FACE - Acne Vulgaris - Mild, Noninflammatory – Comedolytic
Adapalene (Differin^®) Pregnancy: C; Lactation: Unknown Gel 0.1%		Adolescent and Adult: Apply once daily at bedtime after cleansing the area to be treated. Cover entire affected area lightly. Wash hands after use. Exacerbation of condition may be seen early in therapy but, unless severe, is not a reason to discontinue. Therapeutic results should be seen after 8-12 weeks of therapy.	Caution: Keep away from eye(s), mouth, angles of nose, and mucous membranes. Avoid excessive exposure to sun and sunlamps. Do not apply over sunburned skin. Avoid coadministering with topical products, which may cause irritation to the skin. This includes products containing sulfur, resorcinol, benzoyl peroxide, or salicylic acid. Important side effects: May cause irritation, burning, and stinging on application. Erythema, scaling, dryness, and other local irritation may occur, especially during the first few weeks of therapy. Unless irritation is severe, application should continue and irritation usually lessens with continued use. If excessive irritation occurs, application should be discontinued or applied less frequently.
Azelaic Acid Azelex^® Pregnancy: B; Lactation: Caution Cream 20%		Adolescent and Adult: Thoroughly massage in to affected area twice daily after washing, and pat dry. Improvement usually seen within 4 weeks. Wash hands after application.	Important side effects: May rarely cause hypopigmentation; monitor closely in dark-skinned persons. May cause skin irritation. Avoid contact with eye(s).
Benzoyl Peroxide 5-10% Many brands OTC Pregnancy: C; Lactation: Unk Cream 5% and 10% Gel 2.5%, 5%, 10%, and 20% Liquid 2.5%, 5%, and 10% Lotion 5%, 5.5%, 10%		Adolescent and Adult: Begin with a low-potency strength and increase strength and frequency as tolerated. Apply to skin (after cleansing) up to 1-3 times daily. *Note: Gels may be more potent, longer lasting, and more irritating than creams or lotions.	C aution: Do not apply to inflamed or raw skin, mucous membranes, eye(s), eyelids, or lips. May bleach colored fabrics. Important side effects: May cause stinging, drying, or peeling of the skin. Irritation may be reduced by applying to dry skin 30 minutes after washing. Discontinue if irritation is excessive.
Tretinoin (trans-retinoic acid) Topical (Retin-A^®, Avita^®) Pregnancy: C; Lactation: Unknown Cream: 0.0025%, 0.05%, 0.1% Gel 0.025%, 0.01% Liquid 0.05%: 28 mL		Adolescent and Adult: Apply once daily at bedtime after cleansing the area to be treated. Cover entire affected area lightly. Wash hands after use. Improvement may be seen in 2-3 weeks, but may not be optimal until after 6 weeks.	Caution: Keep away from eye(s), mouth, angles of nose, and mucous membranes. Avoid excessive exposure to sun and sunlamps. Do not apply over sunburned skin. Avoid coadministering with topical products containing sulfur, resorcinol, benzoyl peroxide, or salicylic acid. Important side effects: Application may cause transient sensation of warmth or stinging. Excessive application may cause irritation or peeling of skin. If excessive redness, burning, or peeling occurs, reduce frequency of use or temporarily discontinue or reduce strength of product.
FACE - Acne Vulgaris - Mild, Inflammatory (Propionibacterium acnes) - Comedolytic + Topical or Oral Antibiotic
Erythromycin Topical (Erygel^®, EryDerm^®, Staticin^®) Generics available Pregnancy: B, C; Lactation: Unsafe Gel 2%: 30 g - $$ Solution 1½% & 2% Pledgets 2%		Children: Should not need until adolescence. Adolescent and Adult: Apply twice daily after cleansing. May see response in 3-8 weeks; however, may require 12 weeks for full response. Continue as long as satisfactory response is maintained and side effects do not occur.	Important side effects: Local irritation and dryness.
Clindamycin Topical (Cleocin T®) Pregnancy: B; Lactation: Safe Gel 1%: 30 g Sol 1%: 30 mL Lotion 1%: 60 mL-		Children: Should not need until adolescence. Adolescent and Adult: Apply Q12H after cleansing. May see improvement in 2-6 weeks; however, may require 12 weeks for full response. Continue as long as satisfactory response is maintained and significant side effects do not occur.	Important side effects: Local irritation and dryness. May rarely cause diarrhea.
