1. Thiboutot D, Gollnick H, Bettoli V, et al. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol 2009; 60 (5 Suppl.): S1–50

   Article  Google Scholar 

2. Tan HH.Topical antibacterial treatments for acne vulgaris: comparative review and guide to selection. Am J Clin Dermatol 2004; 5 (2): 79–84

   Article PubMed CAS  Google Scholar 

3. Brown SK, Shalita AR. Acne vulgaris. Lancet 1998; 351 (9119): 1871–6

   Article PubMed CAS  Google Scholar 

4. Strauss JS, Krowchuk DP, Leyden JJ, et al. Guidelines of care for acne vulgaris management. J Am Acad Dermatol. 2007; 56 (4): 651–63

   Article PubMed  Google Scholar 

5. Institute for Clinical Systems Improvement. Neely C, Davis M, Lee J, et al.ICSI acne guidelines, 2006 [online]. Available from URL: (http://www.icsi.orgacne/acne_management_3.html) [Accessed 2011 Apr 17]

6. Patel M, Bowe WP, Heughebaert C, et al. The development of antimicrobial resistance due to the antibiotic treatment of acne vulgaris: a review. J Drugs Dermatol 2010; 9 (6): 655–64

   PubMed  Google Scholar 

7. Purdy S, de Berker D. Acne vulgaris. Clin Evid (Online). Epub 2011 Apr 12

8. What role for topical antibacterials in acne? Drug Ther Bull 2010; 48 (12): 141–4

   Google Scholar 

9. Dutil M. Benzoyl peroxide: enhancing antibiotic efficacy in acne management. Skin Therapy Lett 2010; 15 (10): 5–7

   PubMed  Google Scholar 

10. Krakowski AC, Stendardo S, Eichenfield LF. Practical considerations in acne treatment and the clinical impact of topical combination therapy. Pediatr Dermatol 2008; 25 Suppl. 1: 1–14

    Article PubMed  Google Scholar 

11. Fakhouri T, Yentzer BA, Feldman SR. Advancement in benzoyl peroxidebased acne treatment: methods to increase both efficacy and tolerability. J Drugs Dermatol 2009; 8 (7): 657–61

    PubMed  Google Scholar 

12. Del Rosso JQ, Kim GK. Topical antibiotics: therapeutic value or ecologic mischief? Dermatol Ther 2009; 22 (5): 398–406

    Article PubMed  Google Scholar 

13. Del Rosso JQ, Leyden JJ, Thiboutot D, et al. Antibiotic use in acne vulgaris and rosacea: clinical considerations and resistance issues of significance to dermatologists. Cutis 2008; 82 (2 Suppl. 2): 5–12

    PubMed  Google Scholar 

14. Leyden JJ, Del Rosso JQ, Webster GF. Clinical considerations in the treatment of acne vulgaris and other inflammatory skin disorders: focus on antibiotic resistance. Cutis 2007; 79 (6 Suppl.): 9–25

    PubMed  Google Scholar 

15. Tan AW, Tan HH. Acne vulgaris: a review of antibiotic therapy. Expert Opin Pharmacother 2005; 6 (3): 409–18

    Article PubMed CAS  Google Scholar 

16. Simonart T, Dramaix M. Treatment of acne with topical antibiotics: lessons from clinical studies. Br J Dermatol 2005; 153 (2): 395–403

    Article PubMed CAS  Google Scholar 

17. Williams HC, Dellavalle RP, Garner S. Acne vulgaris. Lancet. Epub 2011 Aug 29

18. Chivot M. Retinoid therapy for acne. A comparative review. Am J Clin Dermatol 2005; 6 (1): 13–9

    Article  Google Scholar 

19. Thiboutot D, Arsonnaud S, Soto P. Efficacy and tolerability of adapalene 0.3% gel compared to tazarotene 0.1%gel in the treatment of acne vulgaris. J Drugs Dermatol 2008; 7 (6 Suppl.): s3–10

    Google Scholar 

20. Gollnick H, Cunliffe W, Berson D, et al. Management of acne: a report from a Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol 2003; 49 (1 Suppl.): S1–37

