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)