Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.
Acne is classified as 2 primary types1:
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 products are available as single-entity or combination products and contain active ingredients such as benzoyl peroxide, salicylic acid, or sulfur.
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 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, 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
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:
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