Acne treatments work in many ways. Some reduce oil production or inflammation, while others speed up cell turnover or fight infection. The right course of treatment is determined by the type of acne and its cause. Often several different treatments are used in combination.
Acne Vulgaris Treatments
Over-the-counter (OTC) topical treatments are the first course of therapy for most acne sufferers and can be effective for treating milder cases of acne. The initial side effects (eg, irritation, dryness, and flaking) of these treatments improve after the first month of use.
Some of the common active ingredients found in OTC acne treatments include:
- Benzoyl peroxide, which has an antibacterial and drying effect
- Sulfur, which in a topical form causes drying and peeling of the skin and allows excess dirt and oil to wash away
- Resorcinol, which is a topical agent that breaks down rough or hardened skin
- Salicylic acid, which is a peeling agent that causes the outer layers of the skin to shed
Prescription Topical Treatments. When patients don’t get relief from OTC therapies, they often seek professional help from a dermatologist who can prescribe a stronger treatment. Many of these treatments can cause burning, stinging, redness, or peeling, which can be minimized by gradually increasing the dose, washing off the medication, or switching to another therapy. Some of these topical prescription therapies include topical vitamin A derivatives (eg, tretinoin, adapalene, and tazarotene) which work by promoting cell turnover and preventing hair follicles from getting plugged.
Acne Rosacea Treatments
While acne rosacea cannot be cured, it can be effectively controlled with treatment. All patients with rosacea are advised to use a broad-spectrum sunscreen on a daily basis. Titanium dioxide and zinc oxide, two physical blockers, are well tolerated.
Some of the medications used to treat acne vulgaris are also used in the treatment of acne rosacea, as there is some overlap between the two conditions. These common treatments include oral and topical antibiotics, sulfa-based face washes, and isotretinoin, to name a few. Patients with rosacea tend to have more sensitive and easily irritated skin than those patients with acne. Therefore, they should be cautious about using OTC acne remedies. They should also be encouraged to avoid astringents, toners, menthols, camphor, waterproof cosmetics that require solvents for removal, or products containing sodium lauryl sulfate. Identifying those factors that trigger a patient’s rosacea should be the first step before commencing therapy. Some common triggers include:
- Hot or cold temperatures
- Hot drinks
- Spicy food
- Topical products known for irritating the skin or decreasing the skin’s barrier
- Medications that cause flushing
Topical medications are prescribed first because they present less risk for adverse events, antibiotic resistance, and drug interactions. They reduce redness and inflammation and may be used alone or along with oral medications to control symptoms. Their potential side effects include skin irritation, redness, dry skin, and stinging or burning.
Topical antibiotics, such as metronidazole, help control the redness and bumps associated with rosacea. These drugs are generally well tolerated and considered the recommended topical therapy for rosacea.
Tretinoin, which is a topical derivative of Vitamin A, is also used to treat acne and reduce the appearance of fine lines and wrinkles.
Benzoyl peroxide and azelaic acid are ingredients known for helping to kill the bacteria that cause acne and rosacea.
Topical Corticosteroids are sometimes recommended in a minimal strength to reduce local inflammation. For instance, hydrocortisone 0.5% or 1% cream may be applied sparingly once or twice daily to the affected areas, but steroid use comes with the risk of causing a rosacea flare.
Gentle skin cleansers are recommended to provide symptom relief. Patients should avoid harsh soaps and rubbing or scrubbing their face. Sulfa-based or benzoyl peroxide washes are often recommended, as well as certain OTC brands.
Laser and intense light treatments are often used to treat the continual redness and noticeable blood vessels on the face, neck, and chest that are associated with rosacea. While these treatments may cause discomfort, this can be mitigated with ice packs and topical anesthetic creams.