Acne Vulgaris

Clinical Cases

Case 1

Mild acne

  • 17-year-old female patient
  • First consultation
  • Regular menses
  • No previous acne treatment
  • Mainly comedones and few inflammatory acne lesions on the face, sensitive skin


  • Wash skin with non-soap containing face wash
  • Apply adapalene 0.1% cream or gel, every night for 2 months; start by using 2-3 times per week and increasing frequency to daily use as tolerated
  • Use a non-comedogenic moisturizer, if needed
  • Control in 6-8 weeks.

Follow-up appointment at 6 weeks

  • Very few comedones and no other lesions
  • Continue adapalene for 3-6 months
  • Control in 6 months
  • Long-term maintenance with adapalene at night

Case 2

Moderate acne

  • 18-year-old female patient
  • Previous treatment: doxycycline and topical clindamycin for 8 weeks with some improvement but relapsed when stopping the drug
  • Inflammatory lesions, comedones on the face, also on the back and chest, no visible scars


  • Wash skin with non-soap containing wash
  • Apply benzoyl peroxide gel in the morning and adapalene 0.1% or tretinoin 0.025% cream at night to the face; if skin gets irritated, use once every other night for 2 weeks
  • Alternatively, a fixed formulation of benzoyl peroxide mixed with topical retinoid can be used at night
  • Doxycycline hyclate 100 mg once or twice daily
  • Use a non-comedogenic moisturizer
  • Control in 6-8 weeks

Follow-up appointment at 8 weeks

  • Improvement of 70%
  • Some inflammatory lesions and comedones
  • Continue doxycycline 100 mg for 1 month + topical regimen for 3 months
  • Control in 3 months
  • Long-term maintenance with topical retinoid cream at night

Case 3

Severe acne

  • 18-year-old teenager
  • Previous treatment: systemic antibiotics (not routine use), over the counter topical products, topical medications
  • Last treatment: minocycline 100 mg daily + tretinoin 0.05% cream + benzoyl peroxide wash for 6 months, with improvement but relapse after stopping the drugs; no treatment for the last 2 months
  • Numerous inflammatory lesions, with cysts, nodules, and comedones on the face and trunk, also with scarring


  • Referral to a dermatologist, if available
  • Oral isotretinoin is first-line therapy for scarring and severe acne: 0.5 mg/kg/d per iPledge program (See www.ipledgeprogram.com)
  • Stop other forms of acne treatment, if any
  • Non-comedogenic moisturizer, mild cleanser
  • Improvement in 1 month

Follow-up appointment at 1 month

  • Still with moderate number of inflammatory lesions, fewer cysts and nodules
  • Continue isotretinoin at 0.5 mg/kg/d or consider increase to 1mg/kg/d per iPledge program

Monthly follow-up appointment

  • Continue isotretinoin for goal dose of 100-150 mg/kg total dosing

Long-term maintenance with topical retinoid +/- benzoyl peroxide: Fixed formulations of topical retinoids mixed with antimicrobials such as benzoyl peroxide are available for patient convenience/adherence to regimen.