Topical therapy is the first line of treatment for people with mild to moderate acne, including retinoids, benzoyl   peroxide, antibiotics, and anti-inflammatory agents. 

     Oral therapies include antibiotics such as tetracycline,  minocycline, doxycycline, and clindamycin are often  prescribed for the management of moderate and severe    inflammatory acne. These agents suppress the growth of P. acnes and may exhibit  anti-inflammatory effects. Use of these antibiotics may be limited, however, due to the incidence of unwanted adverse effects, such as GI upset, vaginal candidiasis, phototoxicity , and a reduction in the  efficacy of oral contraceptives.

     While systemic and topical antibiotics can be  effective in the treatment of inflammatory acne vulgaris,  widespread use of those agents is becoming  increasingly associated with  the emergence of resistant pathogens. This resistance highlights the need for  alternative nonantimicrobial agents for the  treatment of acne. According to 1 study, nicotinamide gel (niacinamide gel) provides potent anti-inflammatory activity  without the risk of inducing  bacterial resistance. In the  double-blind investigation, the result of topically applied 4% Nicotinamide gel was compared with that of 1% clindamycin gel for the treatment of moderate inflammatory acne vulgaris. After 8 weeks, both treatments produced comparable   beneficial results. Because topical clindamycin is associated with the emergence of resistant microorganisms, nicotinamide gel is a desired alternative  treatment for acne vulgaris.**

       ** Int J Dermatol 1995;34;434-437.

      Nutritional supplements which may compliment medical therapy include:

•      Omega-3 oils- due to their anti-inflammatory effect
•      Vitamin A -  promotes skin healing
•      Zinc- aids in the healing of tissue and assists in preventing scarring
•      Probiotics- especially important for patients taking oral antibiotics,  also helps to improve immune function