Which statement best describes the management approach for moderate acne?

• A. Only topical therapy is sufficient.
• B. Topical retinoid with benzoyl peroxide is used, and oral antibiotics such as tetracycline may be added.
• C. Oral isotretinoin is first-line.
• D. No antibiotics are ever used.

Answer: (B)

For moderate acne, a layered, multi-agent approach is most effective. The best strategy uses a topical retinoid paired with benzoyl peroxide, with the option to add an oral antibiotic if inflammation is significant or not responding quickly.

The topical retinoid helps normalize follicular keratinization and reduces comedones, while benzoyl peroxide provides antibacterial action against Propionibacterium acnes and helps prevent the development of antibiotic resistance. When inflammatory lesions persist or are more extensive, adding an oral antibiotic such as doxycycline or tetracycline can rapidly reduce bacterial load and inflammation, while the topical regimen continues to prevent new lesions. Isotretinoin is not first-line for moderate acne; it’s reserved for severe nodulocystic acne or cases refractory to conventional therapies. A plan that relies on only topical therapy or avoids antibiotics altogether wouldn’t adequately address the inflammatory component of moderate acne.