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Treatment of Mild to Moderate Acne: Presented at AAFP

By Laura Gater

CHICAGO, IL -- October 11, 2007 -- Monotherapy with topical retinoids is the treatment of choice for mild comedonal acne, according to a poster presented here at the American Academy of Family Physicians' (AAFP) Scientific Assembly.

Shobha Rao, MD, University of Texas Southwestern Medical Center, Dallas, Texas, United States, discussed the current approach to management of acne in a poster on October 6.

Acne vulgaris is the most common cutaneous disorder, affecting about 45 million people in the United States. Five to 6 million visits regarding acne are made to physicians in outpatient offices each year.

Mild acne is defined as fewer than 20 comedones, fewer than 15 inflammatory lesions, or fewer than 30 total lesions. Mild treatment includes topical retinoids, tretinoin, adapalene, and tazarotene.

Moderate acne is defined as 20 to 100 comedones or 15 to 50 inflammatory lesions or 30 to 125 total lesions. Treatment for moderate acne involves benzoyl peroxide or topical retinoids plus erythromycin or clindamycin. Benzoyl peroxide is preferred to topical retinoids because of its antibacterial and anticomedogenic properties. Benzoyl peroxide in combination with antibiotic cream has the potential to reduce antibiotic-associated resistance to Propionibacterium acnes.

In recent studies, both 1% clindamycin and 2% erythromycin were comparable in reducing inflammatory and non-inflammatory lesions in patients with moderate acne.

A randomised, controlled trial (RCT) showed that 0.1% tazarotene gel was effective in reducing both noninflammatory (P =.002) and inflammatory lesions (P =.01).

Another 12-week RCT of 237 patients with mild to moderate acne aged 12 to 30 years demonstrated superior efficacy with 0.1% adapalene cream over placebo (P =.05).

A recent meta-analysis concluded that topical tazarotene is more effective and better tolerated when compared with other topical retinoids, including adapalene and tretinoin.

The study concluded that for moderate comedonal and mild to moderate papulopustular acne, combination therapy with either benzoyl peroxide or topical retinoids (tretinoin, adapalene, or tazarotene) plus topical antibiotics (erythromycin or clindamycin) is recommended. In addition, it showed that monotherapy with topical retinoids is the treatment of choice for mild comedonal acne.


[Presentation title: Treatment of Mild to Moderate Acne. Poster P-055]

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