2812 2813 2814 ![A white \"Rx\" symbol is centered within a square black and white design.](https://cdn.orris.care/cdss_images/84fba99050656995a3349a5d418bec16245ca58ce1565eb5f8543b17d01e3993.png) 2815 2816 2817

Acne activity	Treatment^a
Mild: Several papules, pustules, and/or comedones; no nodules.	Initial	Follow-up
	First-line	For additional control:
	Topical retinoid	Increase strength of topical retinoid
	BPO ± topical antibiotic^c	Change from wash to leave-on BPO or
	or	or
	Topical retinoid + BPO ± topical antibiotic^c	Add or replace with another topical agent
	Alternative topicals
	Dapsone
	Clascoterone
	Azelaic acid^e
Moderate: Multiple papules and pustules; few scattered nodules; variable comedones	First-line	For additional control:
	Topical retinoid + BPO	See above for topical options
	± topical antibiotic, oral antibiotic^c, and/or	Add oral antibiotic^c:
	oral hormonal therapy^f (female patients)	and/or hormonal therapy^f (female patients)
	Alternative topicals	or
	Dapsone	Change to isotretinoin
	Clascoterone
	Azelaic acid^e
Severe: Numerous papules and pustules; multiple nodules; variable comedones	First-line	For additional control:
	Topical retinoid + BPO + oral antibiotic^c	Change to isotretinoin
	± hormonal therapy^f (female patients)	or
	Isotretinoin
	Consider alternative topical (see above)
Very severe: Numerous nodules with congoate or hemorrhagic lesions; ± systemic symptoms (acne fulminans)	Prednisone ± isotretinoin (low-dose initially)	Isotretinoin (slow dose escalation)

2818 2819 Table 36.4 Treatment of acne vulgaris. Lack of response to therapy should prompt consideration of non-adherence, exacerbating factors (e.g. medications [see Table 36.1], endocrin [... Output truncated due to length. 1337 tokens/4916 characters removed ...]