Skin care can be daunting for the more than 37-million teenagers and adults
who suffer from acne, the most common skin disorder in the United States.
The abundance of over-the-counter and prescription options available leaves
many acne sufferers standing at the medicine cabinet pondering their best
bets for treatment.
"The ultimate goal of acne therapy is to help clear up the pimples you have
and to prevent the occurrence of future breakouts," says Lawrence J. Green,
MD, assistant professor of Dermatology at George Washington University
School of Medicine. "Over-the-counter products may provide a temporary
solution, but when your acne is beyond self-treatment, it's time to see a
dermatologist. The earlier we intervene, the better we can help you manage
your acne." Following is a brief description of several acne treatments.
Talk to your dermatologist about which treatments are best suited for your
skin and lifestyle. Click on a topic below to learn what you should know about: Acne should be considered a chronic condition. Some people need to use acne medication long term, until their condition remits. In some cases, medication must be used indefinitely. There are several ways to treat acne. The information that follows will help you to understand what medications might be prescribed by your health care professional.
Back to Top Back to Top
Back to Top
Back to Top Back to Top
Topical Medications
•
Tretinoin
•
RETIN-A® (tretinoin)
•
RETIN-A® MICRO™ (trentinoin gel) microsphere, 0.1%
•
Adapalene Gel
•
Azelaic Acid Cream
•
Benzoyl Peroxide
Topical Antibiotics
Oral Antibiotics
Isotretinoin
To find out about birth control pills and acne, click here.
Topical medications are applied to the surface of your skin. These medications include RETIN-AĆ (tretinoin) and RETIN-AĆ MICRO™ (tretinoin gel) microsphere, 0.1%, adapalene gel, azelaic acid cream, benzoyl peroxide, and a few antibiotics (erythromycin, clindamycin, or tetracycline). These medications may be used on the same day, but should not be applied at the same time of day. In individuals, these drugs may cause skin reactions such as redness, dryness, and minor peeling of the skin. If you have questions, please consult your health care professional.
Tretinoin
Tretinoin, the active ingredient in RETIN-A, RETIN-A MICRO, and RENOVAĆ (tretinoin emollient cream) 0.05%, has been used to treat acne for nearly 30 years. But while RENOVA is a rich emollient cream developed specifically for treating fine wrinkles, brown spots and surface roughness, RETIN-A and RETIN-A MICRO are formulated for acne-prone skin.
RETIN-A® (tretinoin)
There are three different forms of RETIN-A -- cream, gel and liquid. They are available in different strengths that are available from your health care professional. Unlike many over-the-counter acne treatments, RETIN-A has the ability to get beneath the surface of your skin and work where acne begins. While the exact mechanism of action is unknown, RETIN-A is thought to loosen and expel existing acne plugs in the skin and prevent new lesions from forming. It directly attacks the cause of acne, the plug.
RETIN-A should be applied to the face once a day, before bed, using enough to cover the entire face lightly. Patients should wait 20-30 minutes after washing before applying RETIN-A.
Therapeutic results should be noticed after two to three weeks, but more than six weeks of therapy may be required before beneficial effects are seen. During the first few weeks of therapy, an exacerbation of pimples may occur. This is due to the action of the medication on deep, previously unseen pimples and should not be considered a reason to discontinue use. During the first few weeks of therapy, some irritation, including redness and peeling, will be experienced by most patients. Generally, these effects are manageable and diminish over time. However, some people with sensitive skin may experience excessive irritation. The manufacturer recommends application of RETIN-A once daily in the evening after washing (see above). This product must also be used with caution in the sunlight, as it thins the stratum corneum (outermost layer of the skin), making the skin sensitive to sunlight.
Click here for full U.S. Prescribing Information.
(Note: You will need Adobe Acrobat Reader. You can download it for free from Adobe's web site.)
