Acne Treatments

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:

• Noninflammatory acne: characterizedby the presence of closed(whiteheads) or open (blackheads)comedones
• Inflammatory acne: characterizedby the presence of pimples whichmay rupture to form inflammatorylesions that are raised, reddenedareas on the skin called papules

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 Acne Products

Nonprescription products are availableas single-entity or combination productsand contain active ingredients suchas benzoyl peroxide, salicylic acid, orsulfur.

Benzoyl Peroxide

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

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

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

The Role of the Pharmacist

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 include^1,2:

• Never squeeze or pick acne lesions,which can increase incidence ofscarring.
• Cleanse the skin at least twicedaily to produce a mild dryingeffectthat loosens comedones.
• Cleanse the skin with a soft washcloth,warm water, and an appropriatefacial soap.
• Avoid harsh scrubbing of the skin.
• Women should be advised to usemakeup that is oil-free or labeledas "noncomedogenic."

Table

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

• 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.