Acne Treatment Options: OTC, Prescription Topicals, Oral Medications, and In-Office Procedures

Over-the-Counter

• Benzoyl peroxide (BPO): 2.5–10% wash/gel/cream; bactericidal, anti-inflammatory; bleaching effect.
• Salicylic acid: 0.5–2% wash/pads; keratolytic, comedolytic; good for blackheads.
• Adapalene 0.1% gel: OTC retinoid; first-line for comedonal acne.
• Sulfur, resorcinol, alpha-hydroxy acids: Adjunctive.

Prescription Topical

• Tretinoin, tazarotene, trifarotene (stronger retinoids).
• Clindamycin/erythromycin ± BPO (fixed combinations).
• Dapsone 5–7.5% gel (inflammatory).
• Clascoterone 1% cream (androgen receptor inhibitor).

Prescription Oral

• Doxycycline/minocycline/sarecycline (anti-inflammatory + antimicrobial).
• Combined OCPs (estrogen + progestin) for hormonal acne (females).
• Spironolactone 50–200 mg/day (anti-androgen; females).
• Isotretinoin: 0.5–1 mg/kg/day × 16–24 weeks; only curative; teratogenic (iPLEDGE).

In-Office Procedures

• Chemical peels (glycolic, salicylic, Jessner's).
• Photodynamic therapy (ALA + blue/red light).
• Laser (1540 nm, 1550 nm fractional for scars; Nd:YAG for inflammation).
• Intralesional triamcinolone (nodulocystic).
• Comedone extraction, microdermabrasion.

Treatment ladder: OTC → topical Rx → oral antibiotics ± topical → isotretinoin. Maintenance with topical retinoid prevents relapse.