    Article PubMed  Google Scholar 

21. Gollnick H, Schramm M. Topical therapy in acne. J Eur Acad Dermatol Venereol 1998; 11 Suppl. 1: S8–12; discussion S28-9

    Article PubMed  Google Scholar 

22. Leyden JJ. A review of the use of combination therapies for the treatment of acne vulgaris. J Am Acad Dermatol 2003; 49 (3 Suppl.): S200–10

    Article PubMed  Google Scholar 

23. Mills OH, Kligman AM. Treatment of acne vulgaris with topically applied erythromycin and tretinoin. Acta Derm Venereol 1978; 58 (6): 555–7

    PubMed  Google Scholar 

24. Martin B, Meunier C, Montels D, et al. Chemical stability of adapalene and tretinoin when combined with benzoyl peroxide in presence and in absence of visible light and ultraviolet radiation. Br J Dermatol 1998; 139 Suppl. 52: 8–11

    Article PubMed CAS  Google Scholar 

25. Lookingbill DP, Chalker DK, Lindholm JS, et al. Treatment of acne with a combination clindamycin/benzoyl peroxide gel compared with clindamycin gel, benzoyl peroxide gel and vehicle gel: combined results of two double-blind investigations. J Am Acad Dermatol 1997; 37 (4): 590–5

    Article PubMed CAS  Google Scholar 

26. Bojar RA, Eady EA, Jones CE, et al. Inhibition of erythromycin-resistant propionibacteria on the skin of acne patients by topical erythromycin with and without zinc. Br J Dermatol 1994; 130 (3): 329–36

    Article PubMed CAS  Google Scholar 

27. Mills OH, Kligman AM, Pochi P, et al. Comparing 2.5%, 5%, and 10% benzoyl peroxide on inflammatory acne vulgaris. Int J Dermatol 1986; 25 (10): 664–7

    Article PubMed  Google Scholar 

28. Lyons RE. Comparative effectiveness of benzoyl peroxide and tretinoin in acne vulgaris. Int J Dermatol. 1978; 17 (3): 246–51

    Article PubMed CAS  Google Scholar 

29. Hughes BR, Norris JF, Cunliffe WJ. A double-blind evaluation of topical isotretinoin 0.05%, benzoyl peroxide gel 5%and placebo in patients with acne. Clin Exp Dermatol 1992; 17 (3): 165–8

    Article PubMed CAS  Google Scholar 

30. Bucknall JH, Murdoch PN. Comparison of tretinoin solution and benzoyl peroxide lotion in the treatment of acne vulgaris. Curr Med Res Opin 1977; 5 (3): 266–8

    Article PubMed CAS  Google Scholar 

31. Handojo I. Retinoic acid cream (Airol cream) and benzoyl-peroxide in the treatment of acne vulgaris. Southeast Asian J Trop Med Public Health 1979; 10 (4): 548–51

    PubMed CAS  Google Scholar 

32. Zaenglein AL, Thiboutot DM. Expert committee recommendations for acne management. Pediatrics 2006; 118 (3): 1188–99

    Article PubMed  Google Scholar 

33. Weinberg JM. The utility of benzoyl peroxide in hydrophase base (Brevoxyl) in the treatment of acne vulgaris. J Drugs Dermatol 2006; 5 (4): 344–9

    PubMed  Google Scholar 

34. Sawleshwarkar SN, Salgaonkar V, Oberai CM. Multicenter study to evaluate efficacy and irritation potential of benzoyl peroxide 4%cream in hydrophase base (Brevoxyl) in acne vulgaris. Indian J Dermatol Venereol Leprol 2003; 69 (1): 19–22

    PubMed CAS  Google Scholar 

35. Gold LS. Fixed-combination products in the management of acne vulgaris. Cutis 2010; 85 (3): 160–7

    PubMed  Google Scholar 

36. Gold MH. A multicenter efficacy and tolerability evaluation of benzoyl peroxide in a 10% urea vehicle for the treatment of acne vulgaris. J Drugs Dermatol 2006; 5 (5): 442–5

