Topical Retinoids are derived from vitamin A and are a key component to treating facial acne. Retinoids work by unclogging pores and preventing whiteheads and blackheads from forming. Retinoids are available by prescription in multiple strengths and both cream and gel formulations. These medications should not be used by women who are pregnant or breastfeeding.
- Tretinoin (Retin-A) 0.025%, 0.05%, 0.1% cream; 0.01%, 0.025% gel; 0.04% , 0.1% micro gel,
- Tazarotene (Tazorac) 0.05% and 0.1% cream/gel
- Adapalene (Differin) 0.1% cream/gel/lotion and 0.3% gel
Directions: Apply pea-sized amount to a dry face at bedtime as tolerated. Start by applying every 2-3 nights. If tolerated, slowly increase application frequency to nightly. This medication is drying and a non-comedogenic moisturizer can be layered over it. While some redness is expected, if you develop irritation, decrease the frequency of application. Retinoids should be applied to the entire face and not used as a ‘spot’ treatment. It takes 6-12 weeks of consistent use to see results.
- Retinol, found in numerous over-the-counter acne and anti-aging products, are milder and work slower than the prescription strength retinoids.
- Retinol also is found in many acne and anti-aging skin care lines offered by dermatology offices. These products usually contain a higher concentration of retinol than those found over-the-counter and are commonly combined with antioxidants and emollients to maximize effect and decrease dryness and irritation. The R | Essentials® skin care line is reasonably priced and sold in our offices.
Topical Antibiotics are commonly used in combination with other topical agents, including retinoids. These medications can cause skin dryness and irritation. If this occurs, use less frequently.
Topical clindamycin is considered to be safe to use during pregnancy. Although there are no known adverse effects from the other prescription and over-the-counter acne treatments, their safety in pregnant woman has not been confirmed and, thus, cannot be recommended.
- Benzoyl peroxide is available over-the-counter in multiple strengths (2% -10%) and can be found as a cream, gel, lotion, or liquid. Benzoyl peroxide can be used as a facial/body wash, applied to the entire affected area, or as a ‘spot’ treatment once or twice daily. This medication, alone or in a combination formula, can bleach fabrics.
- Clindamycin 1% is a prescription medication that is available as a gel, lotion, solution, and foam; apply once or twice daily.
- Acayna gel, BenzaClin gel, and Duac gel – contain both benzoyl peroxide and clindamycin; apply once to twice daily
Retinoid and Topical Antibiotic Combination Medications
- Epiduo gel – combination product of 2.5% benzoyl peroxide and 0.1% adalapene; apply once daily at bedtime
- Ziana gel and Veltin Gel – contains both 1.2% clindamycin and tretinoin 0.025%; apply once daily at bedtime
Oral antibiotics may be used to treat moderate to severe acne. Children less than 9 years-old should not take the first two medications listed because they can affect growth and stain teeth. Oral antibiotics generally are not recommended to treat acne in women who are pregnant or breast-feeding. Taking antibiotics with food (non-dairy) can decrease stomach upset.
- Doxycycline (20mg, 100mg) twice daily or delayed-release doxycycline (200mg ½ tablet) once daily
- Minocycline (50mg, 75mg, or 100mg) twice daily or extended release Solodyn (dose based on weight) once daily
- Trimethoprim-Sulfamethoxazole (Bactrim, Septra) 80mg/400mg SMX or 160mg/800mg DS twice daily
Additional Topical Acne Medications
- Azelaic Acid (Azalex 20% cream and Finacea 15% gel) – apply twice daily; indicated for acne rosacea
- Aczone (topical Dapsone 5% gel) – apply twice daily; works to decrease inflammation and redness
- Glycolic acid and salicylic acid – available alone or combined together in washes, lotions, pads, and peels. These products are used to decrease oil and exfoliate skin.
Treatment Specific for Women
Hormonal medications (spironolactone and specific types of birth control) are commonly used to treat acne in women. However, these therapies are not appropriate for every woman. They should never be taken during pregnancy and should be used with caution in patients who smoke as well as those with certain medical conditions such as high blood pressure, blood clots, and migraines as well as those with a personal or family history of breast, ovarian, or uterine cancer.
Additional Acne Treatments
Laser and light treatments for acne are relatively new and the data is currently limited. This type of treatment is usually not covered by insurance. Laser and light treatment often works best in combination with other acne treatment, but the results can be unpredictable. With more research, lasers and light therapies may become a better treatment option in the future.
Isotretinoin (‘Accutane’) may be used to acne that is severe, scarring, or resistant to treatment. While this medication is generally very effective, it does have the potential of many adverse side effects and should never be taken during pregnancy.
Tips for Clear Skin
- Use your acne treatments exactly as prescribed by the dermatologist. Acne only clears when the treatment targets all the factors contributing to your acne. Since most acne medications target only 1 or 2 factors, a combination of 2 or 3 products may be necessary. Stop using treatments that are not part of your treatment plan as they may lead to more dryness and breakouts.
- Wash your face twice daily and after sweating. When washing the skin, use warm water and a mild cleanser. More frequent washing and scrubbing can dry and irritate your skin making acne worse.
- Avoid abrasive soap, facial scrub, toners, alcohol-based astringents, masks, and washcloths. These can irritate the skin, and irritated skin is more likely to break out. Irritated skin also makes it more difficult to tolerate acne medication. Acne is not caused by a lack of hygiene.
- Apply acne medications to dry skin by waiting 15-30 minutes after washing. Applying acne medication to moist skin right after you shower or wash your face may increase irritation.
- Apply a facial moisturizer that contains sunscreen with a SPF of 30 every morning over your topical acne medications. Limit sun exposure which can make redness or dark spots last longer. Many acne medications make the skin more sensitive to UV light from the sun or tanning lamps.
- If your skin gets dry from your acne medication, apply additional facial moisturizer. A facial moisturizer that won’t clog the pores will usually be labeled as non-comedogenic or oil-free and can be used as often as needed. Our office commonly recommends CeraVe AM Facial Moisturizing Lotion with SPF 30. It can be found at many stores. Wearing an oil-free makeup is fine. Apply topical acne medication before makeup.
- Diet may or may not have a role in acne symptoms –more research is required. For your overall health, and the health of your skin, do your best to consistently eat a healthful diet.
- Never pop, squeeze, or pick acne. Popping and squeezing pimples, whiteheads, blackheads, and cysts can make acne worse and often leads to scarring which can be permanent.
- Give acne-fighting products time to work. Often it takes 6-8 weeks before you begin to see an improvement. Improvement does not mean clear skin, but a noticeable difference. It generally takes about 6 months to see clear skin.
- Continue using the medication when skin clears. To keep skin clear, most people with acne need to continue using at least one acne medication for months and sometimes years.