RETIN-A® MICRO™ (trentinoin gel) microsphere, 0.1%
RETIN-A MICRO delivers the maximum strength of tretinoin with minimal irritation. Tretinoin is entrapped in Microsponge® systems (round microscopic particles made of synthetic polymer) and formulated into a gel. The microspheres hold the medication in reserve, allowing the skin to absorb small amounts of tretinoin over time. Dermatologists who conducted the pivotal clinical studies believe this may be why most RETIN-A MICRO patients experience little or no irritation. The microspheres themselves remain on top of the skin and are easily washed off when patients shower or wash their faces. RETIN-A MICRO also reduces the appearance of facial oiliness (shine) on the skin's surface.
The advantage to acne patients, particularly those with sensitive skin, is that they get a full-strength RETIN-A therapy with a favorable irritation profile. RETIN-A MICRO can be applied immediately after patients wash their face, unlike the 20-30 minute waiting period for RETIN-A. Since its launch in March 1997, RETIN-A MICRO has become the second-most prescribed form of RETIN-A.
RETIN-A® MICRO™ was not compared to RETIN-A in clinical acne trials, however, clinical safety and efficacy results appear consistent with results observed with other forms of RETIN-A. In clinical studies, RETIN-A MICRO was studied against placebo for efficacy and tolerability. Of those using RETIN-A MICRO, 90 percent experienced no or mild erythema (redness), 84 percent experienced no or slight peeling, 88 percent experienced no or slight burning/stinging, and 91 percent experienced no or slight itching at two weeks -- the typical peak irritation period for tretinoin.
The most common adverse reactions to RETIN-A MICRO were limited to mild or moderate irritation of the skin. Six percent of patients discontinued due to irritation. As with all topical retinoids, the skin of certain individuals may become excessively dry, red, swollen, or blistered. The manufacturer recommends application of RETIN-A MICRO once daily in the evening after washing. This product must also be used with caution in the sunlight, as it thins the stratum corneum (outermost layer of the skin), making the skin sensitive to sunlight.
Therapeutic results with RETIN-A MICRO may be noticed after two weeks, but up to seven weeks of therapy may be required before consistent beneficial effects are observed. RETIN-A MICRO significantly improved patients' acne by 12 weeks in clinical studies.
Click here for full U.S. Prescribing Information.
(Note: You will need Adobe Acrobat Reader. You can download it for free from Adobe's web site.)
Adapalene Gel
Adapalene gel 0.1% is a new retinoid-like compound that has some of the biologic activities of tretinoin. Its exact mode of action is unknown.
In controlled clinical trials comparing adapalene gel 0.1% and tretinoin gel 0.025% (the most irritating form of tretinoin) in the treatment of grades II and III acne, adapalene gel was shown to reduce both the number and severity of acne lesions after 12 weeks of treatment. The subjects who had received adapalene reported significantly less evidence of skin irritation and dryness.
In a separate study, clinical evaluation of "overall" signs of irritation showed no statistically significant product differences between adapalene gel 0.1% and RETIN-A MICRO. In general, during the first seven days of the study, the adapalene gel 0.1% side showed more irritation while, during days 8-15, the RETIN-A MICRO side showed more irritation. For the remainder of the study no statistical trend in product difference was found. There are no published studies comparing the efficacy of adapalene gel 0.1% to tretinoin cream, tretinoin gel 0.01%, or RETIN-A MICRO.
Some adverse events such as erythema (redness), scaling, dryness, pruritus (severe itching) and burning will occur in about 10% to 40% of patients. Pruritus or burning immediately following application also occurs in approximately 20% of patients. The following additional adverse experiences were reported in approximately 1% or less of patients: skin irritation, burning/stinging, erythema (redness), sunburn, and acne flares. These side effects are most common during the first month of therapy and decrease in both severity and frequency thereafter. Some patients may notice an apparent exacerbation of acne during the initial weeks of treatment when the drug is acting on previously invisible lesions.
The manufacturer recommends application of adapalene gel once daily in the evening after washing. This product must also be used with caution in the sunlight, as it thins the stratum corneum (outermost layer of the skin), making the skin sensitive to sunlight.
