Combination therapy

A number of RCTs have investigated oral and topical antibiotics either against or in combination with other agents, (see Web Table 13.9) the rationale for this being that treatments that attack more than one factor implicated in the pathogenesis of acne will be more effective. The different mechanisms of action are summarised in Table 13.4.

Table 13.4 Targets of acne therapies (adapted from Gollnick160)

Sebum excretion Keratinisation Follicular P. acnes Inflammation

Table 13.4 Targets of acne therapies (adapted from Gollnick160)

Sebum excretion Keratinisation Follicular P. acnes Inflammation

Benzoyl peroxide

-

(+)

+++

(+)

Tretinoin

-

++

(+)

-

Clindamycin

-

-

++

-

Antiandrogens

++

-

-

-

Azelaic acid

-

++

++

+

Tetracyclines

-

-

++

+

Erythromycin

-

-

++

-

Isotretinoin

+++

++

(+)

++

+++, very strong effect; ++ strong effect; + moderate effect; (+) Indirect/weak effect; - no effect

+++, very strong effect; ++ strong effect; + moderate effect; (+) Indirect/weak effect; - no effect

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