topical acne treatment

The number of topical and systemic drugs for the treatment of acne vulgaris has been enriched a lot recently. Topical drugs on the one hand have been newly discovered or further developments of already available agents such as in the group of retinoids or galenic formulation have improved efficacy or local tolerance. For instance, topical Dapsone has been approved recently in the US for acne treatment.

It seems better to combine topical retinoids with BPO or with azelaic acid to enhance the efficacy and slow down the development of resistance. BPO is still the gold standard for papular-pustular acne of mild-to-moderate type in concentrations of 2–5%. Azelaic acid is an alternative with efficacy on the comedones and is antibacterial without development of resistances.

Sometimes the physical removal by electrocautery or laser of multiple packed closed comedones, macrocomedones and microcysts is necessary to enhance the efficacy of topical comedolytic agents and to speed up the therapeutic results.

The most common advantage of topical antibiotics is their very low irritative profile; however, the most and increasing disadvantage is the development of bacterial resistance for Propionibacterium acnes. To overcome this problem, clindamycin and erythromycin have been increased in concentration from 1 to 4% and new formulations with zinc or combination products with BPOs or retinoids.

However, topical treatment has its limitation and patient should be advised about all their options and possible side effects when choosing the most adequate depending on the type of acne developed. Topical medication should be applied daily once or twice as per doctor’s recommendation for 3-6 months. Results start to show as early as 2-3 weeks, sometimes even longer.

Most creams for acne cause irritation and for this reason, these can be build up progressively rather that start using them too often from beginning. Acne is a chronic inflammatory condition and the long term use of topicals is often needed to keep it under control.