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Aesthetics Practice Today

Combination Topical Skin Care for Acne

Published January 22, 2013 2:43 PM by Mina Grasso
Teens and adults suffer from acne due to hormone fluctuations and stress. Some feel diet may play a role. These factors stimulate sebaceous glands that causes the oil production that the P. acne live on. Most patients have tried a variety of over-the-counter acne remedies before they get to our clinic. 

Acne can range from mild blackheads and whiteheads (comedonal acne) caused by pores blocked by sebum and skin cells to inflammatory acne that usually presents with redness and inflammation under blocked pores. The most severe form of acne is cystic acne. Cystic acne usually is painful related to a deeper bacterial infection most commonly by propionibacterium acnes. Cystic acne may lead to disfigurement and result in residual scarring and the goal would be to treat as soon as possible to avoid further scarring.

Over the Counter Remedies

For milder cases of acne, various soaps, washes, toners and cleansers have been effective. Two of the most common are benzoyl peroxide and salicylic acid. Benzoyl peroxide acts as an antibacterial treating propionibacterium acnes. Salicylic acid is a keraolytic agent that softens and exfoliates the outer layer of skin, the stratum corneum, and helps prevent clogging of the pores with sebum and skin.

Prescription Acne Skin Care

  • Azelaic Acid solution can be useful in treating mild comedonal acne. Patients usually do not complain of irritation with use of this product.
  • Topical Antibiotics such as clindamycin, erythromycin and sodium sulfacetamide have been effective against propionibacterium acnes.
  • Topical Retinoids work to reduce outbreaks by modulating cell turnover, which prevents inflamed skin cells from clogging pores. It reduces the frequency and severity of acne breakouts. Side effects such as increased sensitivity to sunlight, dryness, redness and peeling need to be discussed. These side effects can be managed to improve compliance with treatment.

Combination Topical Therapy

Antibiotic resistance is always of concern. Combining topical antibiotics with benzoyl peroxide has been one approach to reduce antibiotic resistance. In addition, combination therapy using clindamycin or erythromycin with low dose benzoyl peroxide has proven to be more effective than clindamycin or erythromycin alone, in some studies.

Combining topical retinoids enhance the penetration of topical antibiotics and improves treatment outcome. Later this month, I will address added benefits to combination therapy using laser and light technologies.

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    Occupation: Physician Assistant/Nurse Practitioner
    Setting: Miami & Upland, Calif.
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