    PubMed  Google Scholar 

37. Jelvehgari M, Siahi-Shadbad MR, Azarmi S, et al. The microsponge delivery system of benzoyl peroxide: preparation, characterization and release studies. Int J Pharm 2006; 308 (1-2): 124–32

    Article PubMed CAS  Google Scholar 

38. UK National Health Service Clinical Knowledge Summary. Acne vulgaris, 2009 [online]. Available from URL: (http://www.cks.nhs.uk/search?&page=1&q=acne%20vulgaris&site=0) [Accessed 2011 Apr 13]

39. Kinney MA, Yentzer BA, Fleischer AB, et al. Trends in the treatment of acne vulgaris: are measures being taken to avoid antimicrobial resistance? J Drugs Dermatol 2010; 9 (5): 519–24

    PubMed  Google Scholar 

40. Chalker DK, Shalita A, Smith JG, et al. A double-blind study of the effectiveness of a 3% erythromycin and 5% benzoyl peroxide combination in the treatment of acne vulgaris. J Am Acad Dermatol 1983; 9 (6): 933–6

    Article PubMed CAS  Google Scholar 

41. Tschen E. Potential role for a new combination topical therapy in treating mild to moderate acne vulgaris. Cutis 2001; 67 (2 Suppl.): 25–7

    PubMed CAS  Google Scholar 

42. Leyden J. Are 2 combined antimicrobial mechanisms better than 1 for the treatment of acne vulgaris? Clinical and antimicrobial results of a topical combination product containing 1% clindamycin and 5% benzoyl peroxide. Introduction Cutis 2001; 67 (2 Suppl.): 5–7

    CAS  Google Scholar 

43. Thiboutot D, Zaenglein A, Weiss J, et al. An aqueous gel fixed combination of clindamycin phosphate 1.2% and benzoyl peroxide 2.5% for the once-daily treatment of moderate to severe acne vulgaris: assessment of efficacy and safety in 2813 patients. J Am Acad Dermatol 2008; 59 (5): 792–800

    Article PubMed  Google Scholar 

44. Kircik L, Green L, Thiboutot D, et al. Comparing a novel solubilized benzoyl peroxide gel with benzoyl peroxide/clindamycin: final data from a multicenter, investigator-blind, randomized study. J Drugs Dermatol 2009; 8 (9): 812–8

    PubMed  Google Scholar 

45. Langner A, Chu A, Goulden V, et al. A randomized, single-blind comparison of topical clindamycin + benzoyl peroxide and adapalene in the treatment of mild to moderate facial acne vulgaris. Br J Dermatol 2008; 158 (1): 122–9

    Article PubMed CAS  Google Scholar 

46. Ozolins M, Eady EA, Avery AJ, et al. Comparison of five antimicrobial regimens for treatment of mild to moderate inflammatory facial acne vulgaris in the community: randomised controlled trial. Lancet 2004; 364 (9452): 2188–95

    Article PubMed CAS  Google Scholar 

47. Seidler E, Kimball AB. Meta-analysis of randomized controlled trials using 5%benzoyl peroxide and clindamycin versus 2.5%benzoyl peroxide and clindamycintopical treatments in acne [abstract]. J Am Acad Dermatol 2011; 64 (2): AB6

    Google Scholar 

48. Bucks D, Angel A, Del Rosso J, et al. Can delivery be enhanced and skin irritation minimized using a lower concentration of benzoyl peroxide in a fixed combination product [abstract]? J Am Acad Dermatol 2009; 60 (3): AB16

    Google Scholar 

49. Ozolins M, Eady EA, Avery A, et al. Randomised controlled multiple treatment comparison to provide a cost-effectiveness rationale for the selection of antimicrobial therapy in acne. Health Technol Assess 2005; 9 (1): iii–212

    PubMed CAS  Google Scholar 

50. Wolf JE, Kaplan D, Kraus SJ, et al. Efficacy and tolerability of combined topical treatment of acne vulgaris with adapalene and clindamycin: a multicenter, randomized, investigator-blinded study. J Am Acad Dermatol 2003; 49 (3 Suppl.): S211–7

