Acne Treatment | Acne Medications

Acne may have several causes but when it comes to acne treatment we can summarize them into at least 3 categories (antibacterials, pore unblockers, oil reducers). Most acne treatment products are using what we know as “monotherapy”. Monotherapy is an acne treatment procedure utilizing only one anti-acne treatment product. This single anti-acne treatment product may function as an antibacterial agent, keratolytic agent or both. The best acne treatment product or acne medication should be able to kill acne-causing bacteria, prevent the formation of comedo or pore blockage and reduce the sebum output of the oil glands.

The best acne treatment product should also be able to reduce skin irritation, accelerate skin repair and moisturize the skin. Since there is no single anti-acne treatment product or procedure that can address all the major causes of acne, the only option that dermatologists have is to combine them in a synergistic way. This acne treatment method is known as multi-therapy acne treatment. Multi-therapy acne treatment is better than monotherapy acne treatment because it utilize the synergistic effect of several anti-acne products. Multi-therapy acne treatment also includes bioactive ingredients that are designed to accelerate skin repair, moisturize the skin and reduce skin irritation.

1. Antibacterial: The main purpose of this acne medicine is to reduce the population of acne-causing bacteria known as Propionibacterium Acnes. This bacteria cause redness and inflammation of the oil glands; in more advanced cases they cause the formation of pus. If left untreated, bacterial infection can cause damage to the dermis, which would leave depressed scars. Antibacterial can be taken orally or applied topically. Topically applied antibacterial has the least amount of side effects and is generally safer to use. Oral antibiotics are reserved for moderate to severe acne because of its side effects to the internal organs and the issue of “bacterial resistance”.

Examples:

2. Keratolytic/Comedolytic: These are acne medications that open up blocked pores and prevent them from being clogged; they open up the pores by encouraging the skin to peel. Peeling removes trapped sebum and dead skin cells inside the pores. In acne prone skin, there is an excess production of keratin that causes the pores to become blocked with dead skin cells and trapped sebum. Trapped sebum encourages the growth of acne-causing bacteria because sebum is their main source of nourishment. It is therefore necessary for an effective acne treatment strategy to always keep the pores free from blockage.

Alpha-Hydroxy Acid Family (Glycolic Acid, Lactic Acid)
Beta-Hydroxy Acid Family (Salicylic Acid)
Retinoids (Retinoic Acid, Adapalene, Retinol Palmitate)
Sulfur

3. Anti-Androgens: Oral anti-androgens are effective in suppressing the male hormone, which causes the oil gland to produce more oil. The problem with oral anti-androgens is that it can only be used by females. It cannot be used by males for the purpose of just treating acne because it can cause the reversal of male secondary sex characteristics. Anti-androgens are used only by males under medical supervision and in certain conditions such as in treating hypersexuality, prostate enlargement and male pattern baldness. Currently, there are no topical anti-androgens that are as effective as oral anti-androgens.

Spironolactone (Aldactone, Spiritone)
Cyproterone acetate (Androcur, Climen, Diane 35, Ginette 35)
Flutamide (Eulexin), nilutamide (Anandron, Nilandron)
Finasteride (Proscar, Propecia)

4. Sebosuppresive agents: These are acne medications that reduce the production of sebum in the oil glands. The most effective sebosuppresive agent is oral isotretinoin. Oral isotretinoin makes the size of the small glands smaller thus they produce less oil. However, oral isotretinoin is reported to produce very nasty side effects including liver damage, depression, tendonitis and blood sugar problems. Since oral isotretinoin is a bit dangerous, it is only prescribed as a last line treatment for severe acne.

There are topical sebosuppresive agents that are safer compared to oral sebusuppresive agents but they are very modest in reducing the amount of facial oil. Zinc Oxide and Copper Peptide seems to block 5-Alpha Reductase. 5-Alpha Reductase is an enzyme responsible for converting testosterone to dihydrotesterone, the hormone responsible for triggering the oil glands to produce more oil. Isolutrol is an extract from the bile of sharks and is also aimed at reducing the oil secretion of the oil glands. However, the results of the studies using Isolutrol to reduce facial oiliness are mixed. Some studies say that it can reduce facial oiliness while others say that it is not effective. Topical niacinamide one study demonstrated some ability to reduce facial oiliness.

Example of topical sebosuppresive agents:
(Zinc Oxide, Copper Peptide, Isolutrol, Topical Niacinamide)

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4. A randomized, double-blind, multicenter, parallel group study to compare relative efficacies of the topical gels 3% erythromycin/5% benzoyl peroxide and 0.025% tretinoin/erythromycin 4% in the treatment of moderate acne vulgaris of the face. J Cutan Med Surg. 2003 Jan-Feb;7(1):31-7. Epub 2002 Oct 9.
5. Study results of benzoyl peroxide 5%/clindamycin 1% topical gel, adapalene 0.1% gel, and use in combination for acne vulgaris. J Drugs Dermatol. 2007 Jun;6(6):616-22.
6. Efficacy and safety of azelaic acid and glycolic acid combination therapy compared with tretinoin therapy for acne.Clin Ther. 1998 Jul-Aug;20(4):711-21.
7. The comparative efficacy of benzoyl peroxide 5%/erythromycin 3% gel and erythromycin 4%/zinc 1.2% solution in the treatment of acne vulgaris. Br J Dermatol. 1997 Feb;136(2):235-8.

What you need to know about Acne Treatment