Acne Medication / Acne Treatment
We've discussed the causes and types of acne. Now it is time to put
everything together to understand acne medications and acne
treatments. As we've learned acne results from two main
mechanisms. Thus, the vast majority of acne treatment can be
broken down into one of two broad categories:
1. Reducing the growth of P. Acnes
2. Allowing pores to open up
I'll begin with a review of over-the-counter (OTC) medications
because for many people they will be sufficient.
For people with a predominance of comedones (both blackheads and
whiteheads) and milder acne a medication such a salicylic acid may
be used. salicylic acid helps promote shedding of the outer layer of
skin which helps open up the comedones. Skin irritation can be a
limiting factor in Salicylic acid use.
For people with inflammatory papules and pustules a medication
targeted towards P. Acnes is helpful.
P. Acnes can be killed using medications which have
anti-bacterial or antibiotic (bacteria killing) properties. The most
commonly used of these agents is benzoyl peroxide. Benzoyl
peroxide is applied topically (to the skin) and is available over
the counter in 1, 2.5, 5, and 10% strengths both as gels and
lotions. Benzoyl peroxide can be irritating to the skin which can
be a limiting factor in its use. It should not generally be applied
more than once or twice a day.
Thus, while benzoyl peroxide helps to kill P. Acnes Salicylic acid
helps to reduce comedones. Thus for more moderate cases
sometimes using both medications is helpful. Again, skin irritation
can be a big limiting factor.
Prescription Medications
Topical antibiotic medications such erythromycin, clindamycin,
azelaic acid also reduce the growth of P. Acnes and may be
prescribed by your doctor. Preparations combining benzoyl
peroxide with clindamycin (Benzaclin) and benzoyl peroxide with
erythromycin (Benzamycin) may also be prescribed by your doctor.
Benzamycin must be refrigerated which some people find
inconvenient.
Other prescription medications which help unclog pores (help
reduce blackheads and whiteheads) include tretinoin (Retin - A) and
adapalene (Differin). These medications fall under the class of
medications known as retinoids. Retin-A must be applied at bedtime
as the sunlight inactivates it. It can be irritating to the skin but most
people get used to these side effects especially when used in
lower concentrations. A newer formulation is Retin-A micro. Retin-A
micro contains Retin-A in time released capsules thus helping to
reduce skin irritation. Retin-A can cause sun sensitivity so it is
important to where sunscreen (oil-free) during the day. These
medications are often prescribed in conjunction with topical
benzoyl peroxide or topical or oral antibiotics. Thereby the acne
is being targeted at two levels:
1. Reducing P. Acnes.
2. Reducing the number of comedones
It is important to remember that benzoyl peroxide inactivates Retin-A
and thus the two medications cannot be used at the same time. Thus
your doctor may prescribe Retin-A at night and benzoyl peroxide
during the day.
Differin comes in a gel or cream. It is not inactivated by the sun so
some people use it during the day. It can also tend to be somewhat
less irritating than Retin-A. Also it does not get inactivated by
benzoyl peroxide so some doctors prescribe differin in combination
with benzoyl peroxide. In fact, it comes in combination known as
epiduo (.1% differin, 2.5 % benzoyl peroxide) which is used once daily.
Again sun sensitivity can be an issue and sunscreen is
recommended if sun exposure is unavoidable.
Oral Acne Medications
For moderate to severe acne your doctor may also prescribe a
oral antibiotic. Commonly used medications are doxycycline,
minocycline and erythromycin. The antibiotics help kill bacteria thus
help to reduce inflammatory papules and pustules.
Sebum production is influenced by male hormones (androgens).
Therefore, for females an OCP (oral contraceptive pill) may be
helpful in acne by reducing androgen levels.
For severe nodular cystic acne the oral medication isotretinoin
(Accutane) may be used. Accutane works by profoundly reducing
sebum production. Accutane is the drug of choice in patients
who have severe acne with scarring. Accutane can only be
prescribed by your dermatologist. Females taking Accutane
must NOT get pregnant as Accutane causes severe birth
defects. Other side effects include joint pains, stiffness,
tendinitis, and high triglycerides. Nevertheless, for those with
severe acne Accutane can lead to prolonged remissions.
everything together to understand acne medications and acne
treatments. As we've learned acne results from two main
mechanisms. Thus, the vast majority of acne treatment can be
broken down into one of two broad categories:
1. Reducing the growth of P. Acnes
2. Allowing pores to open up
I'll begin with a review of over-the-counter (OTC) medications
because for many people they will be sufficient.
