11 Medications For Treating Acne

Medications For Treating Acne

The goals of treatment of acne are controlling the lesions and preventing scarring. Improvement in appearance may not happen for 3-6 weeks. Maximal benefits may be seen after 8-12 weeks of therapy. The medications available are topical and systemic agents.


Medications for Acne

Topical Agents

Topical agents may be available as solutions, gels, creams or lotions. Gels and solutions are best for patients having oily skin. Creams are better for patients with dry or sensitive skin. Lotions are appropriate for any type of skin. These agents should be applied after the affected area has been washed and patted dry, being sure to avoid the eyes, nose and mouth.


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Topical Agents


Benzoyl Peroxide

Benzoyl peroxide (BPO) has both antibacterial and comedolytic (breaking up of whiteheads or blackheads and unclogging the pores) properties. It is available in various concentrations (2.5-10%) and formulations (gel, cream, lotion and body washes). Apply a thin film of BPO to the affected areas once or twice daily. Side effects develop usually in the first week of therapy.

They include skin rash (1-2%), peeling and dryness; these will decrease with continued use. To reduce these side effects, without affecting the benefits of the medication, the concentration of BPO or the frequency of administration should be altered. BPO may also cause bleaching of clothes and bed linen. For mild acne, BPO alone may suffice. For moderate acne, BPO is used in combination with a topical retinoid for best results.

Benzoyl Peroxide


Retinoids

Retinoids are comedolytic and anti-inflammatory as well. They are indicated for mild to moderate acne. Common side effects include dryness, redness, scaling, itching and burning. Acne may even worsen in the first few weeks of therapy. You should avoid prolonged exposure to the sun as it may worsen the skin irritation. Be sure to wear sunscreen daily (sun protection factor >/= 15) and start with a pea-sized amount per application.

The retinoids that are available are (1) Tretinoin – This is to be applied nightly. Tretinoin gel is more potent than its cream.  Therapy should be started with 0.025% cream every other day and titrated up as needed, particularly in those with sensitive or fair skin. Its safety in pregnancy is not proven, so pregnant women should consult their doctor before using it. (2) Adapalene – This is to be applied nightly. It is available as gel and cream (0.1%). It causes less skin irritation than the other topical retinoids. (3) Tazarotene – This is a second-line topical retinoid. It is available as gel or cream (0.1%). It is contraindicated in pregnancy.

Retinoids


Azelaic Acid

This has bacteriostatic (halting the growth of bacteria) and keratolytic (removing the excess thickened portions of skin) properties. It is available as 20% cream. It should be massaged into the skin twice daily. Skin irritation and redness can occur in 1-5% of people. You should use it if you have mild to moderate acne and are unable to tolerate topical retinoids. If you have a dark complexion, use it with caution because it can cause decreased pigmentation of the skin.


Exfoliating Agents

These are salicylic acid and sulfur. Use them only if you cannot tolerate BPO or retinoids because they are not as effective.

Exfoliating Agents


Topical Antibiotics

These work by inhibiting the growth and activity of the bacteria that is supposedly responsible for acne, Propionibacterium acnes. They also inhibit the formation of comedones (blackheads and whiteheads). They are to be applied once or twice daily. Common side effects are skin irritation and staining of clothes. If used in combination with BPO there is synergistic action and also decreases the risk of antibiotic resistance.

Commonly used topical antibiotic preparations are (1) Clindamycin – It is available as a gel, solution or lotion (usually 1% concentration). (2) Erythromycin – It is available as gel and ointment.

Topical Antibiotics


Systemic Agents

Systemic Antibiotics

These are commonly taken for inflammatory acne (acne with redness, swelling and pain). You should take them for 3-4 months. Antibiotic resistance is likely to develop after 4 months of uninterrupted therapy. The antibiotics most commonly prescribed for acne are tetracycline, doxycycline, and erythromycin. However, erythromycin is a second-line agent because of greater degree of resistance to it. Main side effects are gastrointestinal upset and vaginal infection with the fungus Candida.

The doses of the systemic antibiotics used are (1) Tetracycline – The dose is 250-500 mg twice daily. It should be taken on an empty stomach and 1-2 hours before or 4 hours after antacids or dairy products. It is contraindicated in pregnant women and in children less than 9 years because it can stain the developing teeth. (2) Doxycycline – Its dose is 100 mg twice daily. It is superior to tetracycline in some respects. However, it can cause increased photosensitivity (sensitivity to light). (3) Erythromycin – The dose is 1-2 g in 2-4 divided doses. It is generally given only to those who cannot tolerate tetracyclines. (4) Other antibiotics include minocycline, azithromycin and trimethoprim-sulfamethoxazole.

Systemic Antibiotics


Oral Contraceptives

Oral contraceptives (OCs) cause significant reduction in lesion development by blocking or reducing androgens. They work best in combination with other agents, either topical or systemic.  OCs that combine ethinyl estradiol with norgestimate or desogestrel are the best choice. OCs containing drospirneone are also good.

Oral Contraceptives


Isotretinoin

Oral isotretinoin is usually used for severe acne. It works against all the aspects of the disease. The dose is 0.5-1 mg/kg body weight daily in 2 divided doses. 2 mg/kg can be used if the disease is severe. Initial therapy is for 4-5 months, with repeat courses, if necessary, after at least 2 months of initial therapy. Side effects include dryness of skin, mouth and nose, inflammation of lips (cheilitis) and eyes (conjunctivitis), and photosensitivity. Muscle and joint pains can also occur. It is best avoided by pregnant women as there is an increased risk of fetal malformation.

Isotretinoin


Spironolactone

Spironolactone is an antiandrogen, whose use is generally limited to women with treatment-resistant acne. It should be avoided in males because it can cause feminization. Dose is 50-100 mg/day in 2-3 divided doses. Menstrual irregularities are the most common side effects. Other side effects are breast enlargement and tenderness, reduced libido and increased potassium levels (hyperkalemia).

Spironolactone


Corticosteroids

Intralesional corticosteroid injection is adjunctive therapy that produces a rapid reduction in inflammation and reduces the likelihood of scarring. Diluted triamcinolone (0.63-2.5 mg/ml) is most commonly used. It may be repeated after 3 weeks if necessary. Side effects like local skin atrophy and changes in pigmentation can be reduced by using a dilute solution.

Corticosteroids

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