Case 1
Skin Care Routine
LM is a 16-year-old girl who comes to the pharmacy complaining of acne. She recently developed a few pimples on her forehead and chin. As a high school student, she is concerned about her skin and wants to improve it. She has mild acne, which consists of a few whiteheads and blackheads. Currently, she washes her face with regular soap but does not use any other skin care products.
Q: What recommendations do you have for LM?
A: LM appears to have mild acne, which typically consists of comedones (whiteheads and blackheads) with minimal inflammation. This type of acne can be managed effectively with OTC treatments. Two common options are benzoyl peroxide and salicylic acid. Benzoyl peroxide, available in strengths ranging from 2.5% to 5%, helps reduce bacteria and inflammation, making it an effective first-line treatment. Salicylic acid, available in 0.5% to 2% strengths, works by gently exfoliating the skin and unclogging pores.1,2
About the Author
Rupal Patel Mansukhani, PharmD, FAPhA, NCTTP, is a clinical professor of pharmacy practice and administration at Ernest Mario School of Pharmacy at Rutgers, The State University of New Jersey, in Piscataway and a transitions-of-care clinical pharmacist at Morristown Medical Center in New Jersey.
Sneha Baxi Srivastava, PharmD, BCACP, CDE, is associate director of skills education at Rosalind Franklin University of Medicine and Science College of Pharmacy in North Chicago, Illinois. She is deeply passionate about embracing the pillars of lifestyle medicine, selfcare, effective communication, and inclusivity to create lasting positive health and wellness outcomes.
Because LM is new to acne treatments, she should begin with a lower-strength product to minimize the risk of irritation.
A proper skin care routine is essential for acne management. LM should establish a habit of washing her face twice daily, once in the morning and once in the evening, using a mild, nonirritating cleanser. After cleansing, she can apply a benzoyl peroxide or salicylic acid treatment. It is important to use a lightweight, oil-free moisturizer to prevent excessive dryness because some acne treatments can be drying. Additionally, she should apply sunscreen daily because acne treatments can make the skin more sensitive to the sun. If she remains consistent with her regimen, she should begin to see improvement within 4 to 6 weeks. If her acne does not improve or worsens, she may need to explore other options, such as adding a topical retinoid or consulting a dermatologist for further evaluation.1,2
Case 2
Persistent Breakouts
RD is a 22-year-old man who comes to the pharmacy looking for help to treat his acne. He reports experiencing persistent breakouts despite following a consistent skin care routine that includes benzoyl peroxide 5% for the past 3 weeks. Upon inspection, you notice redness and irritation on his skin.
Q: What recommendations do you have for RD?
A: Because RD has already been using benzoyl peroxide without satisfactory results, the next step would be adding adapalene 0.1% gel, an OTC topical retinoid. Adapalene works by promoting cell turnover, preventing clogged pores, and reducing inflammation. RD should continue using his benzoyl peroxide wash twice daily and apply a thin layer of adapalene in the evening. However, because adapalene can cause dryness and irritation, it may be beneficial for him to start by applying it every other night for the first 2 weeks. If his skin tolerates it well, he can increase the application to once daily.
Case 3
Hormonal Acne
SM is a 35-year-old woman who comes to the pharmacy looking for pimple patches. She experiences painful pimples that appear right before her menstrual cycle each month. She is opposed to using prescription medications but says her daughter recommended pimple patches to conceal her acne. She has tried benzoyl peroxide in the past but found it too drying.
Q: What recommendations do you have for SM?
A: SM appears to have hormonal acne, which is linked to fluctuating androgen levels that increase sebum production. Unlike adolescent acne, which often consists of blackheads and whiteheads, hormonal acne tends to manifest as deep, inflamed, and sometimes painful cystic lesions, usually around the jawline, chin, and lower face. Because SM prefers to avoid prescription treatments, she can try an OTC regimen that targets hormonal acne.
