In the previous post we have discussed the the three over the counter acne treatments most commonly used. These are salicylic acid, sulfur, and benzoyl peroxide. Other topical acne treatment require a doctor's prescription due to potential side effects. They are used for mild-to-moderate cases of acne and many are chemically related to Vitamin A. They are:
Azelaic Acid
- Azelaic acid is an organic compound naturally found in wheat, barley, and rye.
- It is effective for mild and moderate outbreaks of acne by killing bacteria
- Also acts as a keratolytic agent
- Does not work quite well for acne that does not involve bacterial infection
- Available as cream at 20% concentration
- Can irritate the skin and cause hypopigmentation
- Must be prescribed by a health care provider
- Applied twice a day
- Works as well as other agents (tretinoin, benzoyl peroxide)
- Takes 1-2 months to start clearing your acne
- Active ingredient in Azelex®, Finevin®, and Finacea®
Tretinoin
- Tretinoin is the best known among the retinoids, a class of compounds chemically related to Vitamin A
- Works by increasing skin cell turnover, which promotes the removal and prevention of blackheads and whiteheads
- Available on prescription as cream (from 0.025% to 0.1%), as gel (0.01% to 0.05%), and as liquid (0.05%)
- Benzoyl peroxide deactivates tretinoin; therefore, these two cannot be applied together at the same time
- May seem to make acne worse at the start but it must be given time to work, 2-3 months at best
- Can improve wrinkles and fine lines but makes the skin more susceptible to drying, redness, and sunburn; do not use more than the recommended amount to minimize side effects
- Available as generic. Its brand names are Retin-A®, Avita®, and Renova®
Adapalene
- Adapelene is a third-generation retinoid, just like tretinoin, but is newer and just as effective
- Better tolerated or has fewer side effects than tretinoin
- May be applied together with benzoyl peroxide
- Available as the brand name Differin®, in a gel or cream form at 0.1% strength
Tazarotene
- Tazarotene is another retinoid and like adapelene is also newer than tretinoin
- A head-to-head comparison study conducted by Dr. Leyden of the University of Pennsylvania showed that Tazarotene was more effective than tretinoin
- Commonly sold as a gel at 0.05% and 0.1% concentrations
- More expensive compared to the other retinoids
- Causes the same side effects as tretinoin
- Marketed as Tazorac®, Avage®, and Zorac®