Oral isotretinoin is first-line treatment in severe nodular acne, with other agents indicated as second-line or adjunctive therapy

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Oral isotretinoin is the first-line treatment option for severe nodular acne. If isotretinoin is contraindicated or poorly tolerated, combination therapy with an oral antibacterial, benzoyl peroxide and a topical retinoid is recommended. Other options include oral anti-androgens and corticosteroids.

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