Prescription Topical Medicines

Treatment for Moderate to Severe Inflammatory Acne

Moderate to severe inflammatory acne may be treated with prescription topical or oral medicines, alone or in combination.

Prescription Topical Medicines

They include:

• Antibiotics – help stop or slow the growth of bacteria and reduce inflammation - can never completely rid youreself of bacteria (P. acnes) as these bacteria are normally found on human skin. Antibiotics only lower levels of bacteria or inhibit there growth. They never completely remove bacteria (99.999% will be killed but 0.0001% will remain, which can grow).
  

  Topical Antibiotics

  • clindamycin

  • erythromycin

  • act by stopping bacterial growth and preventing inflammation

  • very few side effects

  • can effectively combine with other treatments safely and effectively

  
  

• Vitamin A derivatives (retinoids) – these are part of the thyroid hormone superfamily of hormones and bind to RXR receptos in humans. They act by unplugging existing comedones (plural of comedo), allowing other topical medicines, such as antibiotics, to enter and penetrate the follicles. Therefore, it is advantagous to combine medicines. They assist in decreasing the formation of comedones. These drugs contain an altered form of vitamin A, and not regular vitamin A from the diet but a metabolically altered form. Some examples are tretinoin, adapalene (Differin), and tazarotene (Tazorac).

   

• Adapalene

  • comedolytic

  • a tretinoin but less irritative

  • no photosensitivity

  • expensive

• Antibiotics
  
  

• Vitamin A derivatives (retinoids)

• Isotretionoin / AccutaneTM

  • most effective

  • long-lasting effects

  • acts by reducing sebum production

  • causes atrophy of sebaceous glands that produce sebum

  • increases skin cell turnover

  • stops growth of bacteria

  • MANY side effects; birth defects, skin and mouth dryness, high lipid levels, and reversible hair loss

• Tretinoin / Tazarotene

  • side effects are photosensitivity and irritation

Other prescription topical medicines – may destroy P. acnes and reduce oil production or help stop or slow the growth of bacteria and reduce inflammation. Examples are strength Benzoyl peroxide, sodium sulfacetamide/sulfur-containing products, or Azelaic acid (Azelex).

Like OTC topical medicines, prescription topical medicines come as creams, lotions, solutions, gels, or pads. Creams and lotions provide moisture and are the choice for people with sensitive or dry and damaged skin. If you have very oily skin or live in a hot, humid climate, an alcohol-based gel or solution, which slightly drys the skin is preferential. How to apply the medicine and how often to use it can be learned from your physician and local pharmacist.

It is known that prescription topical medicines can cause minor side effects, including stinging, burning, redness, peeling, scaling, or discoloration of the skin.Some medicines, such as tretinoin, these side effects usually decrease or go away after the medicine is used for a period of time. If these side-effects are prolonged, seek medical attention early.