Topical benzoyl peroxide is suggested as first-line treatment in mild acne. Other topical agents and oral antibiotics are useful in more severe cases, but have more side effects.
A topic in Clinical evidence 1 summarizes the results of 69 systematic reviews, RCTs, or observational studies. Topical benzoyl peroxide should be considered as first-line treatment in mild acne. Topical benzoyl peroxide and topical azelaic acid reduce inflammatory and non-inflammatory lesions compared with placebo, but can cause itching, burning, stinging, and redness of the skin.Topical antibiotics such as clindamycin and erythromycin (alone or with zinc) reduce inflammatory lesions compared with placebo, but have not been shown to reduce non-inflammatory lesions. Tetracycline may reduce overall acne severity. Antimicrobial resistance can develop with use of topical or oral antibiotics, and their efficacy may decrease over time. Tetracyclines may cause skin discoloration, and should be avoided in pregnant or breastfeeding women.Topical preparations of tretinoin, adapalene, and isotretinoin may reduce inflammatory and non-inflammatory lesions, but can also cause redness, burning, dryness, and soreness of the skin.Oral antibiotics (doxycycline, erythromycin, lymecycline, minocycline, oxytetracycline, and tetracycline) are considered useful for people with more severe acne. Oral antibiotics can cause adverse effects such as contraceptive failure. Minocycline has been associated with an increased risk of systemic lupus erythematosus and liver disorders.Oral isotretinoin has been associated with skin problems, change in liver function, teratogenesis, and psychiatric disorders.
Comment: The quality of evidence is downgraded by sparse data and indirectness
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