Comedonal acne
Topical therapies are recommended for the first-line treatment of comedonal acne (Figure 6).29-38
Topical treatments comprise retinoids,44-48 antimicrobials, or antibiotics (benzoyl peroxide [BPO], minocycline [MCN], or clindamycin), or fixed-dose combinations of topical retinoids with BPO48 or antibiotics.49,50-54 Adapalene, tretinoin, and tazarotene are mainstays of topical treatment for mild to moderate acne vulgaris in SOC patients with acne.12-16,44-47,55 Trifarotene is a fourth-generation topical retinoid that is approved for facial and/or truncal acne and can also be considered for patients with SOC. Retinoids are particularly beneficial for SOC acne patients as they treat the active acne lesions and help ameliorate PIH.12-16,44-47,55 Topical retinoids target the microcomedone, the precursor to all clinically visible acne lesions.55 Therefore, retinoids are well suited for treating acne and maintaining acne clearance and should be applied to the affected area instead of only on acne lesions (spot treatment).55 Strategies to minimize skin irritation, such as applying the retinoid every other day and using a moisturizer before therapy, should be instructed at the initiation of therapy.55-61 Clinical experience has shown that moisturizers can markedly improve the cutaneous tolerability of topical retinoids, which can be applied 10 minutes before retinoid therapy, or immediately after the retinoid is applied.55-61 Patients with dry or sensitive skin may prefer creams or lotions, which tend to be less drying, whereas those with oily skin may prefer a gel.16,55
Combination therapy or once-daily application instead of individual treatments or routines requiring multiple applications may enhance convenience and treatment adherence.49,50-54
Papulopustular acne
Mild to moderate conditions may be treated with topicals described for comedonal acne.12-16,44-54 Further topical options are azelaic acid, dapsone, and clascoterone (topical antiandrogen).62-64 Guidelines recommend using topical retinoids, benzoyl peroxide, and fixed-dose combinations to treat inflammatory lesions.27,29-38 For more extensive papulopustular acne, or areas not amenable to topical therapy (such as the back), systemic treatments and topical ther-apies, are recommended.32 If the response to topical treatment is inadequate, a combined oral contraceptive agent (Ethinyl estradiol 20 μg or drospirenone 3 mg) may be considered for women while continuing topical therapy.27,29-38 For more
