TOPICAL
(CREAMS, OINTMENTS, ETC.) TREATMENT OF ACNE
Benzoyl
Peroxide
Available
as lotions, creams or gels in a variety of concentrations,
2.5%, 5%, 10%, benzoyl peroxide is available over-the-counter
as well as by prescription. It kills the bacteria, P.
Acne. Research shows that 10% strength is not necessarily
more effective than the 2.5% or 5% and can be more irritating
to skin. It is applied as a thin film on the face once or
twice a day.
Benzoyl
Peroxide can cause mild redness and scaling of the skin
but on continued use, this problem usually goes away. It
is known that in 1-2% of the population, it can cause an
allergic reaction. Another version is caused Desquam-E,
which is less irritating. Desquam-E is combined with an
antibiotic, erythromycin, and released under the name of
Benzamycin. This combined preparation is more effective
but must be prescribed by a physician.
Retinoids
Retin-A:
Retinoids, such as Retina (tretinoin) are a derivative of
vitamin A. Retinoids works by preventing acne formation
by affecting the way skin is growing and being shed. This
prevents blockage of follicles and therefore prevents a
place for sebum to collect and bacteria to multiple. When
first used, it can actually cause a brief flare-up of acne.
Known
side effects of the retinoids include skin irritation and
sensitivity to sunlight. It is thought that by thinning
the skin, these products increase sensitivity to the ultraviolet
light of sun. Wear hats and sunscreen (at least SPF 15)
if you are placed on this medication.
Retina
is available in cream, gel, and liquid and in different
strengths. It is recommended to start with the lowest strength
and increase the dosage if the effectiveness is not enough
and there is no skin irritation. The liquid version is the
most potent and should be applied 30 minutes after washing
and drying the face. Allowing the skin to dry decreases
the depth of absorption and therefore prevents extensive
irritation.
Oral
Retina medications may be teratogenic (cause birth defects)
and should be avoided in pregnant women or those who are
trying to get pregnant. There is no evidence that topical
Retina is teratogenic.
Retina
Micro and Renova: Tretinoin
0.1% gel is available as Retina Micro, with a time-release
microsponge delivery system. It is shown that this method
causes less irritation to the skin and may be preferred
over other forms. Microscopically, higher concentrations
of medicine are delivered to the targeted follicle without
irritating the surrounding area. A topical version containing
a moisturizing base, called Renova, is used for patients
who suffer from significant skin dryness.
Adapalene
Gel (Differin): A
recently introduced naphthoic acid, Adapalene gel is
thought to have a faster onset of action, more speedy recovery
period, and less skin irritation than other topical creams.
It is applied at bedtime as a thin layer of film over the
affected area, and may worsen acne in the first few weeks
of treatment.
Tazarotene:
Available
as gel applied once daily in the evenings, Tazarotene
is a Retinoid that is FDA approved for mild to moderate
acne and has been used for plaque psoriasis (a skin disease)
in the past. All of the side effects of other Retinoids
apply to this medication as well.
Azelaic
Acid (Azelex cream)
FDA-approved
in the U.S. in 1996, Azelaic Acid is a relatively new drug
derived from a substance found in wheat, rye, and barley.
It kills bacteria as well as clears the inflammation of
acne. It is known to be as effective as benzoyl peroxide
and topical erythromycin.
One
advantage of Azelaic acid is that it does not cause photosensitivity.
It can be a good choice for people with very fair skin who
cannot avoid being in the sun. Side effects are itching,
burning, and stinging, which may stop after a few weeks
of daily treatment.
Topical
Antibiotics (Clindamycin
and Erythromycin)
Two
popular topical antibiotics used to destroy P. Acne
are clindamycin and erythromycin. Both are available in
various forms, including gel, cream, lotion, solutions,
and pads. And both antibiotics are considered equally effective.
Some
physicians prescribe a topical antibiotic concurrently with
the oral form, in hopes of achieving better outcome. However,
there is no proof that there is an advantage to this strategy.
In fact, it appears that the topical form can be as effective
as the oral form. The choice depends on the patient’s
preference and compliance. Some studies show that P.
acne, the bacteria responsible for acne, may develop
resistance to erythromycin after six months of therapy.
Benzamycin:
Benzamycin
is a topical antibiotic with a combination of 5% benzoyl
peroxide and 3% erythromycin. Studies show that this combination
is more effective than either one alone, because it prevents
the resistance of the bacteria to erythromycin. This medication
needs to be refrigerated.
