benzoyl Peroxide 1%-5% in the morning OR clindamycin gel/solution/cream in the morning in addition to using an otc benzoyl peroxide wash in the morning.

OR

  • Oral antibiotic (if more severe)
    • Doxycycline 50-100 mg po daily or bid
    • Minocycline 50-100 mg po daily or bid

Severe Acne (Cysts, Nodules, Evidence of Scarring)

  • Isotretinoin is likely needed. Referral to dermatology is appropriate

Product Recommendations for Acne-Prone Skin

Gentle Skin Cleansers

  • Purpose Gentle Cleansing Bar
  • Purpose Gentle Cleansing Wash (pump)
  • Neutrogena Fresh Foaming Cleanser (pump)
  • Olay Foaming Face Wash (pump)
  • Olay Gentle Foaming Face Wash (pump)
  • Cetaphil Antibacterial Soap (bar)

Facial Moisturizers

  • Cetaphil UVA/UVB Defense Facial Moisturizer (SFC 50)
  • Neutrogena Healthy Defense (SPF 30 or 45)
  • Neutrogena Oil-Free Moisture (SPF 15)
  • Olay Complete (SPF 20)
  • Olay Complete Defense (SPF 30)

OTC Acne Treatments (Washes and Topical Medications)

  • Clean and Clear Invisible Blemish Treatment, Maximum Strength (2% salicylic acid)
  • Clearasil Daily Acne Control Cream (10% benzoyl peroxide)
  • Clearasil Maximum Strength Acne Treatment (10% benzoyl peroxide)
  • Clearasil Ultra Rapid Action Treatment Cream (10% benzoyl peroxide)
  • Neutrogena Clear Pore Wash (5% benzoyl peroxide)
  • Neutrogena Oil Free Acne Wash (2% salicylic acid)
  • PanOxyl Acne Cleansing Bar (5% or 10% benzoyl peroxide)
  • PanOxyl Wash (4 or 10% benzoyl peroxide)