Acne affects an estimated 80% of the population between the ages of 11 and 30, and pharmacists are likely to encounter many patients seeking advice on their OTC options.
Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.
Acne vulgaris continues to be a verycommon skin condition in the UnitedStates, accounting for more than 20% ofall dermatologic visits each year.1 Acneaffects an estimated 80% of the populationbetween the ages of 11 and 30.2 Inaddition, statistics from the AmericanDermatological Associationshow that60 million individuals have active acne,and 20 million of those have severecases that cause scarring.3 Acne canaffect anyone, and an estimated 30% ofindividuals who have acne use a nonprescriptionacne product.3
Acne is classified as 2 primary types1:
Although the exact cause of acne isnot known, many factors may contributeto its development. One of the mostcommon triggers of acne is puberty,leading to an increase of androgens,which causes the sebaceous glands toenlarge and make more sebum.1,2,4 Otherfactors or triggers that may contributeto or exacerbate an acne outbreakinclude genetics, hormonal changes, oilbasedcosmetics, stress, physical irritation,and the use of certain prescriptionmedications, such as phenytoin, phenobarbital,lithium, and steroids.1,3,4
Nonprescription products are availableas single-entity or combination productsand contain active ingredients suchas benzoyl peroxide, salicylic acid, orsulfur.
Benzoyl peroxide is the most effectiveand commonly used nonprescriptionagent for acne. It works by decreasingPropionibacterium acnes and removingdead cells from the skin to preventcomedones,1,5 and it is typically usedfor noninflammatory acne. It is importantto note that although a varietyof products contain benzoyl peroxidein different concentrations (eg, gels,lotions, cleansers, creams, masks, andsoaps), they are not all equivalent.1,5The drying effect of the alcohol gel basemay actually enhance the effectivenessof benzoyl peroxide; therefore, the gelbase formulations may be consideredmore effective.1
The adverse effects associated withthe use of benzoyl peroxide includeexcessive dryness of the skin, tingling,and burning. Patients should also beadvised that benzoyl peroxide maybleach hair, towels, or clothing if itcomes in contact with these objects.1,4Patients should be advised to continuetreatment for at least 4 to 6 weeks andseek medical advice if no improvementis seen after 6 weeks of therapyor if the patient experiences adverseeffects.1 Since benzoyl peroxide can beirritating to the skin, patients should bereminded to use caution when applyingbenzoyl peroxide in areas near theeyes, lips, nose, or mouth and areaswith open scrapes or cuts.1
For more information on acne, please visitthe following Web sites:
American Academy of Dermatology: www.aad.org.
The National Institute of Arthritis andMusculoskeletal and Skin Diseases:www.niams.nih.gov/Health_Info/Acne/acne_ff.asp.
Salicylic acid is classified as a mildcomedolytic agent. It is effective intreating noninflammatory acne.5 It isavailable in concentrations that rangefrom 0.5% to 2%.1 Salicylic acid aids inthe correction of the abnormal sheddingof skin cells, as well as uncloggingpores to treat or prevent acnelesions.1,5
Sulfur, either precipitated or colloidal,is included in acne products asa keratolytic and antibacterial agentin concentrations that range from 3%to 8%.1 Nonprescription acne productsoften contain a combination of sulfurand resorcinol. Resorcinol is thoughtto enhance the effects of sulfur. Theseproducts are mainly used as kerolytics.1
Pharmacists should first ascertainif self-treatment is appropriate andrecommend that patients with severecases of acne seek further evaluationfrom a dermatologist, if warranted.Pharmacists should stress the importanceof routine skin care. In additionto ensuring that patients clearly understandthe proper use of these acneproducts, pharmacists also can makesuggestions concerning nonpharmacologicmeasures that may decreaseor prevent acne flare-ups. Some ofthese suggestions include1,2:
Benzoyl Peroxide Products