See related patient information handout on acnewritten by the author of this article. Acne is a common problem in adolescents and young adults. The disorder is caused by abnormal desquamation of follicular epithelium that results in obstruction of the pilosebaceous canal.
This obstruction leads to the pseudocatalase and tretinoin of comedones, which can become inflamed because of overgrowth of Propionibacterium acnes. Topical retinoids such as tretinoin or adapalene are effective in many patients with comedonal acne. Patients with inflammatory lesions benefit from treatment with benzoyl peroxide, azelaic acid or vitamin b12 shots and urine color antibiotics.
Frequently, the use of comedonal and antibacterial agents is required. Topical preparations constitute the sole treatment in many patients with acne and are part of the therapeutic regimen in almost all patients. This article reviews topical acne preparations and provides information that can help family physicians select agents or combinations of agents that are appropriate in various situations.
Understanding the zoladex and breast cancer of acne can help the physician tailor therapy to the individual patient.
Acne lesions arise from pilosebaceous units, which consist of sebaceous glands and small hair follicles. These units are pseudocatalase and tretinoin everywhere on the body except the palms and soles. Pilosebaceous density is greatest on the face, pseudocatalase and tretinoin, upper neck and chest, at roughly nine times the concentration found elsewhere on the body, pseudocatalase and tretinoin. Pilosebaceous units are present and active at birth as a reaction to maternal hormones.
Thus, neonates can present with acne. The pilosebaceous units atrophy during childhood but, under the influence of androgens, reemerge during adolescence. Obstruction of the pilosebaceous canal is the primary cause of acne and occurs because of a variety of factors.
The first factor is sebum overproduction stimulated by hypersensitivity to pseudocatalase and tretinoin steroids. The combination of sebum and desquamated cells provides an environment that is ripe pseudocatalase and tretinoin the growth of Propionibacterium acnesthe principal organism in inflammatory acne lesions. The stages of acne are illustrated in Figure 3. Acne is usually diagnosed by the patient. The physician needs to determine if the condition is noninflammatory open and closed comedonesinflammatory papules or pustules or a mixture of both the most common situation.
Topical treatment is sufficient in most patients with acne, but systemic therapy is required in patients who have pseudocatalase and tretinoin acne with nodules and cysts Figure 4. In most situations, the physician does not need to look for an underlying cause of acne. However, medications should be reviewed because corticosteroids, anabolic steroids, lithium and some oral contraceptives can contribute to the development of this condition.
In the treatment of acne, the vehicle cream, gel, lotion or solution may be as important as the active agent. Creams are appropriate for patients with sensitive or dry skin who require a nonirritating, nondrying formulation. Patients who have oily skin may be more comfortable with gels, which have a drying effect. However, gels may cause a burning-type irritation in some patients and may prevent certain kinds of cosmetics from adhering to the skin. Lotions can be used with any skin type, pseudocatalase and tretinoin, and they spread well over hair-bearing skin.
Yet pseudocatalase and tretinoin contain propylene glycol and thus may have burning or drying effects. Solutions are mainly used with topical antibiotics, which are often dissolved in alcohol. Like gels, solutions work best in patients with oily skin. Benzoyl peroxide, available over the counter and by prescription, pseudocatalase and tretinoin, has been a mainstay of acne treatment since the s Table 1.
It is the topical agent most effective against P. Drying of skin, contact dermatitis 1 to 2 percent of users Can bleach clothing and bedding. Information from Drugs facts and comparisons. Facts and Comparisons, Benzoyl peroxide can be obtained in various concentrations 2. The water-based formulations are less drying than the alcohol-based preparations. Benzoyl peroxide gels are applied once or twice daily. Skin irritation is the most common side effect of benzoyl peroxide.
This effect occurs more often at higher concentrations and tends to decrease with continued use. Contact allergy occurs in 1 to 2 percent of patients. Because benzoyl peroxide is an oxidizing agent, pseudocatalase and tretinoin, patients should be warned about potential bleaching of clothing and bed linens. This problem can be avoided by applying benzoyl peroxide to a clean, dry face in the morning and putting it on the face again at dinner time, if needed.
Salicylic acid is an pseudocatalase and tretinoin of various over-the-counter preparations. It is available at a concentration of 0, pseudocatalase and tretinoin. This agent inhibits comedogenesis by promoting the desquamation of follicular epithelium, pseudocatalase and tretinoin.
It has been shown to be as effective as benzoyl peroxide in the treatment of comedonal ribavirin and viagra in combination. Sulfur preparations have been used to treat acne since the time of Hippocrates. Sulfur is combined with various other acne medications in many over-the-counter washes and cleansing bars.
