Benzoyl peroxide-is one of the top recommended treatments for mild acne. It’s antiseptic properties reduce the number of surface skin bacteria and it does not cause bacterial resistance to antibiotics. It also reduces the number of yeasts on the surface of the skin. Benzoyl peroxide is an oxidizing agent that drains comedones (mild acne) on the skin surface and acts as an anti-inflammatory. Some problems with using benzoyl peroxide include:
- Dryness of the treated area. If the skin is visibly scaly, apply a light oil free moisturizer.
- Skin irritation is rarely severe. Occasionally excessive irritation may lead to discontinuing use. Consider applying benzoyl peroxide less frequently.
- Contact dermatitis (red, dry, itchy skin) can be due to irritation or allergy. It can be treated with a topical steroid such as hydrocortisone cream. Contact your skin care specialist if irritation persists.
- Benzoyl peroxide is a bleaching agent and works to suppress bacteria as well as fade the skin discolorations associated with acne but can also bleach clothing or linens. Make sure the treated area is completely dry before it touches clothing or bedding.
While using benzoyl peroxide, you should always avoid anything that might irritate the skin such as abrasive soaps or cleansers, alcohol and prolonged exposure to sunlight. Benzoyl peroxide dries out the skin, so some redness and peeling should be expected.
Benzoyl Peroxide is usually applied over the affected areas in a gel or cream form, in concentrations of 2.5% increasing through the usually effective 5% to up to 10%. Research suggests that 5 and 10% concentrations are not significantly more effective than 2.5% and 2.5% is usually better tolerated.
Symptoms of overdose are: severe burning, itching, scaling, redness, blistering, swelling or chronic skin rash.
Totarol-is an anti-bacterial alternative for Benzoyle Peroxide. Benzoyl peroxide generates free radicals in the skin and its effect is similar to unprotected sun exposure. Skin redness (erythema), caused by sun exposure creates free radical activity (oxidative stress) in the skin. Depending on the concentration of Benzoyl Peroxide, frequency of use and treatment duration of Benzoyl Peroxide it may not be the best choice for aging skin. Women experiencing peri-menopause or menopause may have a low tolerance to the irritating side effects of Benzoyl Peroxide. Research and laboratory testing on the potent anti-bacterial Totarol harvested from the Totora tree in New Zeland has shown to be a safe and effective treatment for acne with no side effects. While the inflammatory nature of moderate to severe acne will cause the skin to age more quickly, the use of Benzoyl Peroxide may even accelerate skin aging. Controlling acne with high potency anti-oxidants, and alternative anti-bacterial solutions are the key to preventing premature aging of sensitive skin.
Tea Tree Oil -is an essential oil obtained by steam distillation from the leaves of Melaleuca alternifolia, a plant native to Australia. Tea tree oil contains a constituent called terpinen-4-ol that is thought to be responsible for most of tea tree oil's antimicrobial activity. Because tea tree oil can kill bacteria, it has been proposed that applying topical tea tree oil to acne lesions may kill the acne causing bacteria Propionibacterium (P. acnes). Tea Tree Oil is used as an alternative to Benzoyl Peroxide for sensitive skin.
Sulfur –has been used for more than 50 years in combination with other agents, such as alcohol, salicylic acid and resorcinol and is found in many over-the-counter acne medications. It is a potent anti-bacterial and drying agent that accelerates healing and controls excessive oil production. Sulfur is not frequently used alone as an acne treatment but in combination with Salicylic Acid and other Herbal remedies.
Resorcinol –increases cell turnover and serves to eliminate clogged pores. Resorcinol can be found in concentrations of 2 – 17% in acne lotions and professional peels. It is distilled from Brazilwood and is usually used with combinations of Salicylic Acid, Glycolic Acid, Lactic Acid, Sulfer and Benzoyl Peroxide to treat moderate to severe acne. Resorcinol is a mild non-prescription topical antiseptic and peeling agent.
Salicylic acid –Beta Hydroxy Acid (BHA) helps cut down the shedding of cells lining the follicles of the oil glands. In mild acne, Salicylic Acid helps break down blackheads and whiteheads. Just like Benzoyl Peroxide, you must continue it's use in order to keep the skin exfoliated and keep it unclogged. Salicylic Acid is derived from the Wintergreen Plant and is an effective treatment for non-inflammatory acne lesions especially when used in combination with Glycolic Acid and Benzoyl Peroxide. Salicylic acid does have a slight effect on slowing oil production and helping to control the proliferation of P. acnes. Like Benzoyl Peroxide, Salicylic Acid must be used continuously to keep pores clear of dead cell debris and oil. Salicylic Acid may be irritating to the skin so frequency of use needs to be managed.
Lactic acid –Alpha Hydroxy Acid (AHA) naturally occurs in milk. It’s considered to be an organic carboxylic acid, meaning there is less potential for allergic reaction with this type of solution. Lactic Acid is less harsh and more moisturizing than Glycolic Acid so Lactic Acid may be a beneficial alternative for those with sensitive acne skin. Lactic may be used in combination with Glycolic and Salicylic Acids for mild acne treatment.