    Article  Google Scholar 

51. Gollnick HP, Draelos Z, Glenn MJ, et al. Adapalene-benzoyl peroxide, a unique fixed-dose combination topical gel for the treatment of acne vulgaris: a transatlantic, randomized, double-blind, controlled study in 1670 patients. Br J Dermatol 2009; 161 (5): 1180–9

    Article PubMed CAS  Google Scholar 

52. Nil Froushzadeh MA, Siadat AH, Baradaran EH, et al. Clindamycin lotion alone versus combination lotion of clindamycin phosphate plus tretinoin versus combination lotion of clindamycin phosphate plus salicylic acid in the topical treatment of mild to moderate acne vulgaris: a randomized control trial. Indian J Dermatol Venereol Leprol 2009; 75 (3): 279–82

    Article  Google Scholar 

53. Rietschel RL, Duncan SH. Clindamycin phosphate used in combination with tretinoin in the treatment of acne. Int J Dermatol 1983; 22 (1): 41–3

    Article PubMed CAS  Google Scholar 

54. Leyden JJ, Krochmal L, Yaroshinsky A. Two randomized, double-blind, controlled trials of 2219 subjects to compare the combination clindamycin/tretinoin hydrogel with each agent alone and vehicle for the treatment of acne vulgaris. J Am Acad Dermatol 2006; 54 (1): 73–81

    Article PubMed  Google Scholar 

55. Leyden J, Wortzman M, Baldwin EK. Tolerability of clindamycin/tretinoin gel vs. tretinoin microsphere gel and adapalene gel. J Drugs Dermatol 2009; 8 (4): 383–8

    PubMed  Google Scholar 

56. Draelos Z, Tanghetti E. Optimizing the use of trazarotene for the treatment of facial acne vulgaris: a multicenter, double-blinded, randomized parallelgroup trial. Cutis 2002; 69 (2 Suppl.): 20–29

    PubMed  Google Scholar 

57. Tanghetti E, Dhawan S, Torok H, et al. Tazarotene 0.1 percent cream plus clindamycin 1 percent gel versus tretinoin 0.025 percent gel plus clindamycin 1 percent gel in the treatment of facial acne vulgaris. Dermatol Online J 2007; 13 (3): 1

    PubMed  Google Scholar 

58. Brand B, Gilbert R, Baker MD, et al. Cumulative irritancy comparison of adapalene gel 0.1% versus other retinoid products when applied in combination with topical antimicrobial agents. J Am Acad Dermatol 2003; 49 (3 Suppl.): S227–32

    Article  Google Scholar 

59. Draelos ZD, Carter E, Maloney JM, et al. Two randomized studies demonstrate the efficacy and safety of dapsone gel, 5% for the treatment of acne vulgaris. J Am Acad Dermatol. 2007; 56 (3): 439 e1–10

    Article PubMed  Google Scholar 

60. Piette WW, Taylor S, Pariser D, et al. Hematologic safety of dapsone gel, 5%, for topical treatment of acne vulgaris. Arch Dermatol 2008; 144 (12): 1564–70

    Article PubMed CAS  Google Scholar 

61. Fleischer AB, Shalita A, Eichenfield LF, et al. Dapsone gel 5% in combination with adapalene gel 0.1%, benzoyl peroxide gel 4% or moisturizer for the treatment of acne vulgaris: a 12-week, randomized, double-blind study. J Drugs Dermatol 2010; 9 (1): 33–40

    PubMed  Google Scholar 

62. Pazoki-Toroudi H, Nilforoushzadeh MA, Ajami M, et al. Combination of azelaic acid 5% and clindamycin 2% for the treatment of acne vulgaris. Cutan Ocul Toxicol 2011 Dec; 30 (4): 286–91

    Article  Google Scholar 

63. Pazoki-Toroudi H, Nassiri-Kashani M, Tabatabaie H, et al. Combination of azelaic acid 5% and erythromycin 2% in the treatment of acne vulgaris. J Dermatolog Treat 2010; 21 (3): 212–6

