For most of us, acne is just another painful memory of our teenage years filled with daily outbreaks which often included multiple pimples, blackheads, redness, blemishes, inflammation and in severe cases, lifelong scaring.

Fortunately a visit to a dermatologist or a knowledgeable pharmacist can assist you in the selection of products from the wide array of prescription and OTC products. It is important to be patient and to be willing to experiment with products and adjust your regimen if it loses effectiveness. A better understanding of your acne-triggers will assist you as you deal with everything from oily skin to dry skin to various degrees of facial and bodily outbreaks. The descriptions and information below was created with the goal of educating consumers and pharmacists in the discovery and identification of products that will help you understand and take control your acne.

What causes Acne?

Our skin’s hair follicles and oil glands (sebaceous glands), under the influence of various hormonal, environmental and possibly dietary factors can cause increased production of sebum which is simply an oil found in the skin.

During times of puberty or even stress, acne can occur when sebaceous glands of the skin begin to secrete excess oils. Stimulation by hormones can cause the production of these oils. Bacteria on the skin quickly proliferate in the oily environment and inflame the skin.

The central features of acne usually include a stretched or widened hair follicle filled with keratin squamae (skin debris), bacteria, and sebum (oil). It may be tempting to try and poke at, or pop these vexing skin atrocities. It is wise however to resist this temptation to squeeze or drain these clogged dermatologic entities or the consequences could include scarring your skin!

With Acne, trial and error has always been the most successful treatment plan. Topical medications have varying degrees of effectiveness, adverse effects and contraindications. Since these products work in a number of different ways, it is important to understand the benefits and warnings associated with each of these products.

The most important aspect of treatment with topical agents is to remember that excessive dryness, peeling, and redness often occur with each product, especially when combinations are applied. This will necessitate reducing skin contact time with the products or simply skipping a day or two when these adverse effects occur.

In the charts below, products are listed by their brand and generic names or active ingredient.

Over-The-Counter (OTC) Acne Medications

In mild acne, OTC products are often utilized. When these products are no longer effective oral and topical antibiotics are often prescribed and are useful in eliminating or killing Propionibacterium acnes (P. acnes), commonly believed to be the bacterium that causes acne.

Soaps

The use of a Hypoallergenic or Non-comedogenic oil-free product is occasionally an effective treatment by itself. Soap-Free products like “Purpose” are available and are believed to be non-acne causing and less likely to clog pores.

The use of the scrub or products like soap and astringents may reduce oil, clogging and inflammation. These products can cause sloughing of some of the skin debris and often contain alcohol and/or acetone used in combination in many products can be helpful with oily skin types. Alcohol has antimicrobial properties and reduces acne-causing bacteria.

See Table of OTC Acne Medications

Prescription Acne Products

Topical therapy can cause flare-ups of acne initially (especially with the retinoids) including facial flushing, warmth or slight stinging of the skin, lightening or darkening of the skin, red, scaling skin, increase in acne sores, swelling, blistering, or crusting of the skin.

Instruct patients to always avoid using any of these topical products near the eyes, lips or mucous membranes and avoid or at least minimize exposure to sunlight (including sunlamps). Always use a sunscreen during topical acne treatment to avoid sunburn; because of heightened burning susceptibility with use.

See Table of Prescription Acne Medications

General considerations and warnings for all topical acne preparations

If topical products are not effective, it is important to consult with a dermatologist. One such type of acne, Cystic acne (acne vulgaris) is a more severe type of acne that can form deep lumps beneath the skin and may require more sophisticated oral medication treatments. Accutane, usually sold as Claravis or Amnesteem is still considered the most successful treatment for this condition. Accutane is associated with serious side effects such as hair loss, depression, decreased night vision, severe dryness of skin, eyes, nasal passages, glucose changes (especially in diabetic patients), dizziness, inability to tolerate or wear contact lenses, headache, nervousness, lack of energy, nosebleeds, aggressive, strange or violent behavior, heartburn, swelling of the pancreas, thoughts of suicide, vomiting, and irritable bowel syndrome (IBS). It also causes birth defects, therefore, contraception is required during use. Consult with a dermatologist if your acne is severe or does not respond to topical therapy.

Once controlled, acne therapy can be maintained for years with proper washing, avoidance of cosmetics that could clog pore and by keeping hair clean and out of contact with the skin. Reductions of topical therapy can be attempted anytime that the skin condition improves or as patient ages or possibly “out grows” acne.

Authors: Adam M. Kaye Pharm.D. & Jessica S. Kaye

This medication summary is for information only and is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider.