What Is the First-Line Topical Treatment of Acne Vulgaris?
Clinical Scenario
This protocol covers the initial evidence-based management of acne vulgaris. The primary measurable goals are achievement of IGA (Investigator's Global Assessment) success and a meaningful reduction in both inflammatory and noninflammatory lesion counts at 12 weeks.
Treatment Approach
The recommended first-line strategy centres on multimodal topical therapy — combining agents that act through different mechanisms of action rather than relying on a single modality. Specific fixed-dose combination products are preferred over individual agents used separately.
The complete structured regimen — including which combinations are recommended, the conditional alternatives, and what to avoid — is available in the full protocol.
References
DOI: 10.1016/j.jaad.2023.12.017
- Topical therapies are the mainstay of acne treatment: they may be used for acne initial treatment and maintenance as monotherapy (except topical antibiotics) or used in combination with other topical or oral agents.
- When managing acne with topical therapies, multimodal therapy combining multiple mechanisms of actions is recommended as a good practice statement to optimize efficacy and to reduce the risk of antibiotic resistance.
- We recommend fixed-dose topical combinations of BP and topical retinoid, BP and topical antibiotic, and topical retinoid and topical antibiotic for acne treatment based on moderate certainty evidence.
- Notably, topical antibiotic monotherapy is not recommended due to concern for antibiotic resistance.
- Compared to vehicle at 12 weeks, a greater proportion of patients treated with topical retinoids achieved IGA success in 4 RCTs (risk ratio [RR], 1.57 [1.21, 2.04]).
- Compared to vehicle at 12 weeks, a greater proportion of patients treated with BP achieved IGA success in 3 RCTs (RR, 2.70 [1.10, 6.65]).
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