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Non-Prescription Drugs - cleansers, peeling
&/or drying agents. Some of the active ingredients used in these
products include salicylic acid, resorcinol, sulfur, triclosan, and/or
various organic solvents such as alcohol. Products containing sulfur
are not recommended because sulfur may promote development of new
comedones.3 Salicylic acid (Salac®) has a keratolytic effect
(facilitates removal of keratin) and is the preferred cleanser. Prescription Drugs - There are numerous drugs
that can be used to treat acne. They generally fall into a few
different classes or categories. Specifically they are are
anti-microbials, peeling &/or drying agents, and retinoids. Some
of the more commonly used treatments are listed below.
- Antimicrobials - Clindamycin
(Cleocin T®) and erythromycin (A/T/S®), two
macrolide antibiotics, are the mainstays for topical preparations when
treating mild cases of acne. These agents are antimicrobial and
inhibit bacterial protein synthesis (growth). They are
active against Propionibacterium acnes, an anaerobic organism commonly
found in acne lesions. By inhibiting the acne bacteria they work
at the source of the problem. These agents are included in
topical gels or solutions for use directly on the skin. Another
agent, benzoyl peroxide, is both antibacterial and also has
desquamating (peeling) effects. Benzoyl peroxide is frequently
used in topical acne medications as a single ingredient or in
combination with another antimicrobial (e.g. Benzamycin Gel®).
Other topical antimicrobials include azelaic acid (Azelex®),
metronidazole (Metrogel®),
meclocycline (Meclan®),
and tetracycline (Topicycline®).3,
4
- Peeling / Drying Agents - The
peeling and/or drying agents reduce acne by their desquamatory and/or
keratolytic properties. They can cause a more rapid turnover or
removal of dead or dying skin cells and also may reduce the
production of free fatty acids and lipids which contribute to
acne. Benzoyl peroxide, as mentioned before, works by both its
antimicrobial and peeling/drying effects. Sulfur products have
been used in the past but have fallen out of favor. Sulfur is
keratolytic and provides peeling and drying action but may also
promote development of new comedones by increasing horny cell
adhesion.3
- Retinoids - Isotretinoin
(Accutane®), a retinoid, exerts its activity by reduction
in sebum secretion, altering the composition of skin surface lipid,
decreasing the proliferation of the bacterium, Propionibacterium
acnes, and preventing abnormal follicular keratinization.3
Isotretinoin is reserved for use in only the most severe acne
cases. Tretinoin (Retin-A®, others), a topical
retinoid, decreases cohesiveness of follicular epithelial cells with
decreased microcomedone formation. Additionally, tretinoin
stimulates mitotic activity and increases turnover of follicular
epithelial cells, causing extrusion of the comedones.3 Other
retinoids or retinoid-like agents are tazarotene (Tazorac®)
and adapalene (Differin®).
- Other - Other products contain
keratolytics and astringents to aid in removing keratin and to dry the
skin. Many products contain solvents which aid in the removal of
sebum. Some of these products include Sulfacet-R®
Lotion, and Novacet® Lotion, both of which contain sodium
sulfacetamide, an antimicrobial.
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