Glycolic acid - Alpha Hydroxy Acid (AHA) is the term used for several naturally occurring acids found in fruits and other foods. These include lactic acid, derived from sour milk; citric acid, derived from citric fruit such as oranges; and glycolic acid, derived from sugar cane. Alpha hydroxy acids have been used for centuries. Cleopatra used lactic acid from sour milk to lessen lines and blemishes on her face. Alpha hydroxy acids are helpful in treating a variety of skin ailments. They have proven to be effective in treating dry skin, acne, liver or sun spots, lessening fine facial wrinkles, and improving skin texture. Recent studies have also shown that Alpha hydroxy acids can reverse pre-cancerous skin lesions, which are caused by long term sun exposure. These acids have been shown to increase skin thickness up to 15% in patients with sun damaged thin skin. This occurs through the stimulation of collagen production, the skins natural support protein. When used in skin care products, glycolic acid is a natural exfoliant and moisturizer. It is the high acidity of glycolic acid that results in its excellent exfoliant properties. When applied to the skin, glycolic acid penetrates below the superficial layers of skin and breaks up the "glue" that holds these dead skin cells together. Glycolic Acid for Acne treatment is usually combined with Salicylic Acid to break up dead skin cells, open pores and clear the cellular adhesions that clog the hair follicle and attract bacteria.
Topical Prescription Treatments
Non-prescription products can be very successful in treating Acne Grades l through lll. If acne doesn't respond to these treatments it may be necessary to see a doctor or dermatologist to get a stronger prescription medication. Often, a combination of both prescription and non-prescription products is required to achieve optimal results.
Tretinoin-are topical Retinoids prescribed to treat acne ranging from mild to moderately severe. Topical Retinoids are a derivative of vitamin A and are considered to be the cornerstone in Dermatology for acne treatment. Retinoids work to unclog pores and prevent whiteheads and blackheads from forming. Topical Retinoids can irritate the skin and increase sun sensitivity so it is important to use sun protection and follow the Dermatologist’s directions to maximize effectiveness. An added benefit in using topical Retinoids is that they may help diminish the signs of aging, such as fine lines and wrinkles.
Topical Retinoids currently prescribed for acne treatment are:
• Adapalene. A synthetic retinoid applied as a gel or cream, adapalene unclogs pores and possesses moderate to potent anti-inflammatory abilities. Improvement is usually seen in 8 to 12 weeks. Side effects include minor skin irritation and dryness.
• Tazarotene. A synthetic retinoid available as a gel or cream, it works to keep the skin’s pores clear and has proven effective in treating acne. This medication should not be used by women who are pregnant because the medication has produced birth defects in animals. Skin irritation is a possible side effect.
• Tretinoin. The first retinoid developed for topical use, tretinoin is a natural retinoid. It works to gradually unclog pores and keep them unplugged. In the past, many patients found Tretinoin too harsh for their skin; however, the newer forms are proving less irritating. Side effects include redness, scaling, dryness, itching and burning. If these occur, talk with the Dermatologist who prescribed Tretinoin as these side effects can be managed by adjusting the amount applied and when it is applied.
Isotretinoin – (Accutane) is a potent oral retinoid that is reserved for treatment of very severe cystic acne and severe acne that has proven itself resistant to other medications. Isotretinoin (Accutane) is a powerful medication available to prevent scarring cystic acne. It's very effective, but people who take it need close monitoring by a dermatologist because of the possibility of potential side effects. Isotretinoin is associated with severe birth defects, so it can't be taken by pregnant women or women who may become pregnant during the course of treatment or within several weeks of concluding treatment.
Oral Antibiotics -may be needed in combination with topical products to fight bacteria and reduce inflammation to prevent depressed scars from developing. You may need to take these antibiotics for six months so they are prescribed only in severe cases of acne. For patients with moderate to severe and persistent acne, oral antibiotics have been a mainstay of therapy for years. Like topical antimicrobials, oral antibiotics work to reduce the P. acnes population (a contributing factor in acne), which, in turn, decreases inflammation.
Over time, the P. acnes bacteria can become resistant to the antibiotic being used to treat it. When resistance occurs, acne is no longer controlled. Another antibiotic or alternative treatment can be prescribed.
The following are oral broad-spectrum antibiotics used to treat acne:
• Erythromycin. It is effective against a broad spectrum of bacteria, including P. acnes. The most common side effect is irritation of the gastrointestinal tract.
• Tetracycline and derivatives. Tetracyclines reduce the papules and pustules (inflammatory lesions) of acne. These medications should not be taken by children younger than 8 years of age because they can affect growth and stain teeth. They should also not be taken by a woman who is pregnant or breast feeding. During pregnancy and breastfeeding, tetracyclines can affect the development of the child’s bones and teeth, leading to skeletal defects.
Two synthetic derivatives of tetracycline used to treat acne are Doxycycline and Minocycline. Doxycycline proves especially effective in treating inflammatory acne. It can cause sun sensitivity in some patients. Minocyline has a long history of use in treating acne. It is often effective in treating acne that has not responded to other oral antibiotics. Minocycline also seems to produce fewer incidents of antibiotic resistance.
Oral contraceptives-for women who break out mainly around their menstrual cycle, some birth control pills can help. Research shows that these pills can clear acne by slowing down overactive oil glands in the skin. Sometimes, birth control pills are used along with a drug called spironolactone to treat acne in adult females. This medication lowers levels of the hormone androgen in the body. Androgen stimulates the skin’s oil glands. Side effects of this drug include irregular menstruation, breast tenderness, headache and fatigue. Spironolactone is not an appropriate therapy for all patients. Oral contraceptives should not be prescribed to women who smoke, have a blood-clotting disorder, are older than 35 or have a history of migraine headaches—without the advice of a gynecologist.
Topical antimicrobials work to inhibit the P. acnes populations and are used to treat patients with mild to moderately severe inflammatory acne. They may be used alone or combined with a medication that works on another factor that leads to acne aside from P. acnes. A dermatologist can determine whether a topical antimicrobial is appropriate for a patient and if so which topical antimicrobial should be prescribed.
When to seek medical advice
Acne is rarely a serious medical condition. But you may want to seek medical treatment from a dermatologist or Licensed Esthetician for persistent pimples or severe inflamed cysts to avoid scarring or other damage to your skin.