Acne Therapies
The decision as to whether to use topical, oral or combined therapies depends upon the severity of the disease.
- Severe acne: Systemic mono- or combination therapy
- Moderate acne: Topical or systemic (combination) therapy
- Mild acne: Topical therapy
Figure: Therapy options in different acne severity grades.
Systemic therapy
Systemic treatment options with oral substances include oral antibiotics, hormones—especially the anti-androgen/estrogen combination Diane®-35 —and isotretinoin. The usual initial choice of oral antibiotics is oxytetracycline, with alternatives including doxycycline, minocycline and erythromycin. Oral isotretinoin is administered to patients with severe acne and those who have failed to respond adequately to previous courses of otherwise appropriate therapy.
Combination therapy
The addition of Skinoren® to standard treatments, such as antibiotics or antiandrogens, can enhance the efficacy by adding a new combatant and strengthening the action of the systemic agent.
The combination of Skinoren® with the oral antiandrogen preparation Diane®-35 represents an ideal therapy for women with mild to moderate inflammatory acne who also require contraception. Skinoren® adds antikeratinization, antibacterial and anti-inflammatory effects to the sebostatic action of Diane®-35. In a non-controlled trial the reduction in lesion counts was higher after receiving the combination of Skinoren® plus Diane®-35 compared to monotherapy with Diane®-35.
Topical therapy
Topical therapy is indicated in mild to moderate acne and should also be added to most systemic therapy regimen as well as maintenance treatment after discontinuing oral therapy.
In general, topical acne therapy encompasses anticomedonal and antibacterial agents:
Anticomedonal therapy
- Adapalene
- Azelaic acid
- All-trans retinoic acid
Antibacterial therapy
- Adapalene
- Azelaic acid
- Benzol peroxide (BPO)
- Clindamycin
- Erythromycin
Fixed combinations
- Benzol peroxide + erythromycin
- Erythromycin + zinc
- Antibiotics and retinoids