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Topical benzoyl peroxide (gel, cream, lotion, wash) has an antimicrobial effect in acne treatment. Higher-percentage products (10%) cause more irritation and are not more effective (Agency for Healthcare Research and Quality, 2001) (SOR: A). Topical antibiotics such as clindamycin and erythromycin are beneficial treatments (AHRQ, 2001) (SOR: A). Combination products with antibiotics and BP deliver synergistic medications in one preparation (AHRQ, 2001) (SOR: B). Topical retinoids (tretinoin, adapalene, tazarotene) are excellent to treat all types of acne and the primary treatment in comedonal acne (AHRQ, 2001) (SOR: A).

Azelaic acid is useful to treat spotty hyperpigmentation and acne (AHRQ, 2001) (SOR: B).

Oral antibiotics with proven benefit in acne include tetracycline, doxycycline, minocycline, and erythromycin and are particularly useful for inflammatory acne and trunk acne (AHRQ, 2001; Strauss et al., 2007) (SOR: A).

Isotretinoin is the most powerful treatment for cystic and scarring acne that has not responded to other therapies (Fig. 33-14) (Strauss et al., 2007) (SOR: A).

Figure 33-13 Acne fulminans. (e Richard P. Usatine.)

Figure 33-12 Cavernous hemangioma. (e Richard P. Usatine.)

Figure 33-13 Acne fulminans. (e Richard P. Usatine.)

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