For people with a predominance of comedones (both blackheads and
whiteheads) and milder acne a medication such a salicylic acid may
be used. salicylic acid helps promote shedding of the outer layer of
skin which helps open up the comedones. Skin irritation can be a
limiting factor in Salicylic acid use.
For people with inflammatory papules and pustules a medication
targeted towards P. Acnes is helpful.
P. Acnes can be killed using medications which have
anti-bacterial or antibiotic (bacteria killing) properties. The most
commonly used of these agents is benzoyl peroxide. Benzoyl
peroxide is applied topically (to the skin) and is available over
the counter in 1, 2.5, 5, and 10% strengths both as gels and
lotions. Benzoyl peroxide can be irritating to the skin which can
be a limiting factor in its use. It should not generally be applied
more than once or twice a day.
Thus, while benzoyl peroxide helps to kill P. Acnes Salicylic acid
helps to reduce comedones. Thus for more moderate cases
sometimes using both medications is helpful. Again, skin irritation
can be a big limiting factor.
Prescription Medications
Topical antibiotic medications such erythromycin, clindamycin,
azelaic acid also reduce the growth of P. Acnes and may be
prescribed by your doctor. Preparations combining benzoyl
peroxide with clindamycin (Benzaclin) and benzoyl peroxide with
erythromycin (Benzamycin) may also be prescribed by your doctor.
Benzamycin must be refrigerated which some people find
inconvenient.
Other prescription medications which help unclog pores (help
reduce blackheads and whiteheads) include tretinoin (Retin - A) and
adapalene (Differin). These medications fall under the class of
medications known as retinoids. Retin-A must be applied at bedtime
as the sunlight inactivates it. It can be irritating to the skin but most
people get used to these side effects especially when used in
lower concentrations. A newer formulation is Retin-A micro. Retin-A
micro contains Retin-A in time released capsules thus helping to
reduce skin irritation. Retin-A can cause sun sensitivity so it is
important to where sunscreen (oil-free) during the day. These
medications are often prescribed in conjunction with topical
benzoyl peroxide or topical or oral antibiotics. Thereby the acne
is being targeted at two levels:
1. Reducing P. Acnes.
2. Reducing the number of comedones
It is important to remember that benzoyl peroxide inactivates Retin-A
and thus the two medications cannot be used at the same time. Thus
your doctor may prescribe Retin-A at night and benzoyl peroxide
during the day.
Differin comes in a gel or cream. It is not inactivated by the sun so
some people use it during the day. It can also tend to be somewhat
less irritating than Retin-A. Also it does not get inactivated by
benzoyl peroxide so some doctors prescribe differin in combination
with benzoyl peroxide. In fact, it comes in combination known as
epiduo (.1% differin, 2.5 % benzoyl peroxide) which is used once daily.
Again sun sensitivity can be an issue and sunscreen is
recommended if sun exposure is unavoidable.
Oral Acne Medications
For moderate to severe acne your doctor may also prescribe a
oral antibiotic. Commonly used medications are doxycycline,
minocycline and erythromycin. The antibiotics help kill bacteria thus
help to reduce inflammatory papules and pustules.
Sebum production is influenced by male hormones (androgens).
Therefore, for females an OCP (oral contraceptive pill) may be
helpful in acne by reducing androgen levels.
For severe nodular cystic acne the oral medication isotretinoin
(Accutane) may be used. Accutane works by profoundly reducing
sebum production. Accutane is the drug of choice in patients
who have severe acne with scarring. Accutane can only be
prescribed by your dermatologist. Females taking Accutane
must NOT get pregnant as Accutane causes severe birth
defects. Other side effects include joint pains, stiffness,
tendinitis, and high triglycerides. Nevertheless, for those with
severe acne Accutane can lead to prolonged remissions.
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