Treatment Plan

Treatment Plan

General advice:

• Avoid over-cleaning skin
• Remove makeup at night
• Use non-alkaline synthetic detergents twice daily
• Avoid picking/scratching
• Initial treatment takes 6-8 weeks
• A 12-week trial period is required

Mild-Moderate:

First line (12-week trial of any of the following, OD in the evening):

• Topical adapalene with benzoyl peroxide
• Topical tretinoin with clindamycin
• Topical benzoyl peroxide with clindamycin

Moderate-Severe: First/Second line:

• Topical adapalene with benzoyl peroxide
• Topical tretinoin with clindamycin

Third line:

• Topical adapalene + benzoyl peroxide + oral doxycycline/lymecycline o Consider trimethoprim/erythromycin if doxy/lymecycline are contraindicated

Fourth line:

• Topical azelaic acid + oral doxycycline/lymecycline

Special considerations:

• PCOS: Consider combined oral contraceptives (co-cyprindiol aka Dianette)
• Flare-ups: Consider oral prednisolone
• Severe cases: Consider isotretinoin

Follow-up(Review at 12 weeks):

• If topical retinoids/antibiotics are not tolerated –treat w/ topical benzoyl peroxide alone

If using oral antibiotics:

• If complete resolution: Consider no treatment or maintenance with topical adapalene/benzoyl peroxide
• Partial response: Additional 12-week trial (Can extend to 24 weeks if partial response)
• No response: Refer

• For Mild to moderate treatments:
  • If complete resolution: Consider no treatment or maintenance with topical adapalene/benzoyl peroxide
  • Partial response: consider another 1^st line option o No response after 2^nd option: refer

Referral criteria:

• Mild-moderate: After 2 failed treatment approaches
• Moderate-severe: After failed response to oral antibiotics
• Mental health issues/scarring/pigmentation changes
• Acne fulminans
• Acne conglobata