Beyond first-line treatment: management strategies for maintaining acne improvement and compliance.

The management of acne vulgaris is a long-term process that must be individualized to each patient. Relevant factors influencing treatment include the age and gender of the patient, the severity and extent of disease, the efficacy and tolerability of prior interventions, and the degree of compliance with recommended therapies. The follow-up phase of acne management requires a framework for approaching treatment modification that may include concepts such as up-titration, add-on, or switching of available agents to improve efficacy and tolerability. Whenever oral antibiotics are used, abrupt discontinuation in favor of topical maintenance therapy rather than gradual tapering is recommended. Strategies for assessing and optimizing medical adherence are reviewed.