| Clinical Recommendation | Evidence Rating* | References |
|---|---|---|
| Topical azelaic acid (15% or 20%) and benzoyl peroxide (2.5–5%) are effective baseline agents. | B | 36, 37 |
| Topical erythromycin in combination with benzoyl peroxide (5% maximum) can be used as alternative treatment for inflammatory acne. | C | 36 |
| Topical clindamycin in combination with benzoyl peroxide can be used as alternative treatment for inflammatory acne. | C | 37 |
| Topical dapsone is a newer anti-acne agent with less available safety data and should be used with caution in pregnant patients. | C | 18 |
| Topical and oral antibiotics (eg, erythromycin) should be used in combination with benzoyl peroxide to reduce the risk of bacterial resistance. | C | 11 |
| Oral cephalexin can be used in moderate to severe inflammatory acne. | C | 25 |
| Intralesional steroid injections can be used to treat moderate to severe inflammatory acne. | C | 33 |
| Oral glucocorticoids can be used short term to treat fulminant acne after the first trimester. | C | 36 |
↵* B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the Strength of Recommendation Taxonomy evidence rating system, go to http://www.aafp.org/afpsort.xml.