Fixed-combination products in the management of acne vulgaris

Acne vulgaris is the most common dermatologic disorder in the United States. Although its cause is unknown, various factors are implicated in its pathogenesis. No single topical antiacne medication acts on all the major pathophysiologic events. Combined use of agents with different modes of action provides better patient outcomes than monotherapy. Topical fixed-combination therapies include antibiotics with benzoyl peroxide (BPO) or retinoids, and retinoids with BPO. With increased efficacy can come increased irritation from the combination or formulation excipients. Surfactants, preservatives, and high levels of organic solvents including alcohols found in some products are potential irritants. This review considers data on topical fixed-combination acne medications and developments focused on newer lower concentration, optimized formulations aimed at reducing dryness and irritation without compromising efficacy. In the absence of direct comparative clinical trials, this review provides timely guidance for clinicians on the use of these agents.