Acne
Mild Acne
Reference:
Acne Mild - Malady Wise
Step 1 - General Measures
Routinely cleanse with soap‑free products. No more than twice a day
Remove all makeup before sleeping
Don’t pick or squeeze pimples
Use non‑comedogenic sunscreen
Use oil‑free, non‑comedogenic facial products
Low glycaemic index diets
Over-the-counter face washes that contain salicylic acid
Step 2 - Start with topical benzoyl peroxide
Benzac AC, Panoxyl, Clearasil Ultra, Clean and Clear Cleanser
Average cost is $10 to $30.
Can start with 2.5% strength if dry/sensitive skin, but 5% is generally tolerated and more likely to be effective
Available as creams, gels, and cleansers
6 weeks to 3 months of treatment may be required to see if beneficial
The most common side effect is skin irritation (dryness and redness)
Bleaches clothes, towels, and bedding
Not subsidised – available for purchase over-the-counter without a prescription
Step 3 - If lots of comedones (whiteheads + blackheads), use a topical retinoid
Work by reducing comedones
Useful for inflammatory and non‑inflammatory acne
3 to 6 months of treatment may be required to see benefits
General advice
Apply to all skin affected by acne, not only individual lesions - this is a field treatment
Skin irritation is common – start treatment second daily for the first 2 weeks, and avoid excessive skin washing
Apply at night as topical retinoids are degraded by sun exposure
Types
Topical adapalene (e.g. Differin Cream/Gel)
Average cost is $70 to $80.
Least irritating
This can lead to easier sunburn
Topical tretinoin 0.025%, 0.05%, 0.1% (e.g., ReTrieve, Stieva‑A)
Average cost $65 to $75
Step 4 - If not enough, use a combination product
Epiduo Gel 0.1%/2.5% (adapalene and benzoyl peroxide)
Combination of Benzoyl Peroxide and Topical Retinoid
Average cost is $50
Useful if comedones and inflammatory lesions
Acne often worsens a little initially
May lead to the bleaching of hair and clothing
Apply 30 minutes after cleansing to ensure skin is dry before application
Always apply sparingly e.g., a pea-sized amount for the whole face, and wash hands after use
Avoid applying to eczematous or sunburned skin
Avoid exposure to strong sunlight when using Epiduo
Use sunscreen
Duac Once Daily Gel (Benzoyl peroxide 5% and Clindamycin 1% )
Combination of Benzoyl Peroxide and Antibiotic
Average cost $50
Effective for mild inflammatory acne
Must be kept in the fridge and discarded 2 months after opening
Moderate Acne
Step 1 - Use topical treatment as above
Topical retinoid if mainly comedones
Topical combination therapy if both inflammation and comedones
Step 2 - Consider combined hormonal contraceptive pill in women
Combined contraceptive pills are oestrogen dominant and work on acne by reducing the testosterone effect on the skin
All combined pills are generally effective for acne, some work better than others
Step 3 - Add oral antibiotics
Doxycycline
50 to 100mg once per day
Do not halve, crush, or chew tablets
May cause heart burn and make it easier to sunburn
Take the medication after food with a glass of water.
Avoid lying down immediately after taking medication.
Erythromycin
Dose is 250 to 500 mg twice daily
May be effective if Doxycycline has failed.
Trial oral antibiotics for 6 weeks initially and review
If improving, continue for 6 months and stop once acne improves
Can expect 60% improvement at 3 months and 80% at 6 months
If not improvement after 6 weeks consider trialling different antibiotics or consider combined contraceptive pill in women
Continue topical treatments once oral antibiotics are stopped
Severe Acne
If above measures have failed or obvious severe acne
Early dermatologist review
Consider oral isotretinoin therapy (roaccutane)