Acne Treatment Algorithms

Mild Acne Moderate Severe Acne Acne Hidradenitis Female Acne Rosacea Vulgaris Acne Vulgaris Acne Vulgaris Conglobata Fulminans suppurativa (HS) (suspect PCOS)

Scattered open Open and closed Open and closed Foul smelling Severely Erythema and Inflammatory Inflammatory and closed comedones with comedones but cysts, inflammatory and telangiectasias nodules with or nodules and papules comedones inflammatory inflammatory interconnecting ulcerated nodules with or without without sinus distributed mostly Cutaneous papules and papules, pustules abscesses, keloid inflammatory tracks and scarring on the jaw line Morphology pustules and few and nodules and atrophic papules and distributed to the nodules predominate scarring pustules axilla, buttocks, inframammary crease and inguinal folds

None None Inflammation, Inflammation, Fever, joint pain, Skin burning, skin Pain at the site Abnormal painful lesions painful lesions, malaise, loss of flushing, ocular menstruation, lymphadenopathy appetite, weight symptoms obesity, hirsutism, Associated loss, enlarged oily skin and Symptoms liver and spleen, hair, infertility, lymphadenopathy inappropriate male features, insulin resistance

Consider culture Consider culture Consider culture Consider culture CBC, ESR, CRP, Consider culture Consider cultures Labs: DHEA, and/or biopsy and/or biopsy and/or biopsy and/or biopsy X-ray for osteolytic and/or biopsy if free and total if unsure of if unsure of if unsure of if unsure of bone lesions unsure of diagnosis testosterone, Workup diagnosis diagnosis diagnosis diagnosis total estrogen, progesterone, LH, FSH, Free insulin, HgbA1c, TSH, Free T4, CRP, Sed rate

None Oral antibiotics Oral antibiotics or Isotretinoin Isotretinoin, Low dose oral Oral antibiotics or Spironolactone, oral Oral isotretinoin Prednisone antibiotics for Adalimumab contraceptives Medications papular rosacea (Humira) or Isotretinoin

Benzoyl Peroxide BPO + topical BPO + topical Topical retinoid + Topical retinoid + Topical BPO, Hibiclens, See topical (BPO) with or retinoid + topical retinoid + topical BPO BPO metronidazole, clindamycin, treatment options without topical antibiotic antibiotic topical azelaic acid, erythromycin, sulfur for mild, moderate retinoid topical ivermectin, wash, sulfacetamide and severe acne Topical Alternative: Alternative: topical minocycline lotion, dapsone gel vulgaris Medications Topical dapsone Topical dapsone for papular disease I/L or topical azelaic or topical azelaic Triamcinolone acid + BPO + acid + BPO + Topical injections for acute retinoid retinoid oxymetazoline or flares topical brimonidine for erythema Laser therapy

Tool developed by an independent medical education grant from Galderma Laboratories, L.P.