Treatment should be directed toward the known pathogenic factors involved in acne. These include follicular hyperproliferation, excess sebum, C acnes colonization, and inflammation. The grade and severity of the acne help in determining which of the following treatments, alone or in combination, is most appropriate. Current consensus recommends a combination of topical retinoid and antimicrobial therapy as first-line therapy for almost all patients with mild acne. Because antibiotic resistance is a concern, topical or oral antibiotics should not be used as monotherapy in patients with acne.
Benzoyl peroxide products are also effective against C acnes, and bacterial resistance to benzoyl peroxide has not been reported. Benzoyl peroxide products are available over the counter and by prescription in a variety of topical forms, including soaps, washes, lotions, creams, and gels. Benzoyl peroxide products may be used once or twice a day.
Spironolactone may also be used in the treatment of acne. Pregnancy must be avoided while taking spironolactone because of the risk of feminization of the male fetus, and spironolactone is not recommended for males because of the potential for gynecomastia.
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Cite this: William James. Fast Five Quiz: Acne Practice Essentials - Medscape - Jan 15, 2020.