Acne Therapy. Supplement to the Acne Drug Comparison Chart. March 2007. The RxFiles Academic Detailing Program. Saskatoon City Hospital. 701 Queen …

Key Messages, Tips and Pearls :
1) Acne drug therapies require consistent use for several weeks before optimal results are seen.

2) Topical therapies need to be applied to the entire affected area, not just specific lesions.

3) Benzoyl Peroxide (BP) is a very effective and relatively inexpensive acne therapy. Strengths greater than 5% are no more effective but more irritating than strengths ? 5%.

4) Topical retinoids are an effective first line option for comedonal acne.
a. Tretinoin (e.g. Retin-A, Stieva-A, Vitamin A Acid):
i. 0.025-0.05% products are most useful; lower concentrations do not work; higher concentrations are seldom tolerated
b. Adapalene (Differin) may be preferred if:
i. less skin irritation is important
ii. part of a combination regimen where morning application of agent causing minimal sun sensitivity is important (e.g. BP+ABX at night, retinoid in am)

5) Topical antibiotic monotherapy should be avoided. Addition of BP to antibiotic regimens is strongly recommended to reduce bacterial resistance.
(Combo products useful: Benzamycin, BenzaClin / Clindoxyl)

6) Oral antibiotics should be used for shorter “pulses” of therapy (e.g. 8-16 weeks) to reduce the development of bacterial resistance.

7) Any combination oral contraceptive (COC) may
result in improvement in acne.

8) Oral isotretinoin (Accutane, Clarus) is the most effective therapeutic option for severe acne. Physicians should be familiar with cost effective dosing strategies, pregnancy precautions, required monitoring and side effect management.

9) Acne can cause significant stress, psychosocial concerns to the patient. Early intervention is recommended when presentation or family history suggests a severe course is likely.

10) Identification of sensitive skin issues is important so that steps can be taken to reduce drug related irritation {e.g. patients with non-oily skin, previous eczema or a history of sensitivity}.

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