First-line therapy for mild to moderate acne vulgaris?

First-line therapy for mild to moderate acne vulgaris?

• A. Topical retinoids
• B. Systemic antibiotics
• C. Benzoyl peroxide
• D. Isotretinoin

Answer: (A)

Acne starts with abnormal keratinization in the hair follicle that leads to comedones; addressing that process early is key to preventing new lesions. A topical retinoid fits this role best because it normalizes follicular desquamation, reduces formation of microcomedones, and has anti-inflammatory effects that help both comedonal and inflammatory lesions. This broad action makes it the most effective initial therapy for mild to moderate acne. In practice, it’s often used with benzoyl peroxide to boost effectiveness and reduce antibiotic resistance if antibiotics are added later. Systemic antibiotics are reserved for more extensive or inflammatory disease or failure of topical therapy; isotretinoin is for severe nodulocystic acne or refractory cases. Benzoyl peroxide alone helps with bacteria and inflammation but doesn’t address the keratinization issue as well as a retinoid, though it can be used in combination. So starting with a topical retinoid targets the underlying lesion formation and provides comprehensive improvement, making it the best first-line option.

Acne starts with abnormal keratinization in the hair follicle that leads to comedones; addressing that process early is key to preventing new lesions. A topical retinoid fits this role best because it normalizes follicular desquamation, reduces formation of microcomedones, and has anti-inflammatory effects that help both comedonal and inflammatory lesions. This broad action makes it the most effective initial therapy for mild to moderate acne. In practice, it’s often used with benzoyl peroxide to boost effectiveness and reduce antibiotic resistance if antibiotics are added later.

Systemic antibiotics are reserved for more extensive or inflammatory disease or failure of topical therapy; isotretinoin is for severe nodulocystic acne or refractory cases. Benzoyl peroxide alone helps with bacteria and inflammation but doesn’t address the keratinization issue as well as a retinoid, though it can be used in combination. So starting with a topical retinoid targets the underlying lesion formation and provides comprehensive improvement, making it the best first-line option.