Treatment for Moderate to Severe Inflammatory Acne
Adapted by Tracee Cornforth
Patients with moderate to severe inflammatory acne may be treated with an OTC or prescription topical medication, a prescription oral medication, or a combination of these.
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.
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).
Common
Prescription Topical Medications Used To Treat
Acne •
Benzoyl peroxide •
Adapalene gel (Differin) •
Clindamycin phosphate (Cleocin T) •
Azelic acid (Azelex) •
Erythromycin •
Benzoyl peroxide and sulfur •
Tetracycline HCL •
Erythromycin and benzoyl peroxide •
Tretinoin (Retin-A, Avita) •
Sulfur and resorcinol
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.
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. 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.
Reprinted from The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