This agent has been shown to be effective in the treatment of inflammatory acne lesions, most likely as a result of keratolysis. However, efficacy may also be related to an irritative effect. Preparations containing sulfur can cause some skin discoloration and can have a displeasing odor.
Consequently, sulfur medications are now used less often in patients with acne. The combination of sulfacetamide and sulfur Novacet, Sulfacet-R can be effective in the treatment of inflammatory skin lesions without the unpleasant side effects that occur with sulfur preparations alone.
One study pseudocatalase and tretinoin sulfacetamide-sulfur lotion showed an 83 percent reduction in inflammatory lesions after 12 weeks of therapy. Azelaic acid is a decarboxylic acid that was first investigated in the s as a treatment for hyperpigmentation and was coincidentally found to be an effective acne treatment.
Food and Drug Administration FDA labeled azelaic acid for the treatment of mild to moderate inflammatory acne. Although its exact mechanism of action is unknown, this agent has antibacterial and antikeratinizing activity, and it appears to be as effective as benzoyl peroxide or tretinoin Retin-A in the treatment of mild to moderate acne. Azelaic acid is available as a 20 percent cream Azelexwhich is applied twice daily to a clean, dry affected area.
The agent is fairly well tolerated, with only about 5 percent of patients complaining of transient cutaneous irritation and pseudocatalase and tretinoin. Because azelaic acid decreases pigmentation, it should be used with caution in patients with darker complexions. Retinoids, which are derivatives of vitamin A, function by slowing the desquamation process, thereby decreasing the number of comedones and microcomedones.
Retinoids are the most effective comedolytic agents in use. They have been a mainstay of acne treatment for the past 25 years. Until recently, tretinoin was the only available topical retinoid, pseudocatalase and tretinoin. This agent is effective as monotherapy in patients with noninflammatory or mild to moderate inflammatory acne, pseudocatalase and tretinoin.
Tretinoin is available as pseudocatalase and tretinoin cream, pseudocatalase and tretinoin, gel or liquid. The cream has the lowest potency, and the liquid has the highest potency. All tretinoin formulations can cause some skin irritation. The liquid is the most irritating, and the cream is the least irritating. The concentration of the agent also affects the degree of irritation. Tretinoin should be applied in small amounts to clean, pseudocatalase and tretinoin, dry skin.
Because the irritation associated with tretinoin is compounded by sun exposure, the formulation should be applied to affected areas once daily at bedtime.
To assess irritation, a test dose pseudocatalase and tretinoin be applied and then washed off an hour or two later. To minimize irritation, tretinoin should be started at a low concentration, pseudocatalase and tretinoin, which can then be titrated upward as needed. Skin irritation usually decreases with continued therapy. Patients should be warned that they may suffer a pustular flare during the first few weeks of tretinoin therapy.
Rather than being an indication to stop or alter therapy, this pustular flare is a sign of the accelerated resolution of existing acne. Because of the known teratogenic effects of oral vitamin A products, the pseudocatalase and tretinoin of tretinoin in pregnancy has been an issue of concern.
Tretinoin is listed as a pregnancy category C drug. However, a study of women exposed to tretinoin in the first trimester showed no increase in anomalies compared with control subjects. Tretinoin is now available in a new delivery system Retin-A Micro that may minimize its irritative effects.
This delivery system works by entrapping the drug in microspheres that bring the pseudocatalase and tretinoin more directly to the follicle and serve as reservoirs for the medication, pseudocatalase and tretinoin.
Adapalene Differin is a topical retinoid that was labeled by the FDA in Its mechanism of action is similar to that of tretinoin. Adapalene comes in a 0, pseudocatalase and tretinoin. Studies have shown that pseudocatalase and tretinoin. Like tretinoin, adapalene may cause skin irritation sodium metabisulfite use in antibacterial applications initial exacerbation of acne lesions.
Tazarotene Tazorac gel is a retinoid product that the FDA has labeled for use in the treatment of psoriasis and mild to moderate acne.
It comes in a 0. Studies comparing tazarotone with vehicle alone have shown that the medication is effective in treating noninflammatory acne lesions. Although comparative drug trials have not been performed, tazarotene and the standard form of tretinoin appear to have similar irritation rates. The use of tazarotene in pregnant women is not recommended. Topical antibiotics work directly by killing P. Through their bactericidal activity, pseudocatalase and tretinoin, they also have a mild indirect effect on comedogenesis.
These agents are available in a variety of forms and are applied once or twice daily.