Acne Vulgaris Treatment: Topical, Oral, and Procedural Options by Severity

Treatment is tailored to severity, lesion type, scarring risk, and patient factors. Dermatologist guidance optimizes outcomes.

Mild (Comedonal / Few Inflammatory)

• Topical retinoid (adapalene, tretinoin) ± benzoyl peroxide (BPO)
• OTC: salicylic acid, BPO wash

Moderate (Many Papules/Pustules)

• Topical retinoid + BPO/clindamycin (combination preferred)
• Oral antibiotic (doxycycline, sarecycline, minocycline) 3–6 months + topical retinoid/BPO
• Hormonal: combined OCP or spironolactone (females)

Severe / Nodulocystic / Scarring

• Isotretinoin (Accutane): Only curative therapy. 15–20 mg/kg cumulative. Requires iPLEDGE (US), pregnancy prevention, lipid/LFT monitoring
• Intralesional kenalog for nodules

Procedural Adjuncts

• Chemical peels (salicylic, glycolic)
• Microdermabrasion
• Laser/light (PDL, blue-red, photodynamic)
• Comedone extraction

Maintenance

Topical retinoid long-term prevents recurrence. Adherence >12 weeks needed for assessment.