    Article PubMed CAS  Google Scholar 

64. Langner A, Sheehan-Dare R, Layton A. A randomized, single-blind comparison of topical clindamycin + benzoyl peroxide (Duac) and erythromycin + zinc acetate (Zineryt) in the treatment of mild to moderate facial acne vulgaris. J Eur Acad Dermatol Venereol 2007; 21 (3): 311–9

    Article PubMed CAS  Google Scholar 

65. Draelos ZD. The multifunctionality of 10% sodium sulfacetamide, 5% sulfur emollient foam in the treatment of inflammatory facial dermatoses. J Drugs Dermatol 2010; 9 (3): 234–6

    PubMed  Google Scholar 

66. Seidler EM, Kimball AB. Meta-analysis comparing efficacy of benzoyl peroxide, clindamycin, benzoyl peroxide with salicylic acid, and combination benzoyl peroxide/clindamycin in acne. J Am Acad Dermatol 2010; 63 (1): 52–62

    Article PubMed CAS  Google Scholar 

67. Graupe K, Cunliffe WJ, Gollnick HP, et al. Efficacy and safety of topical azelaic acid (20 percent cream): an overview of results from European clinical trials and experimental reports. Cutis 1996; 57 (1 Suppl.): 20–35

    PubMed CAS  Google Scholar 

68. Thiboutot D. Versatility of azelaic acid 15% gel in treatment of inflammatory acne vulgaris. J Drugs Dermatol 2008; 7 (1): 13–6

    PubMed  Google Scholar 

69. Burkhart CG, Burkhart CN. Treatment of acne vulgaris without antibiotics: tertiary amine-benzoyl peroxide combination vs. benzoyl peroxide alone (Proactiv Solution). Int J Dermatol 2007; 46 (1): 89–93

    Article PubMed CAS  Google Scholar 

70. Eady AE, Cove JH, Layton AM. Is antibiotic resistance in cutaneous propionibacteria clinically relevant? Implications of resistance for acne patients and prescribers. Am J Clin Dermatol 2003; 4 (12): 813–31

    Article PubMed  Google Scholar 

71. Eady EA, Gloor M, Leyden JJ. Propionibacterium acnes resistance: a worldwide problem. Dermatology 2003; 206 (1): 54–6

    Article PubMed CAS  Google Scholar 

72. Cooper AJ. Systematic review of Propionibacterium acnes resistance to systemic antibiotics. Med J Aust 1998; 169 (5): 259–61

    PubMed CAS  Google Scholar 

73. Coates P, Vyakrnam S, Eady EA, et al. Prevalence of antibiotic-resistant propionibacteria on the skin of acne patients: 10-year surveillance data and snapshot distribution study. Br J Dermatol 2002; 146 (5): 840–8

    Article PubMed CAS  Google Scholar 

74. Ross JI, Snelling AM, Carnegie E, et al. Antibiotic-resistant acne: lessons from Europe. Br J Dermatol 2003; 148 (3): 467–78

    Article PubMed CAS  Google Scholar 

75. Thiboutot D, Gollnick H, Bettoli V, et al. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group . J Am Acad Dermatol 2009; 605 Suppl.S 1–5

    Article  Google Scholar 

76. Nast A, Bayerl C, Borelli C, et al. S2k-guideline for therapy of acne [in German]. J Dtsch Dermatol Ges 2010; 8 Suppl. 2: s1–59

    Google Scholar 

77. Patel M, Bowe WP, Heughebaert C, et al. The development of antimicrobial resistance due to the antibiotic treatment of acne vulgaris: a review. J Drugs Dermatol 2010; 9 (6): 655–64

    PubMed  Google Scholar 

78. Handojo I. The combined use of topical benzoyl peroxide and tretinoin in the treatment of acne vulgaris. Int J Dermatol 1979; 18 (6): 489–96

    Article PubMed CAS  Google Scholar 

79. Shalita AR, Rafal ES, Anderson DN, et al. Compared efficacy and safety of tretinoin 0.1% microsphere gel alone and in combination with benzoyl peroxide 6%cleanser for the treatment of acne vulgaris. Cutis 2003; 72 (2): 167–72

