algorithm

acne Vulgaris
for
Severe
Moderate
Treatme Mild
Nodular
nt
Comedon Papular/
Papular/Pustula
al
Pustular
r
First

Second

Oral antibiotic
Oral antibiotic Oral isotretinoin
Topical
Topical retinoid
retinoid or
topical antimicrobial topical retinoid BPO topical retinoid oral
combinationa or combinationa
corticosteroids
BPO
or combinationa
Oral isotretinoin
High-dose oral
or oral antibiotic
Topical
antibiotic
Topical dapsone or Oral antibiotic
topical retinoid
dapsone or
azelaic acid or
topical retinoid BPO
topical retinoid
azelaic acid or
BPO/azelaic
salicylic acid
BPO or
or combinationa
salicylic acid
acid or
combinationa
a
combination

Oral
contraceptive/
antiandrogen
Comedone
extraction;
Comedone extraction, intralesional
Laser/light therapy,
Additional
Comedone
laser/light therapy,
corticosteroid,
photodynamic
options
extraction
photodynamic
laser/light
therapy
therapy
therapy,
photodynamic
therapy
Check compliance
Exclude Gramnegative folliculitis
Females: Exclude
polycystic ovary
syndrome, adrenal
Refractory Check
to treatment compliance
or ovarian tumors,
congenital adrenal
hyperplasia
Males: Exclude
congenital adrenal
hyperplasia
Maintenance Topical Topical retinoid retinoid BPO, or combinationa
BPO, or combinationa
Topical retinoid BPO, or combinationa
Topical retinoid BPO, or combinationa
BPO benzoyl peroxide.
Female

Conglobata/
Fulminans

Oral contraceptive/
antiandrogen

Oral
contraceptive/
antiandrogen
Intralesional
corticosteroid,
laser/light
therapy,
photodynamic
therapy