Doxycycline (Vibramycin®) Generics available Pregnancy: D; Lactation: Unsafe Caps: 50 mg, 100 mg Tabs: 50 mg, 100 mg		Adolescent and Adult: 50-100 mg PO twice daily.	Food: May take with food if GI upset occurs. Take 1 hour before or 2 hours after antacids, iron, milk, or other dairy products. Take with full glass of water to prevent esophagitis. Important side effects: Photosensitivity (use sunscreen), esophagitis. May discolor fingernails.
Erythromycin Base (E-Mycin®) Generics available Pregnancy: B; Lactation: Unsafe Tabs: 250 mg, 500 mg		Adolescent and Adult: 250 mg PO four times daily or 500 mg PO twice daily. If no response in 2-3 weeks or severe acne: 500 mg PO four times daily. Maintenance dose: 250-500 mg once daily.	Food: May take with or without meals. Take with food if GI upset occurs. Important side effects: GI upset, hepatitis.
Tetracycline (Sumycin®, Tetracap®) Generics available Pregnancy: D; Lactation: Unsafe Caps: 250 mg, 500 mg Tabs: 250 mg, 500 mg		Adolescent and Adult: 250 mg PO four times daily for 2-3 weeks, then taper to 250-500 mg once daily. If no response after 2-3 weeks, increase to 500 mg PO four times daily before tapering.	Food: Take 1 hour before or 2 hours after meals. Take with full glass of water to minimize esophagitis. Do not take within 3 hours of antacids, iron, milk, or other dairy or calcium products. Important side effects: Photosensitivity (use sunscreen), esophagitis. May discolor fingernails. Rash, nausea, vomiting, diarrhea, superinfection, hepatitis, renal damage.
Minocycline (Minocin®) Pregnancy: D; Lactation: Unsafe Caps: 50 mg, 100 mg		Adolescent and Adult: 100 mg PO twice daily. Costs ($100/mo) and has more side effects than tetracycline or doxycycline.	Food: Take with full glass of water to prevent esophagitis. Do not take with dairy products, antacids, calcium, zinc, or iron products.  Important side effects: GI upset, esophagitis, photosensitivity, drowsiness, dizziness, discoloration of skin.
FACE - Acne Vulgaris - Inflammatory (Propionibacterium acnes) See drugs listed in previous section. Use in combination. Comedolytic + Topical antibiotic + Oral antibiotic
FACE - Acne Vulgaris - Severe (Propionibacterium acnes) Less than 50% response to three-agent therapy after 5-6 months.
Isotretinoin (Accutane^®) Pregnancy: D; Lactation: Unsafe Caps: 10 mg, 20 mg, 40 mg Prescribers of isotretinoin should be completely familiar with the risks associated with its use. The information provided here is brief and not intended to familiarize the prescriber with all risks involved. Prescriptions are limited to a 1-month supply with no automatic refill. Patient and prescriber must sign consent form from manufacturer.	Adolescent and Adult: 0.5-1 mg/kg/day in 2 divided doses for 15-20 weeks or until the total cyst count is decreased by 70%, whichever occurs first. When disease is very severe with scarring or is primarily manifested on the trunk, patient may require dose adjustments up to 2 mg/kg/day as tolerated.		Food: Isotretinoin should be taken with food, which significantly increases absorption. Before upward dose adjustments are made, patients should be questioned about their compliance with food instructions. Take with full glass of water to prevent esophagitis. Major side effects: Known to cause major fetal abnormalities. Verify pregnancy status of female patients and educate them on effective contraception. Do not use in women of childbearing potential not capable of following an effective contraceptive program. May cause CNS side effects, including psychosis or depression. May cause pseudotumor cerebri. Use with tetracycline may increase risk. Do not administer with tetracycline or vitamin A. Other side effects: Photosensitivity, pruritus, insomnia, hyperglycemia, hypertriglyceridemia, decreased night vision, intolerance to contact lenses, others.