Mild Acne

Reference:

• Acne Mild - Fact Sheet

• Acne - Moderate - Fact Sheet

Step 1 - General Measures

• Routinely cleanse with soap‑free products. No more than twice a day

• Remove all makeup before sleeping

• Don’t pick or squeeze pimples

• Use non‑comedogenic sunscreen

• Use oil‑free, non‑comedogenic facial products

• Low glycaemic index diets (less sugar) may improve acne

• Over-the-counter face washes that contain salicylic acid can be useful

Step 2 - Start with topical benzoyl peroxide

• Benzac AC, Panoxyl, Clearasil Ultra, Clean and Clear Cleanser

• Average cost is $10 to $30.

• Can start with 2.5% strength if dry/sensitive skin, but 5% is generally tolerated and more likely to be effective

• Available as creams, gels, and cleansers

• 6 weeks to 3 months of treatment may be required to see if beneficial

• The most common side effect is skin irritation (dryness and redness)

• Bleaches clothes, towels, and bedding

• Not subsidised – available for purchase over-the-counter without a prescription

Step 3 - If lots of comedones (whiteheads + blackheads), use a topical retinoid

• Work by reducing comedones

• Useful for inflammatory and non‑inflammatory acne

• 3 to 6 months of treatment may be required to see benefits

General advice

• Apply to all skin affected by acne, not only individual lesions - this is a field treatment

• Skin irritation is common – start treatment second daily for the first 2 weeks, and avoid excessive skin washing

• Apply at night as topical retinoids are degraded by sun exposure

Types

• Topical adapalene (e.g. Differin Cream/Gel)

  • Average cost is $70 to $80.

  • Least irritating

  • This can lead to easier sunburn

• Topical tretinoin 0.025%, 0.05%, 0.1% (e.g., ReTrieve, Stieva‑A)

  • Average cost $65 to $75

Step 4 - If not enough, use a combination product

Combination of Benzoyl Peroxide and Topical Retinoid

• Epiduo Gel 0.1%/2.5% (adapalene and benzoyl peroxide)

• Average cost is $45 to $50

• Useful if comedones and inflammatory lesions

• Acne often worsens a little initially

• May lead to the bleaching of hair and clothing

• Apply 30 minutes after cleansing to ensure skin is dry before application

• Always apply sparingly e.g., a pea-sized amount for the whole face, and wash hands after use

• Avoid applying to eczematous or sunburned skin

• Avoid exposure to strong sunlight when using Epiduo

• Use sunscreen

• Provide Epiduo consumer medicine information

Combination of Benzoyl Peroxide and Antibiotic

• Duac Once Daily Gel (Benzoyl peroxide 5% and Clindamycin 1% )

• Average cost $40 to $50

• Effective for mild inflammatory acne

• Must be kept in the fridge and discarded 2 months after opening

Moderate Acne

Step 1 - Use topical treatment as above

• Topical retinoid is mainly comedones

• Topical combination therapy if both inflammation and comedones

Step 2 - Consider combined hormonal contraceptive pill in women

• Combined contraceptive pills are oestrogen dominant and work on acne by reducing the testosterone effect on the skin

• All combined pills are generally effective for acne, some work better than others

Step 3 - Add oral antibiotics

Doxycycline

• 50 to 100mg once per day

• Do not halve, crush, or chew tablets

• May cause heart burn and make it easier to sunburn

• Take the medication after food with a glass of water.

• Avoid lying down immediately after taking medication.

Erythromycin

• Dose is 250 to 500 mg twice daily

• May be effective if Doxycycline has failed.

Trial oral antibiotics for 6 weeks initially and review

• If improving, continue for 6 months and stop once acne improves

• Can expect 60% improvement at 3 months and 80% at 6 months

• If not improvement after 6 weeks consider trialling different antibiotics or consider combined contraceptive pill in women

• Continue topical treatments once oral antibiotics are stopped

Severe Acne

• If above measures have failed or obvious severe acne

  • Early dermatologist review

  • Consider oral isotretinoin therapy (roaccutane)