A combination approach that includes gentle exfoliation and anti-inflammatory ingredients is ideal. In the morning, SM should wash her face with a mild cleanser containing niacinamide, which can help regulate oil production and reduce redness. In the evening, she should cleanse her face again and apply either adapalene 0.1% gel or azelaic acid 10%, both of which are effective for treating hormonal acne. Adapalene works by preventing clogged pores, whereas azelaic acid has anti-inflammatory and antibacterial properties. Because SM has previously found benzoyl peroxide too drying, she should avoid harsh scrubs and alcohol-based products as these can worsen irritation and dryness.
Case 4
Sensitive Skin
DS is a 20-year-old man who comes to the pharmacy looking for an acne treatment suitable for sensitive skin. He reports experiencing frequent breakouts but struggles with redness and irritation from every product he has tried, including multiple formulations of benzoyl peroxide.
Q: What recommendations do you have for DS?
A: Because DS has sensitive skin, he requires a gentle yet effective treatment approach to avoid further irritation. A good alternative to benzoyl peroxide is azelaic acid, which has antibacterial and anti-inflammatory properties but is less likely to cause excessive dryness. Another option is a low-strength salicylic acid formulation (≤ 1%), which helps unclog pores while being milder than higher concentrations.
For his skin care routine, DS should start by using a gentle, fragrance-free cleanser twice daily. It is crucial that he avoids products containing alcohol, sulfates, or other harsh ingredients that may strip the skin’s natural moisture barrier. After cleansing, he can apply azelaic acid 10% or a mild salicylic acid serum in the evening. To maintain skin hydration and prevent further irritation, he should use a noncomedogenic moisturizer after applying his treatment. Because acne treatments can take time to show results, it is important to educate DS about the importance of consistency. He should give the regimen at least 6 to 8 weeks before assessing its effectiveness.
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. https://www.jaad.org/article/s0190-9622(15)02614-6/fulltext
2. Dréno B, Pécastaings S, Corvec S, Veraldi S, Khammari A, Roques C. Cutibacterium acnes (Propionibacterium acnes) and acne vulgaris: a brief look at the latest updates. J Eur Acad Dermatol Venereol. 2018;32(suppl 2):5-14. doi:10.1111/jdv.15043
3. Eichenfield LF, Krakowski AC, Piggott C, et al. Evidence-based recommendations for the diagnosis and treatment of pediatric acne. Pediatrics. 2013;131(suppl 3):S163-186. doi:10.1542/peds.2013-0490B
4. Sagransky M, Yentzer BA, Feldman SR. Benzoyl peroxide: a review of its current use in the treatment of acne vulgaris. Expert Opin Pharmacother. 2009;10(15):2555-2562. doi:10.1517/14656560903277228
5. Kolli SS, Pecone D, Pona A, Cline A, Feldman SR. Topical retinoids in acne vulgaris: a systematic review. Am J Clin Dermatol. 2019;20(3):345-365. doi:10.1007/s40257-019-00423-z
6. Harper JC, Thiboutot DM. Pathogenesis of acne: recent research advances. Adv Dermatol. 2003;19:1-10. https://pubmed.ncbi.nlm.nih.gov/14626815/
7. Thiboutot DM, Dréno B, Abanmi A, et al. Practical management of acne for clinicians: an international consensus from the Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol. 2018;78(2 suppl 1):S1-S23.e1. doi:10.1016/j.jaad.2017.09.078
8. Hakozaki T, Minwalla L, Zhuang J, et al. The effect of niacinamide on reducing cutaneous pigmentation and suppression of melanosome transfer. Br J Dermatol. 2002;147(1):20-31. doi:10.1046/j.1365-2133.2002.04834.x
9. Leyden JJ. A review of the use of combination therapies for the treatment of acne vulgaris. J Am Acad Dermatol. 2003;49(suppl 3):S200-210. doi:10.1067/s0190-9622(03)01154-x
10. Bladon PT, Burke BM, Cunliffe WJ, Forster RA, Holland KT, King K. Topical azelaic acid and the treatment of acne: a clinical and laboratory comparison with oral tetracycline. Br J Dermatol. 1986;114(4):493-499. doi:10.1111/j.1365-2133.1986.tb0856.x
