PRESCRIPTION ACNE CREAMS AND TOPICAL ACNE PRODUCTS LIST

Acne is a skin condition affecting 40- 60 million people in America, and 3 out of every 4 teenagers. In spite its prevalence, acne remains a condition that is largely undertreated and often misunderstood. According to some studies only 11% of individuals with acne will see a physician about it. Many will attempt to treat their acne with over-the-counter products, but up to 40% will do nothing at all. Myths abound about acne. Some mistakenly believe it is a personal hygiene issue. Others think that greasy foods or chocolate have been proven to cause acne. The fact is that acne is actually a far more complex condition than we tend to realize. The true causes of acne include follicular hyperkeratinization, neutrophil pathology, t-cell defects and hormonal imbalances. No wonder we find it easier to just say it is caused by chocolate! Easier…yes…but not correct.

Due to the fact that many patients are reluctant to seek the advice and help of a physician or dermatologist, I am offering the following article to assist patients in speaking with their doctor. Sometimes it is easier to talk about something when you feel a bit more informed about the treatments. Therefore this article will briefly review the currently available prescription topical treatments for acne. Oral therapies, of which there are several, will be covered in a separate article.

Prescription topical (meaning creams, ointments, gels, etc) treatments for acne can be generally divided into 3 broad categories. Within each of these categories there are a variety of available prescription drugs which I will list. These 3 categories are:

· Topical Antibiotic Preparations for Acne

· Topical Retinoids for Acne

· Miscellaneous Topical Products (non-antibiotics and non-retinoids)

1. Benzoyl Peroxide is probably the most popular antibiotic approach to treating acne. Antibiotics for acne work, in part, by interfering with the replication of a bacteria known as p. acnes. Benzoyl peroxide is available in a variety of over-the-counter products, and is one of the ingredients in the popular "Proactiv" product for treating acne.

Prescription Acne Medications with Benzoyl Peroxide Include:
• Benzac (various formulations and strengths)
• Inova (contains vitamin E also)
• Pacnex (various formulations of liquids and pad)
• Neobenz Micro

2. Clindamycin is another popular prescription acne cream ingredient. All products contain 1% Clindamycin

Prescription Acne Medication with Clindamycin as the active ingredient:
• Cleocin-T (available as a solution, lotion, Gel or swab)
• Clindagel
• Clindamax
• Evoclin

3. Erythromycin is another topical antibiotic often used to treat acne. Most of the “brand name” products have been discontinued (e.g. Erygel) since they have all become available generically. One brand name product still available is called Akne-Mycin.

4. Antibiotic Combinations are a popular approach. These products combine 2 antibiotic ingredients in a single cream, gel or solution.

Prescription acne antibiotic combination products include:
• Acanya (combines benzoyl peroxide and clindamycin)
• BenzaClin (combines benzoyl peroxide and clindamycin)
• Duac CS (combines benzoyl peroxide and clindamycin)
• Epiduo (combines benzoyl peroxide and adapalene – see below for info on adapalene)
• Benzamycin (combines benzoyl peroxide and erythromycin)
• Ziana (combines clindamycin and tretinoin – see below for a discussion of tretinoin)

Since acne is due to a complex combination of causes, it is logical that a variety of products (targeting different causes) would be developed. Tretinoin is the result of such research and development. Tretinoin is a derivative of vitamin A and has been studied for its benefits in treating acne since the 1960’s. Tretinoin came to the prescription market in the late 1990’s in the form of Retin-A, which, according to the manufacturer, continues to be the most prescribed drug by dermatologists today. Since then other products with ingredients “similar” to tretinoin have been developed.

Prescription Acne Topical Products which contain Retinoids:
• Atralin
• Retin-A
• Retin-A Micro
• Differin (active ingredient is called adapalene)
• Tazorac (active ingredient is called tazarotene)
• Tretin-X

Rounding out this review of topical products for acne are those products that do not fit neatly into either of the previous 2 categories. These products contain ingredients for which the exact mechanism of action has not been fully determined.

• Aczone (active ingredient = dapsone). Note, the use of any benzoyl peroxide product in addition to Aczone will cause a temporary yellowing of the skin at the site of application. Aczone is applied twice daily.

• Azelex (contains Azelaic acid). After thoroughly washing the skin, Azelex cream is massaged into the affected areas twice daily. Results are typically seen within 4 weeks.

• Klaron Lotion (active ingredient sodium sulfacetamide). Applied twice daily.

While treating acne with topical creams may help, it may also be necessary to consider replacing certain prescription medications which might be contributing to the acne problem. The following are a few prescription medications know to sometimes cause or worsen acne:

• Tazodone (used for depression or insomnia)
• Haloperidol (an antipsychotic)
• Lithium (for bipolar disorder)
• Estrogens
• Anabolic steroids (for testosterone deficiency)
• Phenytoin, Lamotrigine (for seizure disorders)
• Isoniazid (an antibiotic used for tuberculosis)