| Drug | Class | Adult | Paediatric | Notes |
|---|---|---|---|---|
| Adapalene 0.1% gel (topical retinoid)[1] | Topical retinoid | Apply pea-sized amount once daily at night to affected areas | ≥9 years per local label | First-line topical for mild acne and maintenance; less irritation than tretinoin; safe in skin of colour; sun protection essential |
| Benzoyl peroxide 2.5–5% gel[1] | Topical antimicrobial | Apply once or twice daily | ≥12 years | Reduces P. acnes resistance when combined with antibiotic; bleaches fabric; mild irritation; combine with retinoid |
| Doxycycline (oral)[1] | Tetracycline antibiotic | 100 mg PO daily × 3 months maximum | ≥8 years: 1 mg/kg/day; ≥12 years: 100 mg daily | First-line oral antibiotic for moderate acne; photosensitivity — sunscreen counselling; oesophageal irritation — take with water and upright; combine with topical retinoid + BPO; never as monotherapy |
| Isotretinoin (oral)[1] | Oral retinoid | 0.5–1 mg/kg/day to cumulative 120–150 mg/kg over 4–6 months | Per dermatologist | Severe/nodulocystic or refractory acne; severe teratogenicity — pregnancy prevention programme; LFT/lipids monitoring; mucocutaneous side effects; counsel about mood |
| Spironolactone (women)[1] | Aldosterone antagonist | 50–100 mg PO daily titrated to 200 mg | — | Adult women with hormonal pattern; pregnancy contraindicated (anti-androgen feminisation of male fetus); potassium and BP monitoring |
Severity-graded topical, oral, and isotretinoin-based management of acne vulgaris in adolescents and adults; pigmentation considerations.