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Treatment Basics
Key Messages
You don't treat acne, you
prevent it. There is no one
best or ‘one-size fits all’ acne
treatment.
Finding the best topical
medications - medications you
put on your skin - depends on
your skin type.
It is helpful to look in the
mirror and decide whether
your acne is mostly:
So preventing acne requires
some patience and some
experimentation to find the
right program for you.
For oily skin, choose a
solution or gel-based product.
For dry skin, choose a
cream or lotion-based product.
inflammatory (redness +
swelling); plugging
(whiteheads + blackheads)
or both.
Benzoyl peroxide (2.5% to
5%) products are available
without a prescription and are
usually tried first for mild to
moderate inflammatory acne.
Then you
can add a retinoid or
an antibiotic.
Generally, products require
8 to 12 weeks for
noticeable improvement.
Some products may
initially worsen acne - you
need to give it time.
Don't just apply acne
products to your individual
pimples!
Apply acne products to all
the skin area that you
commonly get pimples to
reduce the chance of
further breakouts.
Isotretinoin has some
side-effects and cannot be
taken by pregnant women...
...but it is the most
effective agent for acne.
Talk to your doctor about acne.
Below is a list of common (but not all) medications for acne.
Non-prescription, topical
Product
Best For
Works By
Applied
Common
Side
Effects
Benzoyl
Peroxide
Mild to
moderate
acne
Reducing
inflammation
and P. acnes
bacteria
At bedtime
or up to
twice daily
Skin
irritation,
redness,
flaking
(2.5% to 5%*)
(e.g., Benzac
AC, Benzagel,
Panoxyl
Aquagel,
Solugel)
Comments
• Inexpensive
• Can bleach hair, clothing, bed sheets;
lingering odor
• Water-based product less irritating
• Benzoyl peroxide-containing soaps and
washes are less effective
• Benzoyl peroxide can degrade other
products. Use a commercial combination
product or space out application times if
also using a retinoid or antibiotic.
• Irritation can be minimized by gradually
increasing wear time (e.g., applying every
other day initially; or, wearing for 2 to 4
hours per night increasing to all night as
tolerated)
• Topical benzoyl peroxide is safe in
pregnancy
Salicyclic
Acid
Mild acne
(.5 to 2%)
Reducing
plugging by
exfoliation
At bedtime
or twice
daily
(e.g. Clearasil
Ultra
Vanishing
Treatment
Cream,
Noxzema
Anti-Acne Gel
or Pads,
Neo-strata
Blemish Spot
Gel, Oxy
maximum
cleaning
pads,
foaming face
wash)
Legend
plugging
mild acne
bedtime
Drying of
skin,
irritation,
redness,
flaking
• Very commonly used, as available over the
counter, but not nearly as much research
support compared to other first line agents
such as BP or retinoids
mild to moderate acne
twice daily
inflammation
*Concentrations above
5% require a prescription
Prescription, topical
Product
Best For
Works By
Applied
Common
Side
Effects
Retinoid
Mild to
moderate
acne with
whiteheads,
blackheads
Unplugging
sebaceous
glands and
reducing
inflammation
At bedtime
Skin
irritation,
increased
risk of
sunburn
Mild to
moderate
acne with
whiteheads,
blackheads
Reducing
inflammation
and P. acnes
bacteria
Twice daily
Skin
irritation,
redness,
dry skin,
flaking
(e.g.,
adapalene
(Differin 0.1%
gel,cream; XP
0.3%),
tretinoin
(Rejuva-A,
Renova,
Retin-A)
tazarotene)
Topical
Antibiotic
(e.g.,
clindamycin
(Dalacin T 1%
solution,
Clinda T 1%
solution,
Clindets
pads)
Legend
mild to moderate acne
Comments
• Tolerance to irritation develops over time
• Wear sunblock with SPF 15 or higher
• Adapalene is best tolerated
• Avoid retinoid use if pregnant
• Most effective when combined with
benzoyl peroxide or retinoid
• Combination with benzoyl peroxide
reduces the chance of bacterial resistance
• Can stop use when inflammation subsides
• Topical erythromycin and clindamycin are
safe in pregnancy
plugging
inflammation
bedtime
twice daily
Prescription, topical - combination products
Product
Best For
Works By
Applied
Common
Side
Effects
Benzoyl
Peroxide
+
Retinoid
Mild to
moderate
acne with
whiteheads,
blackheads
Reducing
inflammation
and P. acnes
bacteria;
unplugging
sebaceous
glands
At bedtime
Skin
irritation,
dry skin,
redness,
burning,
flaking,
increased
risk of
sunburn
Mild to
moderate
acne with
whiteheads,
blackheads
Reducing
inflammation
and P. acnes
bacteria;
unplugging
sebaceous
glands
At bedtime
Skin
irritation,
redness,
dry skin,
flaking,
increased
risk of
sunburn
Mild to
moderate
acne with
whiteheads,
blackheads
Reducing
inflammation
and P. acnes
bacteria
At bedtime
(Benzaclin®,
Clindoxyl®)
or twice daily
(Benzamycin®)
Skin
irritation,
itching,
redness,
dry skin,
flaking
(e.g., Tactuo®)
Antibiotic
+ Retinoid
(e.g., Clindamycin
and tretinoin
(Biacna*)
Erythromycin
+ trentinoin
(Stievamycin
mild,reg, forte)
Benzoyl
Peroxide +
Antibiotic
(e.g.,
Benzaclin®,
Benzamycin®,
Clindoxyl®)
Legend
mild to moderate acne
plugging
Comments
• Benzoyl peroxide component can bleach
hair, clothing, bed sheets; lingering odor
• Wear sunblock with SPF 15 or higher
• Wear sunblock with SPF 15 or higher
• Benzoyl peroxide component can bleach
hair, clothing, bed sheets; lingering odor
• Benzamycin has to be refrigerated
inflammation
bedtime
twice daily
Prescription, systemic (oral)
Product
Best For
Works By
Applied
Common
Side
Effects
Antibiotic
Moderate to
severe acne
Reducing P.
