Key Messages. Treatment Basics. So preventing acne requires some patience and some experimentation to find the right program for you.

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1 Treatment Basics Key Messages You don't treat acne, you prevent it. There is no one best or one-size fits all acne treatment. Finding the best topical medications - medications you put on your skin - depends on your skin type. It is helpful to look in the mirror and decide whether your acne is mostly: So preventing acne requires some patience and some experimentation to find the right program for you. For oily skin, choose a solution or gel-based product. For choose a cream or lotion-based product. inflammatory (redness + swelling); plugging (whiteheads + ) or both.

2 Benzoyl peroxide (2.5% to 5%) products are available without a prescription and are usually tried first for mild to inflammatory acne. Then you can add a retinoid or an antibiotic. Generally, products require 8 to 12 weeks for noticeable improvement. Some products may initially worsen acne - you need to give it time. Don't just apply acne products to your individual pimples! Apply acne products to all the skin area that you commonly get pimples to reduce the chance of further breakouts. Isotretinoin has some side-effects and cannot be taken by pregnant women......but it is the most effective agent for acne. Talk to your doctor about acne. Below is a list of common (but not all) medications for acne.

3 Non-prescription, topical Benzoyl Peroxide acne or up to (2.5% to 5%*) Benzac AC, Benzagel, Panoxyl Aquagel, Solugel) Inexpensive Can bleach hair, clothing, bed sheets; lingering odor Water-based product less irritating Benzoyl peroxide-containing soaps and washes are less effective Benzoyl peroxide can degrade other products. Use a commercial combination product or space out application times if also using a retinoid or antibiotic. Irritation can be minimized by gradually increasing wear time applying every other day initially; or, wearing for 2 to 4 hours per night increasing to all night as tolerated) Topical benzoyl peroxide is safe in pregnancy Salicyclic Acid Mild acne (.5 to 2%) plugging by exfoliation or twice daily (e.g. Clearasil Ultra Vanishing Treatment Cream, Noxzema Anti-Acne Gel or Pads, Neo-strata Blemish Spot Gel, Oxy maximum cleaning pads, foaming face wash) plugging mild acne bedtime Drying of skin, Very commonly used, as available over the counter, but not nearly as much research support compared to other first line agents such as BP or retinoids mild to acne *Concentrations above 5% require a prescription

4 Prescription, topical Retinoid Unplugging glands and reducing Twice daily adapalene (Differin 0.1% gel,cream; XP 0.3%), tretinoin (Rejuva-A, Renova, Retin-A) tazarotene) Topical clindamycin (Dalacin T 1% solution, Clinda T 1% solution, Clindets pads) mild to acne Tolerance to irritation develops over time Adapalene is best tolerated Avoid retinoid use if pregnant Most effective when combined with benzoyl peroxide or retinoid Combination with benzoyl peroxide reduces the chance of l resistance Can stop use when subsides Topical erythromycin and clindamycin are safe in pregnancy plugging bedtime

5 Prescription, topical - combination products Benzoyl Peroxide + Retinoid ; unplugging glands burning,, ; unplugging glands, (Benzaclin, Clindoxyl ) or (Benzamycin ) itching, Tactuo ) + Retinoid Clindamycin and tretinoin (Biacna*) Erythromycin + trentinoin (Stievamycin mild,reg, forte) Benzoyl Peroxide + Benzaclin, Benzamycin, Clindoxyl ) mild to acne plugging Benzoyl peroxide component can bleach hair, clothing, bed sheets; lingering odor Benzoyl peroxide component can bleach hair, clothing, bed sheets; lingering odor Benzamycin has to be refrigerated bedtime

6 Prescription, systemic (oral) severe acne P. acnes by slowing proliferation Once daily: (doxycycline, minocycline, TMP) or (tetracycline, erythromycin, TMP/SMX) Gastrointestinal upset, (tetracyclines), yeast infection tetracyclines (doxycline, minocycline, tetracycline), erythromycin, Septra) Isotretinoin Oral Retinoid severe acne.. but usually more severe (eg. Accutane, Amnesteem, Claravis, Sotret) to severe acne Unknown: acts on glands reducing sebum production Once or depending on regimen Dryness mouth, nose, eyes), peeling, pain and swelling of lips, headache, fatigue, hair loss, joint pain,, blood cholesterol and triglycerides Pulsed (vs. continuous) use may reduce l resistance Avoid tetracylines, TMP or TMP/SMX use if pregnant Avoid taking tetracycline at bedtime to reduce capsule getting stuck in throat and causing an ulcer (especially with tetracyclines) Topical benzoyl peroxide is safe in pregnancy Highly effective for to severe inflammatory acne Causes birth defects; Use two birth control methods. Avoid/stop retinoid use if pregnant Taken with food Usually taken for 4 to 5 months Use a moisturizer and lip balm Monitor for signs/ symptoms of depression once daily unknown

7 Other Oral contraceptives severe acne in females Antiandrogen effect Once daily Breakthrough bleeding/ spotting, suppression of menstruation, nausea, vomiting, breast tenderness, headache, bloating, mood changes severe acne Has both antimicrobial and anticomedonal properties Twice daily (Alesse, Aviane, Diane-35, TriCyclen, Yasmin, Yaz) Azelaic acid Finacea 15% gel (eg. Accutane, Amnesteem, Claravis, Sotret) anticomedonal Can cause skin coulour lightening, especially in darkerskinned patients Avoid the mini pill (progestin only) since it may worsen acne Avoid in smokers over age 35 Avoid if history of blood clots Naturally occurring acid Newer medication Need to monitor for hypopigmentation American Guidelines note that its clinical use, compared to other agents, has limited efficacy according to experts. to severe acne antimicrobial anti-androgen once daily References: e-cps product monographs Accutane ), e-therapeutics ( Disorders: Acne, Sexual Health: Contraception ), RxFiles ( ACNE Pharmacotherapy Comparison Chart ), Up-to-Date [ Patient information: Acne (Beyond the Basics) ] Copyright 2012 Evans Health Lab

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