These agents are another mainstay of acne treatment. Topical antibiotics commonly are used in conjunction with retinoids or benzoyl peroxide in patients with any degree of inflammatory acne. The most frequently used topical antibiotics are clindamycin and erythromycin. These drugs normally are applied once or twice daily. Benzoyl Peroxide and Benzoyl Peroxide Combinations. Benzoyl peroxide is inexpensive and available over the counter. It has a stronger effect on papules than tretinoin, but a weaker effect on comedones.Combinations of topical antibiotics and benzoyl peroxide increase efficacy and reduce antibiotic resistance in patients with P. acnes colonization. The preparations are available in gel form, and include 1 percent clindamycin with 5 percent benzoyl peroxide (BenzaClin) and 3 percent erythromycin with 5 percent benzoyl peroxide (Benzamycin). The preparations are equally effective in the treatment of acne. One study comparing combined 1 percent clindamycin and 5 percent benzoyl peroxide with 1 percent clindamycin alone found the combination product to be more efficacious, with less P. acnes resistance.This agent is a dicarboxylic acid that has bacteriostatic and keratolytic properties. Azelaic acid (Azelex) may be particularly effective in the treatment of acne with postinflammatory hyperpigmentation. Over-the-counter products may be used as primary or adjunctive treatments. Additional prescription topical agents include sulfacetamide (Klaron) and 10 percent sulfacetamide with 5 percent sulfur (Sulfacet-R). Sulfacetamide products are available in cream, gel, and wash formulations. These products generally are not
considered first-line therapies, but they may be used in patients who cannot tolerate other topical agents.
Archive for the ‘care’ Category
Topical Antibiotics
Friday, July 3rd, 2009Therapy
Friday, July 3rd, 2009Selection of topical therapy should be based on the severity and type of acne. Topical retinoids,benzoyl peroxide, and azelaic acid are effective treatments for mild acne. Topical antibiotics and medications with bacteriostatic and anti-inflammatory properties are effective for treating mild to moderate inflammator acne. Proper selection of topical formulations may decrease side effects and increase patient compliance. Fortunately, most acne medications are available in several forms. Creams and lotions typically are reserved for dry or sensitive skin, whereas gels are prescribed for oil-prone complexions. During treatment with prescribed medications, patients should use bland facial washes and moisturizers. Retinoids and Retinoid Analogs. Topical tretinoin is a comedolytic agent that normalizes desquamation of the epithelial lining, thereby preventing obstruction of the pilosebaceous outlet.8 This agent also appears to have direct anti-inflammatory effects. A derivative of vitamin A, tretinoin is available in cream, gel, and liquid forms. In tretinoin microsphere, tretinoin is encapsulated in a polymer that slowly releases
the active medication, resulting in less irritation than with other tretinoin preparations. With all retinoids, visible improvement occurs after eight to 12 weeks of treatment. Tretinoin is inactivated by ultraviolet (UV) light and oxidized by benzoyl peroxide. It therefore should be applied only at night and never with benzoyl peroxide. Tretinoin may decrease the amount of native UV protection by thinning the stratum corneum; thus, daily use of sunscreen is recommended. Because
the irritation caused by tretinoin is dosedependent, treatment should be initiated in a low dose. Patients only need a pea-sized amount of product per application. There is no strong evidence for the teratogenicity of tretinoin, which remains pregnancy category C. A study11 published in 1998 focused on the transdermal absorption of topical tretinoin and found the absorbed concentration to be below endogenous retinoid levels. However, no definitive consensus has been reached on the use of topical tretinoin in pregnancy. It may be wise to avoid use of topical retinoids or retinoid analogs in women who may become pregnant during treatment. Adapalene is a topical synthetic retinoid analog that normalizes differentiation of follicular epithelial cells and demonstrates direct anti-inflammatory properties.
double-blind studies have shown 0.1 percent adapalene gel to be as effective as 0.025 percent tretinoin gel. Adapalene is superior to 0.025 percent tretinoin gel in both tolerability and speed of efficacy,12 and is equivalent in efficacy to 0.1 percent tretinoin microsphere. Adapalene is a reasonable choice as a first-line topical retinoid; this agent may
be especially useful in patients who are unable to tolerate the irritation caused by tretinoin. Tazarotene (Tazorac) is available in 0.05 and 0.1 percent gel and cream formulations. It is a pregnancy category X agent. Tazarotene may be more irritating than other retinoids. Doserelated erythema and burning are the most common adverse effects. Studies have indicated that tazarotene gel is a more efficacious keratolytic than tretinoin 0.025 percent gel14 and tretinoin 0.1 percent microsphere gel.Because tazarotene may increase irritation, it usually is considered a second-line retinoid option in patients who have not responded to topical tretinoin or adapalene therapy.
How Should People With Acne Care for Their Skin?
Thursday, July 2nd, 2009Clean skin gently. Use a mild cleanser in the morning, evening, and after heavy workouts. Scrubbing the skin does not stop acne. It can even make the problem worse. l Try not to touch your skin. People who squeeze, pinch, or pick their pimples can get scars or dark spots on their skin. l Shave carefully. If you shave, you can try both electric and safety razors to see which works best. With safety razors, use a sharp blade. Also, it helps to soften your beard with soap and water before putting on shaving cream. Shave lightly and only when you have to. l Stay out of the sun. Many acne medicines can make people more likely to sunburn. Being in the sun a lot can also make skin wrinkle and raise the risk of skin cancer. l Choose makeup carefully. All makeup should be oil free. Look for the word “noncomedogenic” on the label. This means that the makeup will.