Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.
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Acne is classified as 2 primary types1:
- Noninflammatory acne: characterized by the presence of closed (whiteheads) or open (blackheads) comedones
- Inflammatory acne: characterized by the presence of pimples which may rupture to form inflammatory lesions that are raised, reddened areas on the skin called papules
Although the exact cause of acne is not known, many factors may contribute to its development. One of the most common triggers of acne is puberty, leading to an increase of androgens, which causes the sebaceous glands to enlarge and make more sebum.1,2,4 Other factors or triggers that may contribute to or exacerbate an acne outbreak include genetics, hormonal changes, oilbased cosmetics, stress, physical irritation, and the use of certain prescription medications, such as phenytoin, phenobarbital, lithium, and steroids.1,3,4
Nonprescription Acne Products
Nonprescription products are available as single-entity or combination products and contain active ingredients such as benzoyl peroxide, salicylic acid, or sulfur.
Benzoyl Peroxide
Benzoyl peroxide is the most effective
and commonly used nonprescription
agent for acne. It works by decreasing
Propionibacterium acnes and removing
dead cells from the skin to prevent
comedones,1,5 and it is typically used
for noninflammatory acne. It is important
to note that although a variety
of products contain benzoyl peroxide
in different concentrations (eg, gels,
lotions, cleansers, creams, masks, and
soaps), they are not all equivalent.1,5
The drying effect of the alcohol gel base
may actually enhance the effectiveness
of benzoyl peroxide; therefore, the gel
base formulations may be considered
more effective.1
The adverse effects associated with the use of benzoyl peroxide include excessive dryness of the skin, tingling, and burning. Patients should also be advised that benzoyl peroxide may bleach hair, towels, or clothing if it comes in contact with these objects.1,4 Patients should be advised to continue treatment for at least 4 to 6 weeks and seek medical advice if no improvement is seen after 6 weeks of therapy or if the patient experiences adverse effects.1 Since benzoyl peroxide can be irritating to the skin, patients should be reminded to use caution when applying benzoyl peroxide in areas near the eyes, lips, nose, or mouth and areas with open scrapes or cuts.1
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Salicylic Acid
Salicylic acid is classified as a mild
comedolytic agent. It is effective in
treating noninflammatory acne.5 It is
available in concentrations that range
from 0.5% to 2%.1 Salicylic acid aids in
the correction of the abnormal shedding
of skin cells, as well as unclogging
pores to treat or prevent acne
lesions.1,5
Sulfur
Sulfur, either precipitated or colloidal,
is included in acne products as
a keratolytic and antibacterial agent
in concentrations that range from 3%
to 8%.1 Nonprescription acne products
often contain a combination of sulfur
and resorcinol. Resorcinol is thought
to enhance the effects of sulfur. These
products are mainly used as kerolytics.1
The Role of the Pharmacist
Pharmacists should first ascertain if self-treatment is appropriate and recommend that patients with severe cases of acne seek further evaluation from a dermatologist, if warranted. Pharmacists should stress the importance of routine skin care. In addition to ensuring that patients clearly understand the proper use of these acne products, pharmacists also can make suggestions concerning nonpharmacologic measures that may decrease or prevent acne flare-ups. Some of these suggestions include1,2:
- Never squeeze or pick acne lesions, which can increase incidence of scarring.
- Cleanse the skin at least twice daily to produce a mild drying effect that loosens comedones.
- Cleanse the skin with a soft washcloth, warm water, and an appropriate facial soap.
- Avoid harsh scrubbing of the skin.
- Women should be advised to use makeup that is oil-free or labeled as "noncomedogenic."
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References
- Foster K, Coffey C. Acne. Handbook of Nonprescription Drugs 15th Edition. 803-815.
- Acne. The National Institute of Arthritis and Musculoskeletal and Skin Diseases Web site. www.niams.nih.gov/Health_Info/Acne/default.asp.
- Acne Statistics. The Acne Resource Center Online Web site. www.acne-resource.org/understanding-acne/acne-statistics.html.
- Beers M. Acne Vulgaris. The Merck Manual 18th Edition. 941-946.
- Over-the-Counter Acne Products. AcneNet Web site. www.skincarephysicians.com/acnenet/treatotc.html.