Education And Debate

Fortnightly Review Acne vulgaris

BMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6932.831 (Published 26 March 1994) Cite this as: BMJ 1994;308:831
  1. Eugene Healy, lecturera,
  2. Nick Simpson, senior lecturera
  1. aDepartment of Dermatology, University of Newcastle upon Tyne, Royal Victoria Infirmary, Newcastle upon Tyne NE1 4LP
  1. Correspondence to: Dr Simpson.
  • Accepted 18 November 1993

Topical treatment for mild acne

  • Benzoyl peroxide 2.5-10% once daily Azaleic acid 20% twice daily

  • Tretinoin 0.1-0.25% once daily

  • Isotretinoin 0.05% once or twice daily

  • Clindamycin 1% twice daily

  • Erythromycin 2% and 4% with zinc acetate 1.2% twice daily

  • Tetracycline 4% twice daily

Summary points

  • Summary points

  • Acne is as common as it was 20 years ago but is now less severe in teenagers and affects more people in their 20s and 30s, who have high expectation of treatment

  • Topical treatments are effective for mild to moderate acne, and oral antibiotics (and anti-androgens for women) are helpful for moderate acne

  • For severe acne high dose oral antibiotics can be used, but oral isotretinoin has a rapid effect and a high rate of long term remission

  • Isotretinoin is only available through hospital dermatologists because of its side effects

  • Early treatment and regular review are necessary to prevent scarring

Acne severity

Severity of acne can be graded for therapeutic studies according to the Leeds grading scale,6 but in the general treatment of acne vulgaris most doctors would divide the condition into mild, moderate, and severe. Mild disease consists of open and closed comedones and some papules and pustules, while moderate acne encompasses more frequent papules and pustules with mild scarring. Severe disease contains all of the above plus nodular abscesses and leads to more extensive scarring which may be keloidal in some cases.

Treatment of mild acne

Topical preparations are the mainstay of treatment for mild acne vulgaris (see box). These are popular with patients, but their slow benefit needs careful explanation to encourage good compliance.

Benzoyl peroxide is a potent oxidising agent with antibacterial and keratolytic properties. It does not induce any change in the resistance pattern of aerobic bacteria to antibiotics; it also prevents such resistance when used concomitantly with topical erythromycin.7 Benzoyl peroxide is applied daily in lotions or creams …

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