Version June 2024
| Medications | Dose | Partial list of preparations | Select adverse effects |
| Topical retinoids | |||
| Tretinoin | Once daily, at bedtime | Standard vehicles – Creams: 0.025%, 0.0375%, 0.05%, 0.1% Gels: 0.01%, 0.025% Lotion: 0.05% | Local skin irritation, dryness, and flaking; sun sensitivity NOTE: Micronized gel tretinoin 0.05% (Atralin) contains soluble fish proteins, use with caution in patients with known sensitivity or allergy to fish |
| Optimized vehicles – Microsphere gels: 0.04%, 0.08%, 0.1% Polyolprepolymer-2 cream: 0.025% Polyolprepolymer-2 gel: 0.025% Gel (micronized): 0.05% | |||
| Adapalene | Once daily, at bedtime | Cream: 0.1% Gels: 0.1%, 0.3% Lotion: 0.1% | Local skin irritation, dryness, and flaking; sun sensitivity |
| Tazarotene | Once daily, at bedtime | Creams: 0.05%, 0.1% Gels: 0.05%, 0.1% Foam: 0.1% Lotion: 0.045% | Contraindicated in pregnancy; local skin irritation, dryness, and flaking; sun sensitivity |
| Trifarotene | Once daily, in the evening | Cream: 0.005% | Local skin irritation, dryness, and flaking; sun sensitivity |
| Isotretinoin (not available in United States) | Once daily, at bedtime or twice per day | Gel: 0.05% | Contraindicated in pregnancy and lactation; local skin irritation, dryness, and flaking; sun sensitivity |
| Topical antimicrobials* | |||
| Benzoyl peroxide | Twice daily | Multiple (prescription and nonprescription) 2.5 to 10% gels, lotions, creams, pads, masks, cleansers, foam | Local skin irritation; may bleach hair or clothing |
| Clindamycin | Twice daily Once daily (foam) | 1% gel, lotion, pledget, solution, foam | Rare risk of pseudomembranous colitis; usually prescribed with benzoyl peroxide to decrease resistance |
| Erythromycin | Twice daily | 2% gel, solution, pledget | Usually prescribed with benzoyl peroxide to decrease resistance |
| Dapsone | Twice daily (5% gel) Once daily (7.5% gel) | 5% gel, 7.5% gel | Yellow-orange skin discoloration when applied at the same time as benzoyl peroxide |
| Minocycline | Once daily | 4% foam | Headache |
| Topical combination products | |||
| Benzoyl peroxide 5%/clindamycin 1% | Twice daily | Gel | Local skin irritation; may bleach hair or clothing |
| Benzoyl peroxide 5%/clindamycin 1.2% | Once daily | Gel | Local skin irritation; may bleach hair or clothing |
| Benzoyl peroxide 2.5%/clindamycin 1.2% | Once daily | Gel | Local skin irritation; may bleach hair or clothing |
| Benzoyl peroxide 3.75%/clindamycin 1.2% | Once daily | Gel | Local skin irritation; may bleach hair or clothing |
| Benzoyl peroxide 5%/erythromycin 3% | Twice daily | Gel | Local skin irritation; may bleach hair or clothing |
| Clindamycin 1.2%/tretinoin 0.025% | Once daily, at bedtime | Gel | Local skin irritation |
| Benzoyl peroxide 2.5%/adapalene 0.1% | Once daily | Gel | Local skin irritation; may bleach hair or clothing |
| Benzoyl peroxide 2.5%/adapalene 0.3% | Once daily | Gel | Local skin irritation; may bleach hair or clothing |
| Benzoyl peroxide 3%/tretinoin 0.1% | Once daily | Cream | Local skin irritation; may bleach hair or clothing |
| Azelaic acid | Twice daily | 20% cream, 15% gel, 15% foam | Local skin irritation |
| Salicylic acid | Once to three times daily | Multiple (nonprescription) 0.5 to 2% creams, gels, pads, cleansers, solutions, soaps, pledget, foam | Local skin irritation; potential for salicylate absorption |
| Clascoterone | Twice daily | 1% cream | Scaling, dryness, edema, or irritation of skin, hypothalamic-pituitary-adrenal axis suppression |
| Oral antibiotics¶Δ | |||
| Tetracycline | 500 mg twice daily | Photosensitivity, gastrointestinal distress; contraindicated in pregnancy and young children | |
| Doxycycline | 50 to 100 mg twice daily or 100 mg once daily or Subantimicrobial dosing: 20 mg twice daily or | Photosensitivity, gastrointestinal distress; contraindicated in pregnancy and young children | |
| Minocycline | 50 or 100 mg daily or twice daily or Extended-release formulation: 1 mg/kg/day (round to nearest available strength) | Dizziness, drug-induced lupus, skin discoloration; contraindicated in pregnancy and young children | |
| Sarecycline | Weight-based dosing:
| Photosensitivity, gastrointestinal distress; contraindicated in pregnancy and young children | |
| Erythromycin | 500 mg twice daily (base) | Gastrointestinal distress | |
| Trimethoprim-sulfamethoxazole | 160 mg/800 mg once to twice daily | Stevens-Johnson syndrome, toxic epidermal necrolysis | |
| Azithromycin | Intermittent dosing due to long drug half-life; optimum regimen unknown | Gastrointestinal distress | |
| Hormonal agents¶◊ | |||
| Combination oral contraceptives (estrogen/progestin) | Once daily | Nausea, breast tenderness, weight gain, thromboembolic events | |
| Spironolactone | 50 to 100 mg/day in 1 or 2 equally divided doses§ | Contraindicated in pregnancy; menstrual irregularity, breast tenderness, minor gastrointestinal symptoms, orthostatic hypotension, hyperkalemia, dizziness, headaches, fatigue | |
| Oral retinoid¥ | |||
| Oral isotretinoin | 0.5 mg/kg/day, increasing to 1 mg/kg/day in 1 or 2 equally divided doses; total dose 120 to 150 mg/kg over 20 weeks | Teratogenicity (absolutely contraindicated in pregnancy), mucocutaneous effects, hypertriglyceridemia, others | |
* Topical sulfacetamide (eg, gels, creams, lotions, other) with and without sulfur are also available but not typically used and have limited data.
¶ Usual oral dose for adult or adolescent.
Δ Benzoyl peroxide may be prescribed with oral antibiotics to reduce resistance.
◊ For additional information refer to UpToDate topic review on the management of moderate to severe acne vulgaris.
§ Initiating treatment with a total daily dose of 25 to 50 mg per day, with subsequent dose escalation based upon patient tolerance and response, helps to minimize side effects. Doses of up to 200 mg per day have been utilized for acne; however, limited data suggest that doses of 50 to 100 mg per day may be as effective and may reduce risk for side effects.
¥ For additional information refer to UpToDate topic review of oral isotretinoin therapy for acne vulgaris.آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟
