| Agent | FDA Category | Mechanism of Action | Available Formulations | Notes |
|---|---|---|---|---|
| Azelaic acid | B | Antimicrobial Comedolytic Anti-inflammatory Antityrosinase activity | Cream (20%; approved for acne) Gel (15%; approved for rosacea) | Monotherapy is possible No known bacterial resistance Can improve postinflammatory hyperpigmentation |
| Benzoyl peroxide | C | Antibacterial Comedolytic Anti-inflammatory | Wash, bar, pad, gel, mask, foam, lotion, cream (2.5–10%) | Monotherapy is possible No known bacterial resistance Can cause bleaching |
| Salicylic acid | C | Comedolytic Keratolytic | Lotion, cleanser, gel, cream, foam, soap, toner, pads (0.5- 6%) | Generally well-tolerated by patients Less effective than azelaic acid or benzoyl peroxide |
| Erythromycin | B | Antibacterial | Gel, solution, pad, ointment (2%) Erythromycin/benzoyl peroxide gel (3%/5%) | Should not to be used as monotherapy Bacterial resistance is diminished by combining with benzoyl peroxide |
| Clindamycin | B | Antibacterial | Gel, lotion, solution, foam, swab (1%) Clindamycin/benzoyl peroxide gel (1%/5%, 1.2%/2.5%) | Should not to be used as monotherapy Use with caution in patients with a history of gastrointestinal disease Bacterial resistance is diminished by combining with benzoyl peroxide |
| Tazarotene | X | Comedolytic Anti-inflammatory | Cream, gel, foam (0.05%/0.1%) | Contraindicated in pregnancy |
| Tretinoin | C | Comedolytic Anti-inflammatory | Gel (0.01%/0.025%/0.05%), microsphere gel (0.04%/0.08%/0.1%), cream (0.02–0.1%), topical solution (0.05%) | Not recommended in pregnancy |
| Adapalene | C | Comedolytic Anti-inflammatory | Lotion, cream (0.1%) Gel (0.1%/0.3%) Adapalene/benzoyl peroxide gel (0.1%/2.5%) | Not recommended in pregnancy |
| Dapsone | C | Anti-inflammatory Antimicrobial | Gel (5%) | Low risk of maternal anemia, neonatal hyperbilirubinemia, and hemolytic anemia in patients with G6PD deficiency (for topical dapsone) |
FDA, US Food and Drug Administration; G6PD, glucose-6-phospate dehydrogenase.