Acne

Topical OTC Medications

Benzoyl peroxide, resorcinol, salicylic acid, and sulfur are the most common topical OTC medications used to treat acne. Each works a little differently. Benzoyl peroxide is best at killing P. acnes and may reduce oil production. Resorcinol, salicylic acid, and sulfur help break down blackheads and whiteheads. Salicylic acid also helps cut down the shedding of cells lining the follicles of the oil glands. Topical OTC medications are available in many forms, such as gel, lotion, cream, soap, or pad.

Side Effects

In some patients, OTC acne medications may cause side effects such as skin irritation, burning, or redness. Some people find that the side effects lessen or go away with continued use of the medication. Severe or prolonged side effects should be reported to the doctor.

OTC topical medications are usually moderately effective in treating acne when used regularly. Patients must keep in mind that it can take between 4 and 8 weeks before they notice an improvement in their skin.

Prescription Topical Medications

Several types of prescription topical medications are used to treat acne, including benzoyl peroxide, antibiotics, tretinoin, adapalene, and azelaic acid. Prescription and OTC benzoyl peroxide work in the same way. Many doctors prescribe benzoyl peroxide instead of recommending OTC versions to make sure patients get the most desirable formulation (cream, gel, or lotion).

Antibiotics and azelaic acid help stop or slow the growth of P. acnes and reduce inflammation. Tretinoin, a type of drug called a retinoid that contains vitamin A, is the most effective topical medication for stopping the development of new comedones. It also fights acne by increasing cell turnover, which helps unplug existing comedones, and thereby allows other topical medications, such as antibiotics, to penetrate the follicles better. The doctor may also prescribe a newer drug called adapalene gel, a retinoidlike compound that helps decrease microcomedone formation.

Prescription topical medications come in a variety of products. The doctor will consider the patient’s skin type when prescribing a product. Creams and lotions are moisturizing and tend to be good for people with dry skin. Gels and solutions are generally alcohol based and tend to dry the skin, so patients with excessively oily skin or those who live in hot, humid climates may prefer a gel. The doctor will tell the patient how to apply the medication and how often to use it.

Side Effects

Some people develop side effects from using prescription topical medications. Common side effects include stinging, burning, redness, peeling, scaling, or discoloration of the skin. With retinoids, these side effects usually decrease or go away after the medication is used for a period of time. Patients should report prolonged or severe side effects to their doctor. Between 4 and 8 weeks will most likely pass before patients see improvement in their skin.

Prescription Oral Medications

For patients with moderate to severe acne, the doctor often prescribes oral antibiotics (taken by mouth) in addition to topical medication. Oral antibiotics are thought to help control acne by curbing the growth of P. acnes and decreasing inflammation. Common antibiotics used to treat acne are tetracycline, minocycline, doxycycline, and erythromycin. 

Side Effects

Some people have side effects when taking these antibiotics, such as photosensitivity (higher risk of sunburn), upset stomach, dizziness or lightheadedness, and skin discoloration. Tetracycline is not given to pregnant women or children under 12 years of age because it can discolor developing teeth. Tetracycline and minocycline also decrease the effectiveness of birth control pills, so a backup or alternative form of birth control must be used. Patients usually must take oral antibiotics for as long as 4 to 6 months to effectively treat acne.

Isotretinoin

Advantages 

Isotretinoin is a very effective medication that can help prevent extensive scarring in patients. After 16 to 20 weeks of treatment with isotretinoin, acne completely or almost completely goes away in most patients (up to 90 percent). For some people, however, the acne will come back, and they will need additional treatment with isotretinoin.

Disadvantages

Patients should carefully consider the several disadvantages of isotretinoin. The drug is not only expensive but is also linked to some adverse effects that can be severe. Possible side effects include inflammation of the lip and mucous membrane of the eye; dry mouth, nose, or skin; itching; nosebleeds; muscle aches; photosensitivity; and, rarely, decreased night vision. Other more serious side effects include increased blood cholesterol, lipid, and triglyceride levels and abnormal liver enzymes. To make sure isotretinoin is stopped if these side effects occur, the doctor usually monitors a patient’s complete blood count, blood chemistries, cholesterol, triglycerides, and liver enzymes before therapy is started and periodically during treatment. All of these side effects usually go away after the medication is stopped. Patients who experience side effects while using isotretinoin should tell their doctor. The doctor may be able to reduce the dose of the drug so that the side effects are decreased or stopped.

The most serious potential adverse effect of isotretinoin is that it is teratogenic: it can cause birth defects in the developing fetus of pregnant women who take the drug. Therefore, it is crucial that women of childbearing age are not pregnant and do not get pregnant while taking isotretinoin. Women must use an appropriate birth control method for 1 month before therapy begins, during the entire course of therapy, and for 1 full month after therapy stops. Women should talk to their doctor about when it is safe to get pregnant after therapy with isotretinoin has stopped.