DermaGenex

1. Indication
   1. Mild to moderate Inflammatory Acne Vulgaris
   2. Comedonal Acne Vulgaris
2. Step 1: OTC topical medications for 6 weeks
   1. Acne washes (Phisohex) regularly
   2. Topical Benzoyl Peroxide 2.5% gel qAM
      • Benzoyl Peroxide 2.5% is as effective as 5-10%
      • Lower strength is much less irritating than 5-10%
3. Step 2: Comedolytics and Topical Antibiotics for 6 weeks
   1. Start Comedolytic (discontinue Benzoyl Peroxide)
      1. First-line topical retinoids options
         • Topical Tretinoin (Retin A) 0.025% cream qhs
         • Adapalene (Differin) 0.1% gel
           • May be better tolerated than Retin A
         • Topical Tretinoin microsphere 0.1%
      2. Warn regarding redness and irritation
         • Use only pea size amount per triangle of face
         • Use only at night-time
   2. Consider adding a topical antibiotic
      1. Topical Erythromycin
      2. Topical Clindamycin
4. Step 3: Add Topical Antibiotics
   1. General
      1. Apply topical antibiotic in the morning
      2. Apply topical Comedolytic at bedtime (see above)
         • Continue Tretinoin or Adapalene or
         • Consider Tazarotene (Tazorac) 0.05% gel or cream
           • More irritating than Retin A, but more effective
           • Indicated if no Tretinoin or Adapalene response
           • Pregnancy Category X
   2. Antibiotics Half lives
      1. Clindamycin (longest half life)
      2. Erythromycin (mid range half life)
      3. Tetracycline (shortest half life)
   3. Topical Antibiotic Preparations
      1. Clindamycin HCl (Cleocin-T)
      2. Erythromycin (Akne-mycin, Erygel) Lotion (1.5% 2%)
      3. Tetracycline HCl (Topicycline) Lotion 2.2 mg/ml
      4. Azelaic Acid (Azelex)
         • Consider if postinflammatory hyperpigmentation
      5. Consider sulfa agents if intollerance to other meds
         • Sulfur (Acne lotion 10, Liquimat, Sulpho-Lac)
         • Sulfur 5% and Sodium sulfacetamide 10% (Novacet)
   4. Combination agents (Comedolytic with antibiotic)
      1. Refrigeration required
         • Erythromycin with Benzoyl Peroxide (Benzamycin)
      2. Refrigeration not required
         1. Benzoyl Peroxide, Glycolic Acid, Zinc (Triaz)
         2. Clindamycin 1%/Benzoyl Peroxide 5% Gel (BenzaClin)
            • More effective than Clindamycin alone
5. See Also
   • Adjunctive Acne Vulgaris Management

References:

1. Highwire.org - Moderate Acne Treatment
2. NIH.gov - Moderate Acne Treatment
3. DermaGenex.com - Moderate Acne Treatment
4. Ingentaconnect.com - Moderate Acne Treatment
5. DermaGenex.com - Acne Treatment
6. Blackwell-Synergy.com - Moderate Acne Treatment

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