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Acne vulgaris - Management
How should I treat moderate acne?

  • In moderate acne, inflammatory lesions (papules and pustules) predominate. The acne may be widespread, there may be a risk of scarring, and there may be considerable psychosocial morbidity, all of which are indications for aggressive treatment.
  • Treatment options are a single topical drug, a combination of topical drugs, or oral antibiotics.
    • Consider a single topical drug in people with limited acne which is unlikely to scar.
    • Combined treatment should be considered in all people with moderate acne.
      • Benzoyl peroxide combined with a topical antibiotic is the usual preferred regimen, as it is proven to be effective and may limit the development of bacterial resistance.
      • Other options include a topical retinoid combined with benzoyl peroxide (but this may be poorly tolerated) or a topical retinoid combined with a topical antibiotic (but this may promote bacterial resistance).
    • Consider prescribing an oral antibiotic (tetracycline, oxytetracycline, doxycycline, lymecycline, or erythromycin) if topical treatment cannot be tolerated, if there is moderate acne on the back or shoulders (where it may be particularly extensive or difficult to reach), or if there is a significant risk of scarring or substantial pigment change.
  • Consider prescribing a standard combined oral contraceptive in women who require contraception. Standard combined oral contraceptives or co-cyprindiol (Dianette®) are options.

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