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Key MessagesYou don't treat acne, you
prevent it. There is no one best or ‘one-size fits all’ acne
treatment.
So preventing acne requires some patience and some
experimentation to find the right program for you.
Finding the best topical medications - medications you put on your skin - depends on
your skin type.
For oily skin, choose a solution or gel-based product.
For dry skin, choose a cream or lotion-based product.
It is helpful to look in the mirror and decide whether
your acne is mostly:
inflammatory (redness + swelling); plugging
(whiteheads + blackheads) or both.
Treatment Basics
Talk to your doctor about acne. Below is a list of common (but not all) medications for acne.
Benzoyl peroxide (2.5% to 5%) products are available
without a prescription and are usually tried first for mild to
moderate inflammatory acne.
Then youcan add a retinoid or
an antibiotic.
Generally, products require 8 to 12 weeks for
noticeable improvement.
Some products may initially worsen acne - you
need to give it time.
Don't just apply acne products to your individual
pimples!
Apply acne products to all the skin area that you
commonly get pimples to reduce the chance of
further breakouts.
Isotretinoin has some side-effects and cannot be
taken by pregnant women...
...but it is the most effective agent for acne.
Product Best For Works By Applied Common Side Effects
Comments
Legend
Benzoyl Peroxide(2.5% to 5%*)
(e.g., Benzac AC, Benzagel, Panoxyl Aquagel, Solugel)
• Inexpensive
• Can bleach hair, clothing, bed sheets; lingering odor
• Water-based product less irritating
• Benzoyl peroxide-containing soaps and washes are less effective
• Benzoyl peroxide can degrade other products. Use a commercial combination product or space out application times if also using a retinoid or antibiotic.
• Irritation can be minimized by gradually increasing wear time (e.g., applying every other day initially; or, wearing for 2 to 4 hours per night increasing to all night as tolerated)
• Topical benzoyl peroxide is safe in pregnancy
Salicyclic Acid(.5 to 2%)
(e.g. Clearasil Ultra Vanishing Treatment Cream, Noxzema Anti-Acne Gel or Pads, Neo-strata Blemish Spot Gel, Oxy maximum cleaning pads, foaming face wash)
Reducing plugging by exfoliation
• Very commonly used, as available over the counter, but not nearly as much research support compared to other first line agents such as BP or retinoids
Non-prescription, topical
Mild to moderate acne
Reducing inflammation and P. acnes bacteria
At bedtime or up to twice daily
Skin irritation, redness, flaking
Mild acne At bedtime or twice daily
Drying of skin, irritation, redness, flaking
*Concentrations above 5% require a prescription
mild to moderate acnemild acne
bedtimeplugging
inflammation
twice daily
Product Best For Works By Applied Common Side Effects
Comments
Legend
Retinoid
(e.g., adapalene (Differin 0.1% gel,cream; XP 0.3%), tretinoin (Rejuva-A, Renova, Retin-A) tazarotene)
• Tolerance to irritation develops over time
• Wear sunblock with SPF 15 or higher
• Adapalene is best tolerated
• Avoid retinoid use if pregnant
Topical Antibiotic
(e.g., clindamycin (Dalacin T 1% solution, Clinda T 1% solution, Clindets pads)
Reducing inflammation and P. acnes bacteria
• Most effective when combined with benzoyl peroxide or retinoid
• Combination with benzoyl peroxide reduces the chance of bacterial resistance
• Can stop use when inflammation subsides
• Topical erythromycin and clindamycin are safe in pregnancy
Prescription, topical
Mild to moderate acne with whiteheads, blackheads
Unplugging sebaceous glands and reducing inflammation
At bedtime Skin irritation, increased risk of sunburn
Mild to moderate acne with whiteheads, blackheads
Twice daily Skin irritation, redness, dry skin, flaking
mild to moderate acne bedtime
plugging inflammation
twice daily
Product Best For Works By Applied Common Side Effects
Comments
Legend
Benzoyl Peroxide + Retinoid
(e.g., Tactuo®)
• Benzoyl peroxide component can bleach hair, clothing, bed sheets; lingering odor
