• Topical antibiotics should never be used alone. It should always be combined with topical benzoyl peroxide (BPO) or combination of BPO/retinoids.
• Systemic antibiotics when used should be for short durations of 8-12 weeks.
• For maintenance therapy, topical retinoids should be used as it prevents microcomedone formation. In pregnancy and lactation, topical azelaic acid can be used for maintenance treatment.
• Omega-3, 1 g/day may decrease xerosis by increasing skin hydration.
• Spironolactone which inhibits androgen receptors on sebocytes is an excellent drug for hormonal therapy in acne, but is often underutilized by dermatologists.
• Dairy products especially skimmed milk, whey protein, high glycemic diet and vitamin B12 supplements can trigger acne. For premenstrual flares a short-course of cetirizine for 8 days prior to cycles can be useful.
• Soap free cleansers and non-oily moisturizers will help increase compliance to medications in acne. Treating acne is easier than treating scars. Early and judicious treatment helps prevent marks and scars.
• Several newer agents like topical trifarotene a fourth-generation retinoid, 3% adapalene, 4% nitric oxide, sarecycline, a new tetracycline, topical olumacostat glasaretil, etc. are in the pipeline.

Practice sutra: In the present era of high incidence of antibiotic resistance to P. acnes, dermatologists should judiciously use topical and systemic antibiotics.