The Pharmacy Team’s Role in Evidence-Based Acne Management

For those who have dealt with acne, the process of navigating countless treatment options without clear guidance can feel overwhelming. As some of the most accessible health care professionals, pharmacists and pharmacy interns play a critical role in guiding patients toward safe, effective, and evidence-based acne management. Pharmacy interns frequently assist in selecting appropriate OTC therapies, providing patient counseling and education, and identifying when referral to a dermatologist is necessary.

As a pharmacy intern, I remember counseling a patient who brought several acne products to the counter and asked which one would work after trying multiple options without success. We reviewed the active ingredients together, and I asked questions about their skin type and treatment goals to help make an appropriate recommendation. Seeing their relief and increased confidence in starting a care regimen reinforced the meaningful role that pharmacy professionals play in helping patients navigate acne treatment.

Acne vulgaris is one of the most common dermatologic conditions worldwide, affecting approximately 85% of adolescents and many adults.¹ Although perceived as a cosmetic concern, acne is a chronic inflammatory skin disease that can significantly affect quality of life, self-esteem, and mental health.¹

Understanding Acne Pathophysiology and Guiding OTC Treatment Selection

Acne develops through 4 primary mechanisms: excess sebum production, follicular hyperkeratinization, proliferation of Cutibacterium acnes, and inflammation.^1,2 These processes lead to the formation of inflammatory and noninflammatory lesions, including comedones, papules, pustules, nodules, and cysts. Hormonal fluctuations, particularly increased androgen levels, stimulate sebaceous glands and contribute to acne development. Other contributing factors include genetics, stress, certain medications, and skin care habits that can worsen acne.¹ Understanding this pathophysiology enables pharmacists and pharmacy interns to recommend therapies that target specific underlying causes of acne.

Several evidence-based OTC therapies are available, and proper selection is critical for treatment success.¹ Benzoyl peroxide (PanOxyl; Crown Laboratories) is a first-line therapy because of its antibacterial and anti-inflammatory properties.^1,3 It reduces C acnes and decreases inflammation. Lower concentrations (eg, 2.5%-5.0%) are beneficial in minimizing irritation while maintaining efficacy.³

Salicylic acid is another common agent included in a variety of skin care products that promotes exfoliation and prevents clogged pores, making it effective for the treatment of comedonal acne.² Adapalene 0.1% (Differin; Galderma), an OTC topical retinoid, is one of the most effective nonprescription options. Retinoids promote skin cell turnover and reduce inflammation, but require consistent use for several weeks before visible improvement occurs.^1,2

Counseling on Proper Skin Care Practices and Improving Adherence

Pharmacists and pharmacy interns can significantly improve outcomes by counseling patients on proper skin care routines. Many patients unintentionally worsen acne through improper product use or unrealistic expectations. Patients should be advised to use gentle cleansers twice daily and avoid harsh scrubbing, which can increase inflammation. Noncomedogenic moisturizers and sunscreen are essential, particularly when using retinoids, which increase skin sensitivity.^1,2

Medication adherence is one of the most important determinants of acne treatment success.⁴ As trusted health care professionals, the pharmacy team can improve patient adherence by communicating realistic expectations and addressing patient concerns. Dryness, irritation, and redness are common and expected during early treatment, but gradual introduction, consistent moisturizer use, and nighttime application can help improve tolerability. Emphasizing that visible improvement often takes 6 to 12 weeks is also critical, as premature discontinuation is a common reason for treatment failure.^1,4 Counseling, reassurance, and evidence-based recommendations help patients remain consistent with therapy and achieve improved therapeutic outcomes.⁴

Helping Patients Navigate Acne Misinformation and Optimize Treatment Regimens

With the widespread influence of social media and online skin care trends, many patients attempt to manage acne using multiple active ingredients simultaneously without understanding their proper role or frequency of use. This can lead to excessive dryness, irritation, and disruption of the skin barrier, ultimately worsening acne.^1,2,5

Pharmacy professionals can assess a patient’s current skin care routine and identify potential causes of treatment failure. Common issues include using multiple exfoliating agents, inconsistent retinoid use, or frequent switching between products without allowing sufficient time for improvement.^2,5 This approach allows the pharmacy team to help patients select therapies that target different pathogenic mechanisms of acne while minimizing irritation and improving tolerability.¹

Pharmacy professionals can also educate patients on proper application techniques, such as using a pea-sized amount of topical retinoid for the entire face, applying moisturizers to reduce irritation, and introducing new products gradually to improve tolerability and adherence.^1,3 By correcting misinformation and reinforcing clinically supported skin care practices, patients can utilize acne therapies safely and effectively, improving adherence, therapeutic outcomes, and confidence in treatment plans.^1,3,4

Recognizing When Referral to Dermatology Is Necessary

Although many cases of acne can be effectively managed with OTC therapies, it is also crucial to identify when a referral to a dermatologist is needed. Moderate to severe acne often requires prescription therapies (eg, oral antibiotics, hormonal treatments, or isotretinoin) to adequately control inflammation and prevent further complications.^1,4

Referral to a dermatologist is indicated for patients who experience significant scarring or worsening symptoms despite appropriate OTC treatment.¹ Acne that presents primarily along the jawline, chin, or lower face may suggest a hormonal component is involved. This often requires evaluation and management with prescription therapies such as combined oral contraceptives or antiandrogen agents.^1,3 Early referral and intervention are essential to reduce the risk of permanent scarring and long-term skin damage.¹

As medication experts, pharmacy professionals can identify medication-induced acne associated with certain agents (eg, systemic corticosteroids, hormonal therapies).^1,3 Recognizing these drug-related causes allows for appropriate referral and collaboration with prescribers to optimize therapy when necessary. Through appropriate triage and timely referral, pharmacists and pharmacy interns serve as a critical first point of contact in dermatologic care. Their involvement helps ensure patients receive timely treatment and reduces the risk of disease progression.¹

Conclusion

Acne vulgaris is a highly prevalent condition frequently encountered in community pharmacy practice. Through appropriate OTC recommendations, prescription counseling, skin care education, and adherence support, pharmacists and pharmacy interns play a vital role in improving patient outcomes. As accessible and trusted health care professionals, pharmacists and pharmacy interns serve as a bridge between dermatology and patient care by helping individuals navigate treatment options and appropriate use of therapy. With continued advancements in dermatologic therapy and the expanding role of pharmacy in patient care, pharmacy professionals will remain essential contributors to acne management and overall patient health.⁴

REFERENCES

1. Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945-973.e33. doi:10.1016/j.jaad.2015.12.037

2. Thiboutot D, Gollnick H, Bettoli V, et al; Global Alliance to Improve Outcomes in Acne. New insights into the management of acne: an update from the Global Alliance to Improve Outcomes in Acne group. J Am Acad Dermatol. 2009;60(suppl 5):S1-S50. doi:10.1016/j.jaad.2009.01.019

3. Eichenfield DZ, Sprague J, Eichenfield LF. Management of acne vulgaris: a review. JAMA. 2021;326(20):2055-2067. doi:10.1001/jama.2021.17633

4. Feldman SR, Horn EJ, Balkrishnan R, et al. Medication adherence and acne treatment outcomes. J Am Acad Dermatol. 2007;57(3):440-446.
   doi:10.1016/j.jaad.2007.03.019

5. Tan JKL, Bhate K. A global perspective on the epidemiology of acne. Br J Dermatol. 2015;172(suppl 1):3-12. doi:10.1111/bjd.13462