Combination Therapy in Acne Treatment
Combination Therapy in Acne Treatment of a Topical Retinoid and Topical or Systemic Antibacterial Agent Retinoid plus Antimicrobials Tazarotene or Adapalene gel Applied in the morning for 2 min short contact(30 secs to 5 mins range) depending upon patient tolerability. Tazarotene and Adapalene can be used in the morning as both are light stable and non photosensitizing. But benzoyl peroxide and tretinoin has to be used only during night. With Antimicrobials: Topical: Benzoyl Peroxide, Benzoyl Peroxide-erythromycin(Benzamycin), or azelaic acid(azelex) in the night. Two randomized controlled studies involving 2219 patients conducted by Drs.Krochmal and Yaroshinsky have shown high effectiveness of a combination of clindamycin 1% with tretinoin 0.025% in hydrogel compared to either agent alone. or Systemic:
Alternative Combination Therapy in Acne Treatment Tazarotene Short Contact Therapy with Systemic Azythromycin An alternative combination therapy in acne treatment with atwo five-day courses of systemic Azithromycin is also very effective. The first course is given when the patient is started on Tazarotene short contact therapy twice daily for 2-5 minutes, and the second course after several weeks, when the expected pustular flare up during the topical retinoid use(seen in 20% cases) occurs. Patients using this combination treatment see improvement within 10 days to 2-3weeks, much earlier than the monotherapy with topical retinoids. Topical and systemic antimicrobials are stopped after 4-6 weeks if there is no pustular flare ups.This will avoid emergence of bacterial resistance.
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