Preventing Acne Recurrence It is important to maintain treatment Acne is a chronic condition and patients may have recurrences after treatment. Microcomedones decrease during treatment and increase after topical medications are discontinued. Therefore, maintenance treatment is important to prevent acne flare-ups. Although there is no consensus on the meaning of maintenance therapy for acne, Wolf et al. provide a strong definition: the regular use of appropriate therapeutic agents to ensure that acne is in an identifiable state of remission. The most effective maintenance medications are topical retinoids due to their anti-acneogenic and acne-dissolving properties. Adapalene, a topical retinoid, has been shown to have a significant reduction in microcomedema formation in acne patients. Studies have shown a significant reduction in acne lesions after 16 weeks of maintenance treatment with 0.1% adapalene gel compared to the placebo group. Adapalene can also be used as a fixed-dose combination of benzoyl peroxide. Studies have shown that 0.1% adapalene gel in combination with 2.5% benzoyl peroxide gel is effective and satisfactory as a maintenance treatment for severe acne after 9 months of low levels of Propionibacterium acnes. Adjunctive treatment Chemical peels and photophoresis Chemical peels are available for acne patients. Glycolic acid can be used for acne-inflammatory damage and superficial scarring, polyethylene glycol salicylic acid or ethanol salicylic acid for acne-inflammatory damage, and trichloroacetic acid for superficial scarring. A randomized trial showed that a lipid-soluble hydroxy acid derivative of salicylic acid was as effective as 5% benzoyl peroxide gel for mild to moderate acne. Energy output devices are available as options for acne patients who are intolerant or unresponsive to standard treatment regimens. These options include: intense pulsed light, pulsed dye laser, KTP laser, neodymium-doped yttrium aluminum garnet laser, Q-modulated laser, ultraviolet light, red light, blue light, and photodynamic therapy. Of these, Q modulation is reliable for keratosis pilaris and photodynamic therapy is more effective for moderate to severe acne. Prevention of drug resistance SASA agrees with the guideline recommendations and emphasizes effective measures to prevent the development of antibiotic resistance. These measures include avoiding antibiotic monotherapy, avoiding concomitant oral and topical antibiotics, limiting the duration of antibiotic therapy, and avoiding antibiotics as a maintenance regimen. Topical antibiotics should be combined with benzoyl peroxide and topical retinoids. The SASA Collaborative Group recommends a course of oral and topical antibiotics for acne of less than 12 weeks and good compliance with treatment; it also recommends that the patient’s response to treatment be evaluated every 8 to 12 weeks. Skin care Cleansing, moisturizing and sun protection Skin care is also important for acne treatment, and this includes cleansing, moisturizing and sun protection (protection from UV radiation). Studies have shown that acne patients who wash their faces twice a day with a mild cleanser show significant improvement in their skin and that cleansers reduce the number of inflammatory and non-inflammatory lesions. The ideal cleanser should be non-comedogenic, non-acneic, non-irritating and non-sensitizing. Cleansers should also meet the following requirements: be appropriate for the patient’s skin type; be mild, alcohol-free and non-abrasive; and may contain active anti-acne ingredients such as benzoyl peroxide or salicylic acid. Moisturizers can be used on dry and irritated skin due to acne treatment and can improve topical tolerance of topical treatments. Moisturizers should be water-based, non-greasy, non-comedogenic, non-acneic and hypoallergenic. UV radiation protection is an important adjunctive treatment for acne, preventing hyperemesis and reducing the incidence of photosensitivity dermatitis after oral and topical retinoids. Patients should be educated and encouraged to use umbrellas or hats and sunscreen preparations. A broad-spectrum noncomedogenic sunscreen with a sun protection index above 30 is recommended; to avoid irritation, sunscreens with a water or light liquid base are preferred. Considering the non-adherence of patients, measures are recommended to improve this. The lack of patient understanding of acne can be addressed by educating/informing the patient and establishing open communication. It is important to discuss treatment expectations, the course of treatment, and the time needed to achieve significant results. In addition, skin care (cleansing and moisturizing) should be emphasized to patients to improve compliance.