Combined strategies and adjuvant therapies

The success of therapy for acne vulgaris depends on control of seborrhea, keratinization, bacterial flora and inflammation of the pilosebaceous units. In order to control these factors, with minimum risks of side effects, combined therapeutic strategies become beneficial. These include: topical retinoids and superficial peelings in comedonian acne; adapalene and benzoil peroxide or oral limecycline in inflammatory acne grade II; oral isotretinoin and topical adapalene in acne grade III; isotretinoin, prednisone and azathioprine in conglobate acne and acne fulminans. The main therapeutic indications for acne vulgaris are discussed here.