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Therapeutic Approach

Acne is a common disorder of the pilosebaceous unit, affecting roughly 85% of individuals 12-25 years of age in the United States.1 Therapy should be based on the clinical severity of acne. For mild acne, topical therapy is usually initiated with a topical retinoid and/or benzoyl peroxide. Alternative topical therapies include dapsone gel and clascoterone. For moderate to severe acne, an oral antibiotic, preferably doxycycline, can be added to a topical retinoid and benzoyl peroxide for 3-4 months until improvement is attained. The antibiotic should then be discontinued, and topical routine continued for maintenance. If acne improvement cannot be achieved or maintained with topical therapies once off the systemic antibiotic, or if a patient has severe nodulocystic acne, isotretinoin should be considered. Hormonal therapies, spironolactone and combined oral contraceptive pills, may also be considered as both first- and second-line therapy for female patients with inflammatory acne. For postinflammatory hyperpigmentation, a topical retinoid, azelaic acid, and sunscreen are recommended. See Table 71-1.

Table 71-1Acne Vulgaris Treatment Table

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