Table 2:

Approach to therapy for acne vulgaris^3,6

Severity; clinical findings	Treatment options
	First line	Second line
Mild
Comedonal	Topical retinoid	Alternative topical retinoid Salicylic acid washes
Papular/pustular	Topical retinoid Topical antimicrobial benzoyl peroxide clindamycin erythromycin Combination products	Alternative topical retinoid plus alternative topical antimicrobial Salicylic acid washes
Moderate
Papular/pustular	Oral antibiotics tetracyclines erythromycin trimethoprim–sulfamethoxazole Topical retinoid ± benzoyl peroxide	Alternative oral antibiotic Alternative topical retinoid Benzoyl peroxide
Nodular	Oral antibiotic Topical retinoid ± benzoyl peroxide	Oral isotretinoin Alternative oral antibiotic Alternative topical retinoid Benzoyl peroxide
Severe	Oral isotretinoin	High-dose oral antibiotic Topical retinoid (also maintenance therapy) Benzoyl peroxide

Note: In women with acne, oral contraceptives or androgen receptor blockers (e.g., spironolactone) may be used in addition to the above treatment options.