• Wear sunblock with SPF 15 or higher
Antibiotic + Retinoid
(e.g., Clindamycin and tretinoin (Biacna*) Erythromycin + trentinoin (Stievamycin mild,reg, forte)
Reducing inflammation and P. acnes bacteria; unplugging sebaceous glands
• Wear sunblock with SPF 15 or higher
Prescription, topical - combination products
Mild to moderate acne with whiteheads, blackheads
Reducing inflammation and P. acnes bacteria; unplugging sebaceous glands
At bedtime Skin irritation, dry skin, redness, burning, flaking, increased risk of sunburn
Mild to moderate acne with whiteheads, blackheads
At bedtime Skin irritation, redness, dry skin, flaking, increased risk of sunburn
Benzoyl Peroxide + Antibiotic
(e.g., Benzaclin®, Benzamycin®, Clindoxyl®)
Reducing inflammation and P. acnes bacteria
• Benzoyl peroxide component can bleach hair, clothing, bed sheets; lingering odor
• Benzamycin has to be refrigerated
Mild to moderate acne with whiteheads, blackheads
Skin irritation, itching, redness, dry skin, flaking
At bedtime (Benzaclin®, Clindoxyl®) or twice daily (Benzamycin®)
mild to moderate acne bedtime
plugging inflammation
twice daily
Product Best For Works By Applied Common Side Effects
Comments
Legend
Antibiotic
(e.g., tetracyclines (doxycline, minocycline, tetracycline), erythromycin, Septra)
• Pulsed (vs. continuous) use may reduce risk of bacterial resistance
• Avoid tetracylines, TMP or TMP/SMX use if pregnant
• Avoid taking tetracycline at bedtime to reduce risk of capsule getting stuck in throat and causing an ulcer
• Wear sunblock with SPF 15 or higher (especially with tetracyclines)
• Topical benzoyl peroxide is safe in pregnancy
IsotretinoinOral Retinoid
(eg. Accutane, Amnesteem, Claravis, Sotret)
Unknown: acts on sebaceous glands reducing sebum production
• Highly effective for moderate to severe inflammatory acne
• Causes birth defects; Use two birth control methods. Avoid/stop retinoid use if pregnant
• Taken with food
• Usually taken for 4 to 5 months
• Use a moisturizer and lip balm
• Wear sunblock with SPF 15 or higher
• Monitor for signs/ symptoms of depression
Prescription, systemic (oral)
Moderate to severe acne
Reducing P. acnes bacteria by slowing proliferation
Once daily: (doxycycline, minocycline, TMP) or twice daily (tetracycline,erythromycin,TMP/SMX)
Gastro-intestinal upset, increased risk of sunburn (tetra-cyclines), increased risk of yeast infection
Moderate to severe acne.. but usually more severe
Once or twice daily depending on regimen
Dryness (e.g., mouth, nose, eyes), peeling, redness, irritation, pain and swelling of lips, headache, fatigue, hair loss, joint pain, increased risk of sunburn, increased blood cholesterol and triglycerides
twice dailymoderate to severe acne
once dailybacteria
unknown
Product Best For Works By Applied Common Side Effects
Comments
Legend
Oralcontra-ceptives
(Alesse, Aviane,Diane-35, Tri-Cyclen, Yasmin,Yaz)
• Avoid the ‘mini pill’ (progestin only) since it may worsen acne
• Avoid in smokers over age 35
• Avoid if history of blood clots
Azelaic acidFinacea 15% gel
(eg. Accutane, Amnesteem, Claravis, Sotret)
Has bothantimicrobialand anti-comedonalproperties
• Naturally occurring acid
• Newer medication
• Need to monitor for hypopigmentation
• American Guidelines note that its clinical use, compared to other agents, has limited efficacy according to experts.
Other
Moderate to severe acne in females
Anti-androgeneffect
Once daily Breakthrough bleeding/ spotting, suppression ofmenstruation, nausea,vomiting, breast tenderness, headache,bloating, mood changes
Moderate tosevere acne
Twice daily Can cause skin coulour lightening, especially in darker- skinned patients
References: e-CPS product monographs (e.g., Accutane®), e-Therapeutics (“Skin Disorders: Acne”, “Sexual Health:
Contraception”), RxFiles (“ACNE Pharmacotherapy – Comparison Chart”), Up-to-Date [“Patient information: Acne
(Beyond the Basics)”] Copyright ©2012 Evans Health Lab
twice dailyonce daily
moderate to severe acne
anticomedonal antimicrobial
anti-androgen
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