Azelaic Acid Cream
Azelaic acid cream 20%, which has been available in Europe for several years, has recently been introduced in the United States for the treatment of mild-to-moderate inflammatory acne. Azelaic acid cream is unrelated to other topical treatments in that it is made of a naturally occurring substance found in wheat.
Although its exact mechanism of action is unknown, azelaic acid is believed to decrease the thickness of the stratum corneum and decrease production of keratin (an extremely tough protein substance in hair, nails, and tissue), much like tretinoin but to a lesser extent. Azelaic acid may also possess some anti-inflammatory action.
Although no double-blind comparative studies have been conducted, in vitro studies have demonstrated some antimicrobial activity. Studies of azelaic acid versus 0.05% tretinoin cream and 5% benzoyl peroxide gel demonstrated similar response rates in mild to moderate inflammatory acne. Benzoyl peroxide produced a more rapid response, although after several months the therapeutic effect was similar. Azelaic acid is currently being studied in combination with other acne treatments.
Adverse reactions were generally mild and transient (temporary) in nature. The most common adverse reactions occurring in approximately 5% of patients were pruritus (severe itching), burning, stinging and tingling. There is a potential for allergic reactions. Patients with dark complexions should be monitored for early signs of hypopigmentation (abnormally diminished pigmentation). Improvement of the condition occurs in the majority of patients with inflammatory lesions within four weeks.
Benzoyl Peroxide
Benzoyl peroxide works by killing the bacteria that cause inflammation. It is used mostly in combination with tretinoin and other acne medications. Benzoyl peroxide is available over the counter in 2.5%, 5% and 10% creams and lotions. It is available in gels in the same percentages by prescription only. Clinically, there is little difference between the effectiveness of the various strengths and vehicles used; the greatest difference in effectiveness occurs between the 2.5% and 10% strengths.
The most common adverse effects of this medication include hypersensitivity, irritation, and contact dermatitis (in approximately 2% of patients). Because benzoyl peroxide can produce some irritation, your health care professional may want to change how often and what form of benzoyl peroxide you use, if you develop this side effect. If you use benzoyl peroxide with RETIN-A® or RETIN-A® MICRO™, you should use it in the morning and the tretinoin products before bedtime. Never use both at the same time because one counteracts the other. Keep benzoyl peroxide away from clothing as it has a bleaching effect.
Topical antibiotics kill bacteria that cause the inflammation of acne, reduce some of the inflammation, and decrease fatty acid on the skin surface. Topical erythromycen, clindamycin, and tetracycline come in lotion, cream, or gel formulations, and are sometimes combined with benzoyl peroxide.
Common adverse effects of topical antibiotics include dryness and irritation due to the vehicle base and occasional bacterial resistance.
Oral (taken by mouth) antibiotics may be prescribed if you are already using topical medications but are still getting new pimples. They may also be prescribed if you have many pimples on the back and chest. These medications, include tetracycline, erythromycin, minocycline, doxycycline, and trimethoprim-sulfamethoxazole(TMP-SMX).
Frequency or daily use will depend on the antibiotic prescribed. Check with your health care professional about treatment and adverse effects.
Isotretinoin is an oral medication that is usually reserved for only the most stubborn and severe forms of acne (cystic acne). It works by unsticking the skin cells, unplugging the hair follicles, and decreasing the production of oil. Isotretinoin is taken orally for a period of five months.
This medication may cause serious side effects, including the potential for harm that the medicine may cause to an unborn baby. Sexually active women who use this medication should use two highly effective methods of birth control (such as the Pill and a barrier method). If you are a woman using isotretinoin, your health care professional will make certain that you are not pregnant before treatment. You must also not become pregnant for at least one month after treatment ends. With proper attention to this precaution, the benefits often persist indefinitely after the course of medication is completed.
For information on Warnings, Precautions and additional Adverse Reactions that may occur, regardless of drug relationship, please see your health care professional and read the detailed patient information that accompanies the product and is available from your health care professional or pharmacist.