Acne Vulgaris: A Common Condition

Yvette C. Terrie, BSPharm, RPh
Published Online: Thursday, May 24, 2012

Whether acne is mild, moderate, or severe, topical OTC medications can help control symptoms.


Acne vulgaris is the most common condition seen by dermatologists, affecting an estimated 60% to 70% of people in the United States.1,2

An estimated 20% of affected patients have severe acne, which often results in permanent scarring of the skin.Acne is characterized by whiteheads, blackheads, and blemishes. The condition develops primarily in teenagers, affecting an estimated 80% to 90% of this patient population, but many adults have some acne as well.1,3 Acne is most prevalent among males younger than 16 years and among females older than 23 years.1

Causes and Symptoms

The formation of acne is considered to be multifactorial and influenced by both genetic and hormonal factors.1-5 Key causes of acne include androgenic hormonal triggers, excessive sebum production, alteration in the keratinization process, and proliferation of Propionibacterium acnes bacteria and the resulting inflammatory process.1,3-5

Acne can be divided into 2 main types1-3: Noninflammatory acne consists of open and closed comedones and is characterized by the presence of whiteheads and blackheads. Inflammatory acne is characterized by the presence of pimples, which may rupture to form inflammatory lesions—raised, reddened areas on the skin called papules.

Typically, individuals with acne exhibit both types of the condition. Acne typically occurs on the face area, chest, and back, where the sebaceous glands are the most prominent, although it can occur on other areas of the body as well, such as the neck and upper arms.

Factors that can cause or worsen acne include use of oil-based cosmetics and hair pomades; stress and anxiety; exposure to humidity or dirt; premenstrual or hormonal changes; irritation from occlusive clothing (eg, headbands, hats, helmets); congenital adrenal hyperplasia, polycystic ovary syndrome and other endocrine disorders associated with excess androgens; and use of certain medications, such as phenytoin, isoniazid, phenobarbital, lithium, quinine, rifampin, and steroids.1-5

Treating Acne

The goals of acne treatment are to prevent or minimize the incidence of pimples and prevent scarring. Early treatment is best to avoid scarring. Selection of acne treatment is dependent uponacne type and severity and patient skin sensitivity and preference.1 Most cases of mild-to-moderate acne can be easily managed and controlled by using nonprescription topical acne agents, establishing and adhering to a daily skin care regimen, and avoiding factors that may worsen acne flare-ups.1-5

Patients should be advised that adherence to treatment is critical to controlling acne and decreasing the incidence of scarring. Patients with severe acne and scarring and patients whose acne fails to improve with use of nonprescription treatments should be encouraged to seek further medical care from a dermatologist.1-3 Patients with severe acne often require a combination of therapies, which may include topical retinoids and oral antibiotics.1-5

A wide range of nonprescription topical skin care products is available to treat mild-to-moderate cases of acne. They are available as medicated cleansing bars and pads, liquids, lotions, creams, gels, foams, astringents, and pads or wipes, and typically contain 1 or more of 3 active ingredients: benzoyl peroxide, salicylic acid, and sulfur.

Benzoyl Peroxide
Benzoyl peroxide is considered the most effective and widely used nonprescription medication for both types of acne.1 It is available in concentrations of 2.5% to 10% in nonprescription formulation and helps prevent or eliminate P acnes, the bacteria that causes acne inflammation.1 Benzoyl peroxide also helps remove excess oils from the skin, as well as remove dead skin cells that clog pores.

Benzoyl peroxide may cause excessive dryness of the skin, burning, and tingling. Patients should be advised to use a sunscreen and avoid unnecessary sun exposure when using benzoyl peroxide products.1 Caution should be used when applying it to areas near the lips, nose, and mouth, as well as areas with open scrapes or cuts. In addition, benzoyl peroxide may cause bleaching, so contact with hair and clothing should be avoided. Patients should be advised to continue treatment for at least 4 to 6 weeks and to seek medical advice if there is no improvement or if acne worsens after 6 weeks of therapy.1

Salicylic Acid
Salicylic acid in nonprescription topical products is available in concentrations of 0.5% to 2%. This agent decreases the shedding of cells inside thehair follicles, which prevents clogged pores and provides a milder, though less effective alternative to prescription topical retinoid products.1 Salicylic acid is found in many acne facial washes and cleansers as well as in gels and creams, and is often used twice a day. It may cause excessive peeling, burning, stinging, and redness of the skin. Use of sunscreen and avoidance of unnecessary sun exposure is advised when using products that contain salicylic acid.1

Sulfur
Sulfur is thought to treat acne by preventing the growth of P acnes and may also help remove dead skin cells and excess oil. It is often found in combination with resorcinol or sulfacetamide.1 Use of products containing sulfur may cause dryness, redness, and peeling of the skin. They are typically applied to affected areas 1 to 3 times daily, but their use is often limited because of their chalky yellow color and noticeable odor.1 In addition, products containing resorcinol may cause a reversible dark scaling in individuals with darker skin tones.1

Counseling Acne Patients

Patients should be reminded during counseling that although acne cannot be cured, it can be effectively managed and controlled with proper therapy. Patients should be advised to use these products as directed and to adhere to the selected treatment regimen, because improvement may take several weeks. If no signs of improvement are seen after 6 weeks of treatment with nonprescription topical products, patients should be encouraged to see a dermatologist for other treatment options.

If adverse reactions due to any of these products are observed, they should be discontinued immediately and the patient should contact their primary health care provider. In addition, patients with severe acne should be referred to a dermatologist to discuss other treatment options or recommendations.


Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.


References

1. Foster K, Coffey C. Acne. In: Krinsky D, Berardi R, Ferreri S, et al, eds. Handbook of Nonprescription Drugs. 17th ed. Washington, DC: American Pharmacists Association; 2012.

2. Fulton J. Acne vulgaris. Medscape website. http://emedicine.medscape.com/article/1069804-overview. Accessed March 28, 2012.

3. Thielitz A. Overview of new therapeutic developments for acne. Medscape website. www.medscape.com/viewarticle/587306. Accessed March 28, 2012.

4. Savage LJ, Layton AM. Treating acne vulgaris: systemic, local and combination therapy. Expert Rev Clin Pharmacol. 2010;3(4):563-580.

5. Acne vulgaris. Merck Manual for Healthcare Professionals Online Edition. www.merckmanuals.com/professional/dermatologic_disorders/acne_and_related_disorders/acne_vulgaris.html. Accessed March 28, 2012.



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