First Line Drugs
- CLINDAMYCIN (J01FF01)
- TRETINOIN (D10AD01)
- BENZOYL PEROXIDE, COMBINATIONS (D10AE51)
- BENZOYL PEROXIDE (D10AE01)
- ERYTHROMYCIN, COMBINATIONS (D10AF52)
- CLINDAMYCIN, COMBINATIONS (D10AF51)
Second Line Drugs
- TETRACYCLINE (J01AA07)
1. For mild papulopustular acne
ANY benzoyl peroxide 2.5-10% gels or lotions applied topically, hs $4.29-8.82/60 g
2. For more severe papulopustular acne, add topical antibiotics
erythromycin with ethyl alcohol 2% lotion, bid $8.39/ 60 mL
or erythromycin with ethyl alcohol 1.5% lotion, bid $9.21/60 mL
or clindamycin 1% lotion, bid $17.24/60 mL
or erythromycin/benzoyl peroxide 3%/5% gel, bid $18.26/23.3 g
3. For acne with a significant comedo component, replace benzoyl peroxide with
tretinoin 0.01-0.025% gel, hs $7.10/25 g
or adapalene 0.1% gel, hs $25.00/45 g
or 0.1% cream, hs $25.00/45 g
1. For acne with a significant nodular or cystic component, add systemic antibiotics
tetracycline 1 g/day divided bid to qid x4 weeks, then 250 mg bid; may be taken hs only, if tolerated $0.53/week
or erythromycin base 1 g/day divided bid to qid x4 weeks, then 250 mg bid $1.27/week
or minocycline 50 mg bid, or 100 mg, hs $8.33-16.66/week
2. For treatment of resistant cystic or nodular acne where dermatology consultation unavailable
isotretinoin 0.5-1.0 mg/kg, once daily x16-20 weeks $3.01/40 mg
-Response to any acne treatment occurs in 6-8 weeks.
-For patients with sensitive skin, avoid excessive irritation; use benzoyl peroxide lotions instead of alcohol or acetone-based gels, and use lower concentrations of tretinoin or switch to adapalene.
-There have been no adequate dose-response trials to show increased efficacy of benzoyl peroxide in concentrations greater than 10%.
-There is no clinical difference between tetracycline and doxycycline. Doxycycline may be taken twice daily but at greater expense.
-Consult isotretinoin product monograph regarding teratogenicity.
-Other erythromycins, including modified-release preparations, may be 2-7 times more expensive than erythromycin base.
must be balanced with risks see: