What is the first-line treatment for comedonal acne?

The first-line treatment for comedonal acne is a topical retinoid. Topical retinoids, which include medications like tretinoin, adapalene, and tazarotene, are effective in treating comedonal acne because they promote the turnover of skin cells and prevent the clogging of follicles by reducing the formation of both open (blackheads) and closed (whiteheads) comedones.

By accelerating cell turnover, topical retinoids help to shed dead skin cells that can block pores, thereby preventing new comedones from forming. They also exhibit anti-inflammatory properties that can improve the overall appearance of the skin and support the management of acne.

Other treatments listed, such as oral antibiotics, are generally more suited for inflammatory acne rather than comedonal acne, addressing issues like pustules and cysts. Salicylic acid can be helpful as an adjunctive treatment but is not the first-line approach specifically for comedonal forms. Isotretinoin is reserved for severe, recalcitrant acne due to its potent side effects and is not appropriate as a first-line treatment for mild cases, including comedonal acne.