* Adapalene cream at bedtime or *Tretinoin cream at bedtime or *Benzoyl peroxide 5% applied at bedtime. Progress up to 10% when necessary or
*Fixed-dose combinations adapalene–benzoyl peroxide topically at bedtime or
*Clindamycin–benzoyl peroxide at bedtime or
*Clindamycin 1.2% and tretinoin 0.025% (as a gel) at bedtime
*For women, oral contraceptives may improve treatment outcome when added to the above treatment.
*The medicines and dosage under “Comedonal acne” above.
*The medicines and dosage under “Comedonal acne” above and addition of the following systemic antibiotics for more than 12 wks (this may be given concomitantly with topical antibiotics): Either,
** Caps Tetracycline 250 or 500mg BD for 4 wks until satisfactory results are achieved. Then maintenance dose of 250 or 500mg OD is given OR
** Caps Minocycline 50 or 100mg BD for 4 wks until satisfactory results are achieved (NB: it causes less GIT and photosensitization side effects in comparison Tetracycline. However, on long term use it causes more side effects) OR
** Caps Doxycycline 100mg BD (sub-optimal doses of 20, 50 and 75mg BD have also been shown to be effective). Photosensitization is a major challenge with Doxycycline) OR
**Tabs Azithromycin thrice weekly for 8 wks (better tolerated and compliance than Erythromycin) OR
** Tabs Erythromycin 250 -500mg BD (useful in pregnancy where tetracyclines are contraindicated).
* Oral isotretinoin
0.5 -1.0mg /kg daily [OD or in 2 divided doses] with meals. Dose adjusted after 4 weeks depending on response or side effects OR
*Systemic antibiotics highlighted under “More extensive moderate papulopustular acne” in combination with benzoyl peroxide, with /without topical retinoids.