Most mild cases can be managed with local treatment:
- Washing the face daily with water and a regular soap.
- Acne cream (tretinoin) to promote mild peeling to open the blocked ducts of the sebaceous glands is the first line treatment of mild acne. This is best used at night. Stop treatment for a few days if the skin becomes red and tender.
- A local antiseptic cream (benzoyl peroxide) to reduce inflammation in the sebaceous glands.
- Mild exposure to sunshine.
- No squeezing, picking or scrubbing the spots.
If the acne does not improve in 2 months, or if it is severe, the patient should be referred to a skin clinic at a hospital.
Topical antibiotics (clindamycin or erythromycin) or systemic antibiotics (doxycycline), oral contraceptives, especially if they contain cyproterone (Diane 35), in girls, or oral retinoids (which can cause congenital malformations if given during pregnancy) can be used in severe cases. Usually 6–8 weeks of treatment is needed before improvement is noted. Resistance to topical antibiotics, used to decrease the number of Propionibacterium acnes in the skin, is becoming a problem.