All About Topical Acne Treatments

Treating acne is a very personal experience and it should be started early to prevent scarring. Topical treatments are usually combined to address the various factors in acne pathogenesis. They aim to address the following:

  1. Correct the altered pattern of follicular keratinization
  2. Decrease sebaceous gland activity
  3. Decrease follicular bacterial population, particularly Cutibacterium acnes
  4. Exert anti-inflammatory effect

Let’s learn more about the most commonly used topical treatments for acne! 

Retinoids

Tretinoin is the most widely used for topical treatments of acne because of its ability to unclog pores. In addition, it has great anti-inflammatory effects. It is also available in various strengths and formulations. Adapalene is a synthetic retinoid widely marketed for its greater tolerability. It is both photostable and can be used in conjunction with benzoyl peroxide. Retinoids are applied on the whole face using a thin layer but they can cause dryness and irritation so it is recommended to start slowly with twice a week application and gradually increase the frequency as tolerated. Using moisturizers before and after applying tretinoin (sandwich method) can also help decrease irritation. Regular use of broad-spectrum spectrum sunscreen with SPF of at least 30 is also advised. 

Benzoyl Peroxide

Benzoyl peroxide preparations are among the most common topical medications prescribed by dermatologists and are also readily available over the counter. It is a powerful antimicrobial agent, and  has mild comedolytic properties. They are available in creams, lotions, gels, washes, foams, and pledgets with concentrations ranging from 2.5% to 10%. Higher concentrations are not necessarily more efficacious and can cause increased irritation. Bacteria are unable to develop resistance to benzoyl peroxide, making it the ideal agent for combination with topical or oral antibiotics.

Salicylic Acid

Salicylic acid is a common ingredient found in over the counter acne preparations (gels and washes) in concentrations ranging from 0.5% to 2%. This lipid-soluble β-hydroxy acid has comedolytic properties but somewhat weaker than those of a retinoid. Mild irritant reactions may result especially those with sensitive skin so it is best to patch test the product beforehand. It is generally considered less effective than benzoyl peroxide.

Azelaic acid

Azelaic acid is available by prescription in a 20% cream or 15% gel. This has both antimicrobial and comedolytic properties. It is also a competitive inhibitor of tyrosinase and thus may decrease post-inflammatory hyperpigmentation (PIH). It is generally well tolerated, although transient burning can occur, and is considered safe in pregnancy.

What other treatments are available?

There are other treatment options for acne such as hormonal treatment, oral antibiotics, and procedures like comedone extractions, chemical peels, intralesional injection of steroids among others. These are also combined with topical treatments, depending on the severity of acne. It is best to consult a board-certified dermatologist for individualized treatment of acne especially when your acne is not improving with over the counter products. Acne is best managed through these combination of treatments as well as lifestyle changes and use of gentle skincare products that address that are tailored for you.

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Created With

Dr. Meg Sison
Dermatologist
@drmegsison

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