1) Acne drug therapies require consistent use for
several weeks before optimal results are seen.
2) Topical therapies need to be applied to the entire
affected area, not just specific lesions.
3) Benzoyl Peroxide (BP) is a very effective and
relatively inexpensive acne therapy. Strengths
greater than 5% are no more effective but more
irritating than strengths ≤ 5%.
4) Topical retinoids are an effective first line option
for comedonal acne.
a. Tretinoin (e.g. Retin-A, Stieva-A, Vitamin A Acid):
i. 0.025-0.05% products are most useful; lower
concentrations do not work; higher
concentrations are seldom tolerated
b. Adapalene (Differin) may be preferred if:
i. less skin irritation is important
ii. part of a combination regimen where morning
application of agent causing minimal sun
sensitivity is important (e.g. BP+ABX at night,
retinoid in am)
5) Topical antibiotic monotherapy should be avoided.
Addition of BP to antibiotic regimens is strongly
recommended to reduce bacterial resistance.
(Combo products useful: Benzamycin, BenzaClin / Clindoxyl)
6) Oral antibiotics should be used for shorter
“pulses” of therapy (e.g. 8-16 weeks) to reduce the
development of bacterial resistance.
7) Any combination oral contraceptive (COC) may
result in improvement in acne.
8) Oral isotretinoin (Accutane, Clarus) is the most
effective therapeutic option for severe acne.
Physicians should be familiar with cost effective
dosing strategies, pregnancy precautions, required
monitoring and side effect management.
9) Acne can cause significant stress, psychosocial
concerns to the patient. Early intervention is
recommended when presentation or family history
suggests a severe course is likely.
10) Identification of sensitive skin issues is important
so that steps can be taken to reduce drug related
irritation {e.g. patients with non-oily skin, previous
eczema or a history of sensitivity}.
______________________________________________________
Acknowledgements: Contributors & Reviewers: Dr. D. Lichtenwald (Saskatoon-Derm), Dr. J. Taylor (C. of
Pharmacy, U. of S.), Dr. R. McKay (Regina-Derm), Dr. T. Laubscher (SHR-FM),Dr. M. Evans (CCFP, U. of T.,
Toronto) & RxFiles Advisory Committee. Prepared by: M. Jin PharmDc Candidate; L. Regier BSP, BA, B. Jensen BSP
DISCLAIMER: The content of this newsletter represents the research, experience and opinions of the authors and not those of the Board or Administration of Saskatoon
Health Region (SHR). Neither the authors nor Saskatoon Health Region nor any other party who has been involved in the preparation or publication of this work warrants or
represents that the information contained herein is accurate or complete, and they are not responsible for any errors or omissions or for the result obtained from the use of such
information. Any use of the newsletter will imply acknowledgment of this disclaimer and release any responsibility of SHR, its employees, servants or agents. Readers are
encouraged to confirm the information contained herein with other sources.
