Implications for clinical practice

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In individuals with mild acne whose disease is not adversely affecting their quality of life, antibacterial washes should be considered in the choice of first-line management strategies in step-up approaches. They should also be considered in the maintenance of patients who have ceased therapy following response. They should not be prescribed routinely in patients who are receiving more aggressive therapy as there is no evidence of any additional benefit. Alkaline syndet bars may be preferential to soap in skin care routines.

Mild acne consisting of open and closed comedones with a few inflammatory lesions is commonly treated with topical agents. A number of options have been shown to be effective in placebo-controlled RCTs, and all can be used either alone or in combination. Options include the topical retinoids (isotretinoin, tretinoin and adapalene), benzoyl peroxide, salicylic acid and azelaic acid. Topical antibiotic agents are discussed in the next question.

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