The aim of treating acne is to stop new spots forming and many people may have unrealistic expectations of their treatments and therefore fail to comply with their treatment regimes. As everyone is so individual, it is not uncommon for one treatment to work well on one person, whilst another finds the same treatment may actually worsen their acne.



It is common for doctors to 'combine' a topical product (i.e. something applied directly to the skin) with an oral treatment (i.e. tablets taken by mouth).

TOPICAL TREATMENTS

Some of the creams or gels listed below can be irritant and may cause redness or soreness to the areas applied. Next to each type of treatment listed, we have coded it either

GSL, P, POM, HOM.

For your reference these abbreviations represent:

GSL = General Sales List. Freely available off the shelf. Can also be found in supermarkets or other non-pharmaceutical retail outlets.

P = Available over the counter, without a prescription, but not available off the chemist's shelf. It requires the supervision of a pharmacist.

POM = Prescription Only Medicine, only available upon production of a prescription.

HOM = Hospital Only Medicine. These can only be prescribed by a hospital consultant specialist.

Benzoyl Peroxide (P or POM)

Benzoyl Peroxide has been used for many years and doctors agree it can be an extremely effective treatment either used alone, or in combination with other prescription treatments. There is an argument that using Benzoyl Peroxide when using antibiotics can help reduce the problem of antibiotic resistance. It is very common to see a reaction on the skin, ranging from mild redness to, in exceptional cases, considerable peeling and soreness.

This is because the Benzoyl Peroxide causes a 'stripping' effect and when this happens, most people give up on it, thinking it isn't working. However, if you start with a low percentage (usually they come in 2.5%, 4%, 5% and 10% concentrations) then your skin may start to get used to it.

There are some types of Benzoyl Peroxide creams and gels that have been specially made to help combat the problem of excessive drying and redness. These products are mixed with a special ingredient that makes this problem less likely to happen. As a result, you may be able to start on a higher percentage of Benzoyl Peroxide.

Tip - Benzoyl Peroxide is used commercially for bleaching flour, it will also bleach hair or clothes. Therefore, use an old towel that can be kept specially for wiping hands after applying. Be aware of pillowcases and other bedclothes.

Topical Vitamin A Derivatives (POM)

Vitamin A derivatives have an effect on the cells which line the surface of the duct through which passes the grease from the grease glands and is therefore used where this duct is blocked. Its major effect is on the non-inflammatory lesion of acne (the blackheads and whiteheads). With regular use it reduces the number of blackheads and whiteheads. As the comedones usually precede inflamed spots, then this type of treatment can be very helpful.

Be aware that these types of creams should not be worn when in strong sunshine, as they can cause a sunburn reaction. Therefore it is advisable to apply at night and wash your skin in the morning. These preparations can be very irritating to the skin, so apply very sparingly (about the size of a pea for the face should be sufficient).

Adapalene (POM)

This is a fairly new type of retinoid-like gel cream. It can be very helpful on both inflamed and non-inflamed acne. Some patients report that it causes less irritation than some other topical creams.

Applied once daily.

Salicylic Acid (P or GSL)

The most commonly used topical agents include the antibiotics: tetracycline, erythromycin or clindamycin.

These are usually present in an alcoholic solution. They are sometimes mixed in a more soothing lotion format.

They are absorbed into the skin and help reduce the level of bacteria in the skin and in the duct as well as reducing inflammation commonly present around the spots themselves.

They are particularly useful in mild to moderate acne. The antibiotic should be applied twice a day (or as otherwise directed) to all affected areas, regardless of whether spots are present or not. Topical antibiotics when used alone have probably less effect on the non-inflamed type of spots (blackheads and whiteheads). If you have the non-inflammatory type of acne as well as red or yellow spots, a product such as isotretinoin or tretinoin (see

Topical vitamin A section above) could be used to help these.

In general, these types of antibiotics are very well tolerated by the skin and have few side effects.

Sensitive skin types may find the alcoholic solutions irritating to the skin and may cause excessive dryness.

Tip - Topical tetracycline is yellow when applied to the skin and can cause staining on clothes. It also fluoresces under ultra violet light; so don't apply before going to a disco, unless you want to resemble a glow-worm!

Combined Topical Antibiotics (POM)

As mentioned in the previous section, topical antibiotics can be very helpful in helping the redness and inflammation in acne. When the antibiotic is combined with another proven ingredient, it can help increase its benefits. Therefore, manufacturers have now developed some new treatments (available only on prescription) that can be of more benefit.

They may also reduce the resistance to the organism p.acnes. This is particularly true of erythomycin and zinc and erythromycin and benzoyl peroxide.

Erythromycin and Zinc (POM)

This topical lotion is available in two sizes. One for acne confined to a small area of the body, such as the face and neck, and the larger size to help more widespread acne. Zinc has been used for many years to help treat skin problems and in trials they have found the combined use of both zinc and erythromycin helps to reduce acne.

Tip - Ask the doctor for the larger size if your acne is also on your back, as it will go further. Once opened, each bottle can be used for 6 weeks, so there is little point in asking for the bigger size if you have it only on your face and neck as any unused lotion will have to be discarded after this time.