The management of acne vulgaris, regardless of its severity, encompasses a discussion about the nature of the disease, proper skincare practice, realistic treatment expectations, as well as assessing the physiological impact of the disease on the patient. Some cases may present with mild features, but the acne causes significant physiological distress due to cosmetic concerns, and this may necessitate a more aggressive treatment approach.
Over-the-Counter (OTC) and Non-Pharmacological Methods
Although acne is unavoidable for lots of patients, it can be effectively managed through various OTC and non-pharmacological measures. Regularly washing the face with a pH-balancing cleanser such as benzoyl peroxide or salicylic acid face wash can help manage acne symptoms and can be purchased OTC. Avoiding high glycaemic index foods and dairy-based products may help manage symptoms, along with managing stress levels.Sources: Benzoyl Peroxide – StatPearls – NCBI Bookshelf (opens in a new tab); Effectiveness of a combination of salicylic acid-based products for the treatment of mild comedonal-papular acne: a multicenter prospective observational study – PubMed (opens in a new tab)
Mild Acne Vulgaris
Acne vulgaris is considered mild when it presents with a few scattered comedones (whiteheads/blackheads) or with a few small inflammatory papules without scarring. The primary treatment approach is topical therapy, which commonly involves the use of topical retinoids (tretinoin, tazarotene, adapalene and trifarotene), topical antibiotics (clindamycin and erythromycin) and benzoyl peroxide.Source: Guidelines of care for the management of acne vulgaris – PubMed (opens in a new tab)
Moderate-Severe Acne Vulgaris
Acne vulgaris is considered moderate to severe when presenting with prominent comedones (blackheads/whiteheads), large inflammatory papules, pustules and nodules with associated scarring affecting multiple body areas. Topical and systemic therapies are the primary treatment. Systemic therapies for acne include oral antibiotics (primarily tetracyclines) and hormonal therapies (such as spironolactone or oral contraceptives for female patients). Systemic therapy is often combined with topical therapy, as already discussed for mild cases, except for oral isotretinoin, which is prescribed in isolation but occasionally with a course of oral steroids to avoid an isotretinoin-induced acne flare.Source: The use of isotretinoin for acne – an update on optimal dosing, surveillance, and adverse effects – PubMed (opens in a new tab)
