Put Your Best Face Forward: Treatment of Acne Vulgaris

Nonprescription products offer patients an array of options for treating their acne.

Acne vulgaris, which is characterized by whiteheads, blackheads, and blemishes, affects almost everyone at some point in their lives and is the most prevalent condition seen by dermatologists.^1,2 According to the American Academy of Dermatology, acne affects approximately 85% of people.^3,4

In addition, severe acne, which typically causes permanent skin scarring, affects 20% of the patient population.² Acne manifests primarily in 80% to 90% of teenagers, but occurs in many adults as well—with women more likely to be affected as adults.^1-4 The condition is most prevalent among males younger than 16 years and among women older than 23 years.¹ Acne is thought to be caused by a number of factors, and its development is thought to be greatly influenced by both genetic and hormonal factors.^1-7 Some contributors to the condition include androgenic hormonal triggers, excessive sebum production, alteration in the keratinization process, and proliferation of Propionibacterium acnes and the resulting inflammatory process.^1,4,7

A variety of nonprescription topical skin care products is available for self-treatment and management of mild to moderate cases of acne. These products are available in a range of formulations, such as medicated cleansing bars and pads, liquids, lotions, creams, gels, foams, and pads or wipes. They typically contain the active ingredients benzoyl peroxide, salicylic acid, or sulfur, either as single-entity products or in combination.

The general goals of treating acne are to prevent or minimize the incidence of pimples and to prevent scarring.¹ Factors that should be considered when selecting an acne treatment include the type and severity of the acne, the patient’s level of skin sensitivity, and patient preference.¹

Self-treatment is generally appropriate for mild to moderate cases, which can often be managed and controlled through daily use of nonprescription topical acne agents, establishing and adhering to a daily skin care regimen, and avoiding factors that may worsen acne flare-ups.^1-6 Adherence and patient compliance to treatment are crucial to controlling acne and decreasing the incidence of scarring. Patients with severe acne and scarring should be encouraged to seek further medical care from a dermatologist, as should patients who see no improvement or worsening of acne after using topical nonprescription acne products.^1-4 Those with severe acne may require a combination of therapies, which can include prescription products such as topical retinoids and oral antibiotics.^1-6

Most patients with acne exhibit both the non-inflammatory and inflammatory forms. The condition typically affects the facial area, chest, and back, where the sebaceous glands are the most prominent. Acne can occur on other areas of the body as well, such as the neck and upper arms.¹

Causes of Acne

A variety of factors have been popularly identified as contributors to or responsible for worsening acne. However, while some studies have reported that diets high in sugar may contribute to acne, a number of clinical trials have failed to establish a correlation between development of acne and consumption of perennial suspects such as chocolate, nuts, and greasy food.⁹

Nonprescription Topical Acne Products

Benzoyl peroxide

Benzoyl peroxide (BPO) is considered the most effective and widely used nonprescription medication for both inflammatory and non-inflammatory acne.¹ Available in concentrations of 2.5% to 10% in nonprescription formulation, BPO has the ability to prevent or eliminate infection with P acnes, the bacterium that causes acne inflammation.¹ BPO also removes excess oils from the skin and exfoliates dead skin cells that clog pores. Use of BPO has been associated with excessive dryness of the skin, burning, and tingling. Patients using BPO should be advised to apply sunscreen daily and to avoid unnecessary sun exposure.¹ Caution should be used when applying BPO to areas near the lips, nose, and mouth, as well as to areas with open scrapes or cuts. BPO may cause bleaching, so contact between it and hair and clothing should be avoided. Treatment should be continued for at least 4 to 6 weeks in order to see benefits. Patients should seek medical advice if there is no improvement or if acne worsens after 6 weeks of therapy.¹

Salicylic acid

Salicylic acid in nonprescription topical acne products is available in concentrations of 0.5% to 2%. It decreases the shedding of cells inside the hair follicles, thereby preventing clogged pores and providing a milder, though less effective, alternative to prescription topical retinoid products.¹ Salicylic acid is found in many acne facial washes and cleansers as well as gels, medicated pads, and creams, and is often used twice a day. Use of salicylic acid may cause excessive peeling, burning, stinging, and redness of the skin. Regular application of sunscreen and avoidance of unnecessary sun exposure is advised when using products containing salicylic acid.¹

Sulfur

Sulfur is thought to treat acne by preventing growth of P acnes and may also help remove dead skin cells and excess oil. It is often found in combination with resorcinol or sulfacetamide.¹ Use of products containing sulfur may cause dryness, redness, and peeling of the skin. These products are typically applied to affected areas 1 to 3 times daily, but their use is often limited due to their chalky yellow color and noticeable odor.¹ In addition, products containing resorcinol may cause a reversible dark scaling in patients with darker skin tones.¹

Conclusion

Patients who use nonprescription topical acne products should be advised to exercise patience and give the products time to work. If no signs of improvement are seen after 6 weeks of treatment with the products, patients should be encouraged to consult a dermatologist to explore alternative treatment options. Patients with severe acne and scarring should also be referred to a dermatologist to discuss other treatment options or recommendations.

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

References

• Foster K, Coffey C. Acne. In: Krinsky D. Berardi R, Ferreri S, et al, eds. Handbook of Nonprescription Drugs. 17th ed. Washington, DC: American Pharmacists Association; 2012.
• Fulton J. Acne Vulgaris. Medscape website. http://emedicine.medscape.com/article/1069804-overview. Accessed March 26, 2013.
• Acne facts. American Academy of Dermatology website. www.aad.org/media-resources/stats-and-facts/conditions/acne. Accessed March 28, 2013.
• Tailored acne treatments help women address adult acne with added benefit of improving aging skin. American Academy of Dermatology website. www.aad.org/stories-and-news/news-releases/tailored-acne-treatments-help-women-address-adult-acne-with-the-added-benefit-of-improving-aging-skin. Accessed March 29, 2013.
• Thielitz A. Overview of new therapeutic developments for acne. Medscape website. www.medscape.com/viewarticle/587306. Accessed March 29, 2013.
• Savage LJ, Layton AM. Treating acne vulgaris: systemic, local and combination therapy. Expert Rev Clin Pharmacol. 2010;3(4):563-580.
• Acne vulgaris. Merck Manual for Healthcare Professionals Online Edition. www.merckmanuals.com/professional/dermatologic_disorders/acne_and_related_disorders/acne_vulgaris.html. Accessed March 29, 2013.
• Acne. Medline Plus website. www.nlm.nih.gov/medlineplus/ency/article/000873.htm. Accessed April 4, 2013.