Key MessagesYou don't treat acne, you

prevent it. There is no one best or ‘one-size fits all’ acne

treatment.

So preventing acne requires some patience and some

experimentation to find the right program for you.

Finding the best topical medications - medications you put on your skin - depends on

your skin type.

For oily skin, choose a solution or gel-based product.

For dry skin, choose a cream or lotion-based product.

It is helpful to look in the mirror and decide whether

your acne is mostly:

inflammatory (redness + swelling); plugging

(whiteheads + blackheads) or both.

Treatment Basics

Talk to your doctor about acne. Below is a list of common (but not all) medications for acne.

Benzoyl peroxide (2.5% to 5%) products are available

without a prescription and are usually tried first for mild to

moderate inflammatory acne.

Then youcan 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.

Product Best For Works By Applied Common Side Effects

Comments

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Benzoyl Peroxide(2.5% to 5%*)

(e.g., Benzac AC, Benzagel, Panoxyl Aquagel, Solugel)

• 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(.5 to 2%)

(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)

Reducing plugging by exfoliation

• 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

Non-prescription, topical

Mild to moderate acne

Reducing inflammation and P. acnes bacteria

At bedtime or up to twice daily

Skin irritation, redness, flaking

Mild acne At bedtime or twice daily

Drying of skin, irritation, redness, flaking

*Concentrations above 5% require a prescription

mild to moderate acnemild acne

bedtimeplugging

inflammation

twice daily

Product Best For Works By Applied Common Side Effects

Comments

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Retinoid

(e.g., adapalene (Differin 0.1% gel,cream; XP 0.3%), tretinoin (Rejuva-A, Renova, Retin-A) tazarotene)

• Tolerance to irritation develops over time

• Wear sunblock with SPF 15 or higher

• Adapalene is best tolerated

• Avoid retinoid use if pregnant

Topical Antibiotic

(e.g., clindamycin (Dalacin T 1% solution, Clinda T 1% solution, Clindets pads)

Reducing inflammation and P. acnes bacteria

• 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

Prescription, topical

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

Twice daily Skin irritation, redness, dry skin, flaking

mild to moderate acne bedtime

plugging inflammation

twice daily

Product Best For Works By Applied Common Side Effects

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Benzoyl Peroxide + Retinoid

(e.g., Tactuo®)

• Benzoyl peroxide component can bleach hair, clothing, bed sheets; lingering odor

• Wear sunblock with SPF 15 or higher

Antibiotic + Retinoid

(e.g., Clindamycin and tretinoin (Biacna*) Erythromycin + trentinoin (Stievamycin mild,reg, forte)

Reducing inflammation and P. acnes bacteria; unplugging sebaceous glands

• Wear sunblock with SPF 15 or higher

Prescription, topical - combination products

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

At bedtime Skin irritation, redness, dry skin, flaking, increased risk of sunburn

Benzoyl Peroxide + Antibiotic

(e.g., Benzaclin®, Benzamycin®, Clindoxyl®)

Reducing inflammation and P. acnes bacteria

• Benzoyl peroxide component can bleach hair, clothing, bed sheets; lingering odor

• Benzamycin has to be refrigerated

Mild to moderate acne with whiteheads, blackheads

Skin irritation, itching, redness, dry skin, flaking

At bedtime (Benzaclin®, Clindoxyl®) or twice daily (Benzamycin®)

mild to moderate acne bedtime

plugging inflammation

twice daily

Product Best For Works By Applied Common Side Effects

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Antibiotic

(e.g., tetracyclines (doxycline, minocycline, tetracycline), erythromycin, Septra)

• 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

IsotretinoinOral Retinoid

(eg. Accutane, Amnesteem, Claravis, Sotret)

Unknown: acts on sebaceous glands reducing sebum production

• 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

Prescription, systemic (oral)

Moderate to severe acne

Reducing P. acnes bacteria by slowing proliferation

Once daily: (doxycycline, minocycline, TMP) or twice daily (tetracycline,erythromycin,TMP/SMX)

Gastro-intestinal upset, increased risk of sunburn (tetra-cyclines), increased risk of yeast infection

Moderate to severe acne.. but usually more severe

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

twice dailymoderate to severe acne

once dailybacteria

unknown

Product Best For Works By Applied Common Side Effects

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Oralcontra-ceptives

(Alesse, Aviane,Diane-35, Tri-Cyclen, Yasmin,Yaz)

• Avoid the ‘mini pill’ (progestin only) since it may worsen acne

• Avoid in smokers over age 35

• Avoid if history of blood clots

Azelaic acidFinacea 15% gel

(eg. Accutane, Amnesteem, Claravis, Sotret)

Has bothantimicrobialand anti-comedonalproperties

• 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.

Other

Moderate to severe acne in females

Anti-androgeneffect

Once daily Breakthrough bleeding/ spotting, suppression ofmenstruation, nausea,vomiting, breast tenderness, headache,bloating, mood changes

Moderate tosevere acne

Twice daily Can cause skin coulour lightening, especially in darker- skinned patients

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

twice dailyonce daily

moderate to severe acne

anticomedonal antimicrobial

anti-androgen