Acne Treatments

DECEMBER 01, 2008
Yvette C. Terrie, BSPharm, RPh

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

Acne vulgaris continues to be a very common skin condition in the United States, accounting for more than 20% of all dermatologic visits each year.1 Acne affects an estimated 80% of the population between the ages of 11 and 30.2 In addition, statistics from the American Dermatological Association show that 60 million individuals have active acne, and 20 million of those have severe cases that cause scarring.3 Acne can affect anyone, and an estimated 30% of individuals who have acne use a nonprescription acne product.3

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

For more information on acne, please visit the following Web sites:
American Academy of Dermatology:
The National Institute of Arthritis and Musculoskeletal and Skin Diseases:

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, 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."
Examples of Nonprescription Acne Products

Benzoyl Peroxide Products

  • Clearasil Vanishing Acne Treatment Cream
  • Clearasil Tinted Acne Treatment Cream
  • Clean & Clear Persa-Gel 10, Maximum Strength
  • Neutrogena On-The-Spot Acne Treatment Vanishing Formula
  • Neutrogena Clear Pore Cleanser/Mask
  • OXY Acne 2% Benzoyl Peroxide Wash (2% Benzoyl Peroxide)
  • OXY Shave Cream 2.5% Benzoyl Peroxide Acne Treatment
  • Pan Oxyl Bar/Gel
  • Stridex Benzoyl Peroxide Power Pads
  • ZAPZYT Maximum Strength 10% Benzoyl Peroxide Acne Treatment Gel
  • ZAPZYT Treatment Bar 10% Benzoyl PeroxideSalicylic Acid Products
  • Aveeno Clear Complexion Cleansing Bar
  • Biore Blemish Fighting Ice Cleanser
  • Clearasil Ultra Daily Face Wash
  • Clearasil Blackhead Clearing Scrub
  • Clearasil StayFree Oil Free Gel Wash
  • Clean & Clear Advantage Acne Spot Treatment
  • Clean & Clear Blackhead Clearing Scrub Salicylic Acne Medication
  • Clean & Clear Advantage Oil-Free Acne Moisturizer Salicylic Acne Medication
  • Nature's Gate Natural Results, Salicylic Acid Acne Treatment
  • Neutrogena Advanced Solutions Acne Mask Eliminating Peel
  • Neutrogena Blackhead Eliminating Daily Scrub
  • Neutrogena Oil-Free Acne Wash Salicylic Acid Acne Treatment
  • Neutrogena Rapid Clear Acne Eliminating Treatment Pads
  • Noxzema Triple Clean Pads
  • Olay Total Effects Anti-Blemish Daily Cleanser
  • OXY Daily Cleansing Pads, Focus: Blackheads
  • Phisoderm Anti-Blemish Gel Facial Wash
  • Stridex Maximum Strength Pads
  • Sulfur Products

  • Sulpho-Lac Acne Medication Cream
  • Sulpho-Lac Soap
  • Combination Products

  • Acomel Cream
  • Clearasil Adult Care Acne Treatment Cream
  • Neutrogena Advanced Solutions Acne Mask Eliminating Peel
  • Pernox Cleanser for Oily Skin
  • Sudden Change Scar Zone A Acne Treatment & Scar Diminishing Cream with Green Tea for Sensitive Skin

  • References

    1. Foster K, Coffey C. Acne. Handbook of Nonprescription Drugs 15th Edition. 803-815.
    2. Acne. The National Institute of Arthritis and Musculoskeletal and Skin Diseases Web site.
    3. Acne Statistics. The Acne Resource Center Online Web site.
    4. Beers M. Acne Vulgaris. The Merck Manual 18th Edition. 941-946.
    5. Over-the-Counter Acne Products. AcneNet Web site.