Topical combination therapy with a retinoid and an antibiotic may be sufficient to treat more severe inflammatory disease without adding a systemic agent.
The advantages of combination topical retinoid and topical antimicrobial therapy in acne are as follow:
1) Combination therapy permits the targeting of several pathogenic factors simultaneously.
2) Faster & more complete clearance of both comedones & inflammatory lesions than with
antibiotic alone.
3) Topical retinoid therapy enhances penetration of antimicrobial agents, and speeds up action
of antibiotics.
4) Topical antibiotics decrease the irritant effect of the retinoid.
5) The combination may help limit bacterial resistance to the antibiotic.
Topical retinoids when added early at the start of treatment give fastest results. Antibiotic can be discontinued later when inflammatory lesions resolve.
The therapeutic combination decreases comedogenesis, bacterial growth, and inflammation, thus efficacy and tolerance are maximized, and the degree of skin irritation is minimized.
How to apply? Generally, in a regimen of 2 or more topical agents, the treatments will be applied at different times of day. Most commonly, the topical antibiotic will be applied in the morning and the retinoid at bedtime. However, it has also been suggested that a better approach might be twice-daily application of a topical antibiotic plus a topical retinoid at bedtime so as to minimize the risk of acquiring antibiotic-resistant P.acnes populations.
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