08 Jul Acne: What to Do About You? Part 2: Topicals
Part 2: Topicals
See ‘Acne: What to Do About You? Part 1’ for a discussion on what foods to avoid for clearer skin.
Topical therapy for acne has been around for a really long time. In ancient Egypt, sulfur was used topically as a treatment. More recently, benzoyl peroxide was developed in the 1920s as a treatment for acne and is still commonly used today. Topical therapy for acne can be roughly divided into two groups: antibiotics and retinoids.
The topical antibiotic group is large, varied and some medications also have an anti-inflammatory contribution. The antibiotic group targets the bacteria Propionibacterium acnes (abbreviated P.acnes) the source of much of the inflammation (also known as pain, redness and swelling) in acne. Benzoyl peroxide (BPO) is probably the most widely used as it is available without a prescription. Despite the increase in bacterial antibiotic resistance over the last couple decades, BPO maintains its effectiveness against P.acnes. One word of caution, it is a peroxide (hydrogen peroxide) and can take the color out of clothes and hair.
The other topical antibiotic medications not only work against P.acnes but also have some anti-keratinizing effects, meaning they help reduce the build up of skin cells that block the hair follicles. We have cleansing pads which combine salicylic acid and glycolic acid to kill P.acnes, gently exfoliate, and reduce oil content. Resorcinol is a phenol compound, originally derived from argan oil, often combined with sulfur for antibiotic and drying effects. Prescription topical medications for acne include traditional antibiotics, such as clindamycin and erythromycin, as well as unique medications like azelaic acid and dapsone gel.
The retinoids make up the other category of topical medications for acne. These medications are all derivatives of vitamin A, the best known being tretinoin (all-trans retinoic acid) or Retin-A, but others are adapalene and tazarotene. The retinoids act on the DNA to increase cell turnover in the epidermis especially in the hair follicles and sebaceous glands. This increase turnover reduces the formation of comedones, therefore less P.acnes and less inflammation.
I could go on but sometimes, less is more.