acnes
bacteria by
slowing
proliferation
Once daily:
(doxycycline,
minocycline,
TMP) or
twice daily
(tetracycline,
erythromycin,
TMP/SMX)
Gastrointestinal
upset,
increased
risk of
sunburn
(tetracyclines),
increased
risk of
yeast
infection
(e.g.,
tetracyclines
(doxycline,
minocycline,
tetracycline),
erythromycin,
Septra)
Isotretinoin
Oral
Retinoid
Moderate to
severe acne..
but usually
more severe
(eg. Accutane,
Amnesteem,
Claravis,
Sotret)
Legend
moderate to severe acne
Unknown:
acts on
sebaceous
glands
reducing
sebum
production
Once or
twice daily
depending
on regimen
Dryness
(e.g.,
mouth,
nose,
eyes),
peeling,
redness,
irritation,
pain and
swelling of
lips,
headache,
fatigue,
hair loss,
joint pain,
increased
risk of
sunburn,
increased
blood
cholesterol
and
triglycerides
bacteria
Comments
• Pulsed (vs. continuous) use may reduce
risk of bacterial resistance
• Avoid tetracylines, TMP or TMP/SMX use if
pregnant
• Avoid taking tetracycline at bedtime to
reduce risk of capsule getting stuck in throat
and causing an ulcer
• Wear sunblock with SPF 15 or higher
(especially with tetracyclines)
• Topical benzoyl peroxide is safe in
pregnancy
• Highly effective for moderate to severe
inflammatory acne
• Causes birth defects;
Use two birth control methods. Avoid/stop
retinoid use if pregnant
• Taken with food
• Usually taken for 4 to 5 months
• Use a moisturizer and lip balm
• Wear sunblock with SPF 15 or higher
• Monitor for signs/ symptoms of
depression
once daily
unknown
twice daily
Other
Product
Best For
Works By
Applied
Common
Side
Effects
Oral
contraceptives
Moderate to
severe acne
in females
Antiandrogen
effect
Once daily
Breakthrough
bleeding/
spotting,
suppression
of
menstruation,
nausea,
vomiting,
breast
tenderness,
headache,
bloating,
mood
changes
Moderate to
severe acne
Has both
antimicrobial
and anticomedonal
properties
Twice daily
(Alesse, Aviane,
Diane-35, TriCyclen, Yasmin,
Yaz)
Azelaic acid
Finacea
15% gel
(eg. Accutane,
Amnesteem,
Claravis,
Sotret)
Legend
anticomedonal
Can cause
skin
coulour
lightening,
especially
in darkerskinned
patients
Comments
• Avoid the ‘mini pill’ (progestin only) since it
may worsen acne
• Avoid in smokers over age 35
• Avoid if history of blood clots
• Naturally occurring acid
• Newer medication
• Need to monitor for hypopigmentation
• American Guidelines note that its clinical
use, compared to other agents, has limited
efficacy according to experts.
moderate to severe acne
antimicrobial
anti-androgen
once daily
twice daily
References: e-CPS product monographs (e.g., Accutane®), e-Therapeutics (“Skin Disorders: Acne”, “Sexual Health:
Contraception”), RxFiles (“ACNE Pharmacotherapy – Comparison Chart”), Up-to-Date [“Patient information: Acne
(Beyond the Basics)”]
Copyright ©2012 Evans Health Lab