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Treatment of acne prior to referral was recorded retrospectively in 72 patients alleged to have responded inadequately; 60% had used benzoyl peroxide (BP) but most applied it to lesions only. Although 86% had used tetracycline, most did not take it correctly for maximum absorption and took less than 1 g/day. Most patients used both drugs for less than three months. Eight-two patients referred because of inadequate response were treated with: (I) 5% benzoyl peroxide (BP) (23 patients); (II) 5% BP and 0.5 g/day oxytetracycline (OTC) (24 patients); (III) 5% BP and 1 g/day OTC (18 patients); (IV) 5% BP and 1.5 g/day OTC (17 patients). BP was applied incrementally from 30 min up to 8-10 hours daily to the entire area affected and OTC taken as a single morning dose. Median grade of severity (0-10 analogue scale) fell by 2 in Groups I and II (P less than 0.05), by 2.5 in Group III (P less than 0.05) and by 3 in Group IV (P less than 0.05); number of lesions fell by 56% +/- 7% (s.e.), (P less than 0.001) 70% +/- less than 10% (P less than 0.001), 75% +/- 8% (P less than 0.001) and 78% +/- 10% (P less than 0.001) respectively and treatment was well tolerated. Thus, although effective drugs are frequently prescribed in acne, method of use, dose and duration are likely to determine response.