Best Acne Treatment. Pharmacological Overview

• Benzoyl Peroxide (BP) is used as 1
st
 line monotherapy for mildmoderate acne.
o BP produces powerful anaerobic antibacterial activity due to slow
release of oxygen and comedolysis.
o BP is also a useful  adjunct to topical retinoids, antibiotics (ABX)
topical/oral
, combination oral contraceptives (COCs) & spironolactone.
• Topical retinoids (e.g. tretinoin, adapalene) are important in acne
treatment.
  They affect the desquamation process, reducing the
number of microcomedones & comedones.
o Used for mild-moderate comedonal acne (inflammatory or noninflammatory) or as adjunct with BP, ABX, COCs &
spironolactone.
• Topical ABX are best used in combination with topical retinoids
or BP (↓ potential for antimicrobial resistance).
• Systemic ABX (tetracyclines, erythromycin, & trimethoprim) are
indicated for moderate-severe acne. Due to resistance concerns
monotherapy should be avoided and therapy courses limited where
possible to short durations or “pulses” of 8-12 weeks.
• COCs may be considered over antibiotics for females with
moderate-severe acne.  Spironolactone has been used for adult
women with moderate-severe acne when COCs are
contraindicated or other treatments fail.
• Isotretinoin monotherapy is the most effective therapy for
moderate-severe inflammatory acne; care must be taken to ensure
potential serious adverse events are avoided/recognized.
o Isotretinoin causes a high rate of birth defects in the
developing fetus of pregnant woman.
o Depression & suicide have been reported in people taking
isotretinoin; direct correlation not established.
• Other OTC agents: salicylic acid, sulphur, resorcinol, glycolic acid
& tea tree oil (limited data; all less efficacious than BP).

{Tea tree oil 5%: 1 trial showed effectiveness but slow onset.}