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Acne vulgaris - Management
What should I do if moderate acne fails to respond to treatment?
For people using topical treatments:
- Check adherence to treatment.
- If adherence is poor, this may be because the treatment was poorly tolerated. Consider:
- Reducing the strength (for example, reducing from 5% to 2.5% benzoyl peroxide).
- Switching to an alternative topical drug that causes less irritation (for example a topical antibiotic or azelaic acid).
- Using a different formulation of drug (for example a cream instead of a drug with an alcoholic base).
- If adherence is adequate, consider:
- Increasing the drug strength and/or frequency of application.
- Combining different topical products (if not already doing so). Benzoyl peroxide combined with erythromycin or clindamycin is particularly effective against both non-inflammatory and inflammatory acne.
- Starting an oral antibiotic.
For people taking an oral antibiotic:
- If the person has not responded adequately, bear in mind that it can take up to 3 months for a full response to occur.
- Check adherence to treatment.
- If there has been some response, continue treatment and consider adding topical benzoyl peroxide or a topical retinoid (if the person is not already using these), or prescribe both of these.
- If there has been no response, consider seeking specialist advice or referral.
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