This handout is for acne vulgaris (dermatology lens). Your care team identified this based on: chronic comedonal and/or inflammatory papulopustular eruption of the face/chest/back in an adolescent or adult (aad 2024 acne guideline, reynolds et al jaad; pmid 38300170).
Other reasons your team may use this plan: deep painful nodules/cysts or early atrophic/keloidal scarring → isotretinoin-candidate entry (aad 2024 pmid 38300170 — isotretinoin strongly recommended for severe/scarring acne); sudden, severe, or treatment-recalcitrant acne in an adult female ± hyperandrogenism signs → hormonal-workup entry (aad 2024 pmid 38300170); monomorphic acneiform eruption temporally linked to systemic corticosteroid / egfr-inhibitor / lithium / anabolic-androgen → drug-induced acneiform entry (route derm.drug-eruption.core.v1).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| tretinoin | 0.025–0.05% cream/gel | topical | once nightly | AAD 2024 (PMID 38300170) STRONG — comedolytic + anti-inflammatory; the cornerstone of acne therapy and the key maintenance agent after oral therapy stops. |
| adapalene | 0.1% or 0.3% gel | topical | once daily | AAD 2024 (PMID 38300170) STRONG — third-generation retinoid; best tolerated, photostable, BPO-compatible (0.3%/2.5% fixed combo available). |
| tazarotene | 0.045% lotion / 0.1% cream | topical | once daily | AAD 2024 (PMID 38300170) STRONG (topical retinoid class) — most potent retinoid; teratogen — avoid in pregnancy. |
| trifarotene | 0.005% cream | topical | once daily | AAD 2024 (PMID 38300170) — selective RAR-γ retinoid studied for facial AND truncal acne. |
| benzoyl peroxide | 2.5–5% wash/gel | topical | once–twice daily | AAD 2024 (PMID 38300170) STRONG — bactericidal against C. acnes with NO resistance; MUST accompany any topical or oral antibiotic to limit resistance (good-practice statement). |
Plan: Acne vulgaris — stepwise multi-mechanism ladder (AAD 2024, Reynolds et al JAAD; PMID 38300170)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Chronic-disease maintenance: topical-retinoid maintenance after oral therapy stops (relapse prevention, the single most effective maintenance strategy), adherence/expectation counselling (response takes 8-12 wk; no antibiotic monotherapy/long courses), scar + dyspigmentation management and referral, mental-health surveillance, hormonal-therapy continuity for adult females, and isotretinoin post-course relapse monitoring (a second course may be needed). Skin-of-colour: PIH-directed gentle regimens minimising irritation.
Guideline: AAD 2024 Guidelines of care for the management of acne vulgaris (Reynolds RV, Yeung H, ... Barbieri JS; J Am Acad Dermatol 2024;90(5):1006.e1-1006.e30; PMID 38300170, DOI 10.1016/j.jaad.2023.12.017) — 18 evidence-based recommendations + 5 good-practice statements; STRONG: benzoyl peroxide, topical retinoids, topical antibiotics, oral doxycycline, oral isotretinoin (severe/psychosocial/scarring/refractory); CONDITIONAL: clascoterone, salicylic/azelaic acid, minocycline, sarecycline, combined oral contraceptives, spironolactone. Applied via Keow/Abu-Hilal Can Fam Physician 2025 (PMID 40730431) + antibiotic-stewardship commentary Barbieri/Reynolds JAAD 2024 (PMID 38925435); supporting pivotal RCTs: clascoterone (Hebert JAMA Dermatol 2020 PMID 32320027; long-term Eichenfield JDD 2023 PMID 37556524), sarecycline SC1401/SC1402 (Moore JDD 2018 PMID 30235387; pooled PMID 36671290), spironolactone SAFA RCT (Santer HTA 2024 PMID 39268864), isotretinoin AE systematic review (Vallerand BJD 2017 PMID 28542914) + cumulative-dose RCT (PMID 33185932)