- About Topicals
- Causes of Acne
- What can I expect?
- Safety / Side effects
- After treatment instructions
There are many treatment options available for patients with acne. In the topical treatment of acne, patients use products and medications that are applied directly onto the skin's surface. This is often an important part of a successful acne treatment regimen. At The Menkes Clinic, we provide a comprehensive and personalized approach to each patient with the goal of formulating the most effective acne treatment plan.
COMMON TYPES OF TOPICALS
One of the most commonly used topical acne treatments is benzoyl peroxide, a widely available non-prescription medication that is typically applied directly to pimples. It is formulated in washes, gels and creams and can be mixed with other prescription topical acne medications, such as antibiotics and retinoids to form a combination product. Benzoyl peroxide works as a peeling agent, increasing skin turnover and clearing pores. It also reduces bacteria, thus indirectly working as an antimicrobial agent.
This is commonly used to treat comedonal acne, in particular black heads and non-inflamed pimples. It is a popular ingredient in many non-prescription products and is found widely in over-the-counter lotions, creams, cleansers, medicated treatment pads and toners. Salicylic acid works to promote the sloughing away of dead skin cells and is especially helpful in treating acne because of its ability to penetrate the hair follicle where all acne pimples are initially formed. This results in a reduction in the number of blocked pores and breakouts on the skin.
Antibiotics Topical use of antibiotics has been a cornerstone of acne therapy for over three decades. The most commonly used topical antibiotics are clindamycin and erythromycin. Effective both for their bacterial killing properties and their ability to reduce inflammation and pus, topical antibiotics decrease the numbers of inflamed pimples and also help to keep pores open. Topical antibiotics are available in solutions, wipes, lotions and gels. They are also now available in acne products that contain benzoyl peroxide or a retinoid. These newer combination products (Acanya, Duac, Epiduo) have the benefit of convenience for patients since they are applied only once daily.
Topical retinoids work very well to clear pores and to reduce the frequency and severity of acne outbreaks. These products are derived from vitamin A and work by unplugging clogged pores and preventing dead skin cells from clogging pores. This mechanism also allows other topical medications such as antibiotics to enter the follicle and increase their effectiveness. Topical retinoids are available as creams, gels and liquids and are applied to the skin once a day, usually at night, about 20-30 minutes after washing the face.
Acne is a very common skin problem and can be recognized by the distinctive blackheads, whiteheads, pimples and, for some, the painful red bumps or pustules that feel like and are similar in appearance to boils. In severe cases, acne can leave permanent scars on the skin. There are many factors that contribute to the development of acne, including genetics and hormones. Individuals may inherit an increased chance of suffering from acne if their parents did.
However, the most common reason is due to hormones. The surge of hormones that accompanies the onset of puberty, pregnancy and even menopause causes the sebaceous glands – the area where acne occurs - to enlarge. The sebaceous glands produce sebum which sticks to the dead skin cells that are shed from the lining of the hair follicle wall. Over the course of several days or even weeks, this mixture of sebum and skin cells plugs the hair follicle under the skin surface. This plug cannot be removed or dissolved by washing and is what gives rise to blackheads and whiteheads.
In addition, the mixture of sebum and dead skin cells are an excellent medium for promoting the growth of the bacteria that naturally occur in the pores. As the number of bacteria increase, our immune systems respond by sending special defence cells into the blocked follicle in an attempt to clean it out. The resultant pressure may damage the follicle wall and when it gives way the sebum and dead skin cell plug together with the bacteria and body's defense cells invade the outer tissue surrounding the pore. This is what causes the painful, boil-like lumps, pimples, pustules and papules that we know as acne. And these are the lesions that in some cases can give rise to scarring.
When applied to the skin’s surface, topical acne medications frequently help to reduce the size and number of pimples. Their ease of application and the ability of patients to adjust the amounts used (dose) are some advantages of topical treatment. In patients with mild acne, topical products alone may be sufficient to control pimples. When used in combination with oral acne medication for more severe acne, topical medications can boost the overall effectiveness of treatment, resulting in even clearer skin.
- Reduces size and number of pimples
- May be sufficient to control mild acne
- Convenient, easy to use
- Boosts effectiveness of oral acne medications
Topical acne treatment is available as both prescription medications and over-the-counter (non-prescription) products. It is best for patients to be evaluated by a dermatologist before starting any acne treatment, since many topical acne medications/products can cause irritation, rashes and even worsening of acne. At The Menkes Clinic, we use topical acne medications that are effective as well as appropriate for each patient’s skin type. This is especially important for patients with sensitive skin. We also offer a comprehensive range of acne skin care products to complement prescription treatment.
- Prescription and non-prescription products available
- Dermatologist evaluation is recommended to reduce risk of potential side effects
- May be used in combination with oral acne medication
- All topical products have the potential to cause irritation when used inappropriately
- Side effects are minimized when used under supervision of a dermatologist
- Common side effects: dryness, redness, itching
- Less common side effects: swelling, allergic reactions
- Retinoids should be avoided during pregnancy and while breast-feeding
- Clindamycin should be avoided in patients with inflammatory bowel disease (Crohns, Ulcerative Colitis) or patients with a history of C. difficile colitis
- After consulting your dermatologist, follow instructions carefully and schedule a routine follow up appointment to evaluate your progress.
- Do not use your own products along with your prescribed treatment. This includes cleansers and toners.
- Use a small amount of the prescribed product for the first week. Most topical acne medications have the potential to cause irritation when used too often or in generous amounts.
- When in doubt about irritation potential of any product, do a “use test” by applying a small amount of the medicine behind one ear daily for a few days before actually applying it on the face.
- If irritation (burning, itching, persistent redness) occurs, stop the product and schedule an appointment.
- Always avoid the eyelid area when applying topical acne medicine.
- Follow up with your dermatologist regularly to ensure best results