(This article is part of our new series – “A closer look at medical treatments for acne.”)
Prescription gels and creams (topicals) are the most common medical treatment for acne.
The active ingredients in these products usually target only 1 cause of acne – for example, help to control abnormal shedding of skin cells, or kill bacteria in pimples and cysts and reduce inflammation, or reduce excess oil production.
Newer combination treatments have been developed that include several active ingredients that together target multiple factors at the same time and offer better results.
The main active ingredients in topicals (products applied to the skin) are:
- prescription strength benzoyl peroxide
- combinations of the above agents
Here’s a run down on how these ingredients work, side effects and how long it will take to see results.
Treatment: Retinoids, synthetic by-products of vitamin A. Examples are tretinoin, adapalene, tazarotene.
How it works: normalizes the shedding of skin cells to prevent plugging of pores and limits oil produced, resulting in a reduction in blackheads, whiteheads and inflamed spots. Particularly helpful to even out skin tone.
Side Effects: Irritation, dryness and redness
Dos and Don’ts – (See 7 tips – How to apply prescription topical retinoids). Use a sunscreen and other sun protection as your skin may be more sensitive to the sun. Don’t use if pregnant or nursing.
Expect results: 2 – 3 months. There may be visible improvement at 6 weeks.
Treatment: Benzoyl Peroxide in prescription strengths
How it works: Kills bacteria in pimples and cysts (works in a different way to antibiotics) reducing inflammation; has some ability to exfoliate the skin and help unclog pores.
Side effects: irritation, dry skin, flaking, possible bleaching of hair
Dos and Don’ts: Use a sunscreen. Be aware, may bleach clothes and bedding.
Expect optimal results: 2 – 3 months
Treatment: Topical antibiotics. Examples: clindamycin
How it works: Destroys bacteria in pimples and cysts, reducing inflammation. Topical antibiotics are generally well tolerated but of limited effectiveness when used alone.
Side effects: irritation, dry skin, redness, in rare cases (clindamycin) diarrhea
Dos and Don’ts: Apply to affected areas twice daily.
Expect optimal results: 2 – 3 months
Treatment: Combination topical treatments put 2 or more active ingredients into 1 product. These combinations offer better results and simpler treatment regimens. Examples of combination treatments are: retinoids + benzoyl peroxide; retinoids + antibiotics; antibiotics + benzoyl peroxide.
How it works: Targets multiple acne causes at the same time
Side Effects: see under retinoids, benzoyl peroxide, antibiotics
Dos and don’ts: see under retinoids, benzoyl peroxide, antibiotics
Expect results: 2 – 3 months. Some visible improvement may be seen by 2 weeks, although more significant improvement often takes 4 – 6 weeks.
Treatment: Dapsone 5%, made from a chemical compound, was approved as an acne treatment in Canada in 2012. It is particularly suitable for those with sensitive skin or those who cannot tolerate other topical treatments. This treatment seems to be especially helpful in women.
How it works: Has anti-inflammatory and anti-bacterial properties
Side Effects: Can cause mild to moderate dryness, redness, burning
Dos and Don’ts: Do not apply at the same time with benzoyl peroxide containing medications as the combination can lead to temporary yellow/brown skin discoloration at application sites
Expect results: 2 – 3 months
7 tips – How to apply prescription topicals containing retinoids
Retinoids or combination treatments with retinoids can irritate the skin. Correct use will maximise effectiveness and limit skin reactions.
- Use at night (generally). Cleanse your skin, pat dry. Wait 10 – 15 minutes before applying to lessen risk of irritation such as burning, stinging or itching.
- Apply a pea-sized amount of product to each main area of the face – 1 for nose and chin, 1 for each cheek, 1 for forehead etc.
- Gently massage all over the entire area, not just spots. Avoid eyes, mouth and nostrils.
- Use every other night to start. If well tolerated, increase to every night.
- Consider applying a moisturizer after the retinoid.
- If you develop any irritation or stinging, stop treatment for 1-3 days, cleanse and moisturize in the meantime, and then restart your topical medication applying it for 30 to 60 minutes for a few days before leaving it on for more prolonged time intervals.
- Make application part of your daily routine by placing medications where you can easily see them, using around the same time every day and setting up self-reminders on your phone.