    PubMed  Google Scholar 

80. Thiboutot DM, Weiss J, Bucko A, et al. Adapalene-benzoyl peroxide, a fixeddose combination for the treatment of acne vulgaris: results of a multicenter, randomized double-blind, controlled study. J Am Acad Dermatol 2007; 57 (5): 791–9

    Article PubMed  Google Scholar 

81. Leyden JJ, Preston N, Osborn C, et al. In-vivo effectiveness of adapalene 0.1%/benzoyl peroxide 2.5% gel on antibiotic-sensitive and resistant Propionibacterium acnes. J Clin Aesthet Dermatol 2011; 4 (5): 22–6

    PubMed  Google Scholar 

82. Jackson JM, Fu JJ, Almekinder JL. A randomized, investigator-blinded trial to assess the antimicrobial efficacy of a benzoyl peroxide 5%/clindamycin phosphate 1%gel comparedwith a clindamycin phosphate 1.2%/tretinoin 0.025%gel in the topical treatment of acne vulgaris. J Drugs Dermatol 2010; 9 (2): 131–6

    PubMed  Google Scholar 

83. Bowman S, Gold M, Nasir A, et al. Comparison of clindamycin/benzoyl peroxide, tretinoin plus clindamycin, and the combination of clindamycin/benzoyl peroxide and tretinoin plus clindamycin in the treatment of acne vulgaris: a randomized, blinded study. J Drugs Dermatol 2005; 4 (5): 611–8

    PubMed  Google Scholar 

84. Nast A, Dreno B, Bettoli V, et al. European evidence based (S3) guideline for treatment of acne (ICD L70.0). EU Acne Guidelines Group; draft version 13/5/2011 [online]. Available from URL: (http://www.acne-guideline.com/home_eu/External_open_review/) [Accessed 2011 May 28]

85. Acne Working Group. Management of mild and moderate acne vulgaris. GP Review 2008 Jan 1–11

86. Alexis AF. Clinical considerations on the use of concomitant therapy in the treatment of acne. J Dermatolog Treat 2008; 19 (4): 199–209

    Article PubMed CAS  Google Scholar 

87. Gupta AK, Lynde CW, Kunynetz RA, et al. A randomized, double-blind, multicenter, parallel group study to compare relative efficacies of the topical gels 3% erythromycin/5% benzoyl peroxide and 0.025% tretinoin/eryth romycin 4% in the treatment of moderate acne vulgaris of the face. J Cutan Med Surg 2003; 7 (1): 31–7

    Article PubMed  Google Scholar 

88. Burkhart CG, Scheinfeld NS. Benzoyl peroxide skin washes: basis, logic, effectiveness, and tolerance. Skinmed 2005; 4 (6): 370

    PubMed  Google Scholar 

89. Kraus AL, Munro IC, Orr JC, et al. Benzoyl peroxide: an integrated human safety assessment for carcinogenicity. Regul Toxicol Pharmacol 1995; 21 (1): 87–107

    Article PubMed CAS  Google Scholar 

90. Rothman KF, Pochi PE. Use of oral and topical agents for acne in pregnancy. J Am Acad Dermatol 1988; 19(3): 431–42

    Article PubMed CAS  Google Scholar 

91. Parry MF, Rha CK. Pseudomembranous colitis caused by topical clindamycin phosphate. Arch Dermatol 1986; 122 (5): 583–4

    Article PubMed CAS  Google Scholar 

92. Yentzer BA, Ade RA, Fountain JM, et al. Simplifying regimens promotes greater adherence and outcomes with topical acne medications: a randomized controlled trial. Cutis 2010; 86 (2): 103–8

    PubMed  Google Scholar 

93. Bikowski J. A review of the safety and efficacy of benzoyl peroxide (5.3%) emollient foam in the management of truncal acne vulgaris. J Clin Aesthet Dermatol 2010; 3 (11): 26–9

    PubMed  Google Scholar 

94. Nguyen D, Ornstein C, Weber T. Dollars for docs: how industry dollars reach your doctors [online]. Available from URL: (http://projects.propublica.org/docdollars/) [Accessed 2011 Sep 15]

Download references