Pharmacy Practice IV

Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.

Acne // Page 1 of 14
Acne Vulgaris / Pimples / Spots / Zits

1. Common occurrence
a. Almost everyone
b. More than 90% of all adolescents
c. Nearly 50% of all adult women
d. 25% of all adults

2. Disorder of the pilosebaceous unit. All pimples
begin as a blockage of the hair follicle or pore.
Pilosebaceous unit:
a. Made up of a hair follicle, sebaceous gland, and a hair
b. Found everywhere on the body except on the palms,
soles, top of the feet, and the lower lip
c. Greatest on the face, upper neck, and chest
d. Sebaceous glands produce a substance called sebum
that keeps the skin and hair moisturized
e. During adolescence sebaceous glands enlarge and
produce more sebum under the influence of hormone
androgens
f. After about age 20, sebum production begins to
decrease

3. The Hair Follicle
a. A small, tube-like opening in the skin through which hair and sebum reach the skin's surface
b. Consists of the pore opening, hair root and bulb, sebaceous duct, and sebaceous gland
c. Although it is contained within the dermis, the epidermis lines the inside of the hair follicle
d. In a normal functioning follicle the sebaceous glands secrete oil, or sebum, into the pore. Typically,
sebum and dead cells shed from the stratum corneum emerge at the skin's surface through the pore
opening. When the follicle is "full", the sebum spreads over
the skin surface giving the skin an oily appearance. When
this process works correctly, the skin is moisturized and
remains healthy
e. In acne prone skin, sebum and dead skin cells easily
become trapped within the follicle. This accumulation of
cellular debris and sebaceous matter forms a hard plug that
obstructs the pore opening. This obstruction is called a
comedo. The cells that are normally sloughed off become
"sticky", plugging up the follicle. It manifests itself as non-inflamed bump or blackhead on the skin's
surface. The process of obstructing follicles is called comedogenesis. It causes some follicles to form a
type of acne called comedones, also known as blackheads and whiteheads
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Acne // Page 2 of 14
Factors causing / contributing / affecting

1. Hormones during puberty
a. Increase in male sex hormones called androgens cause the sebaceous glands to get larger and make
more sebum (oil) which can clump together with the dead skin cells on the top layer of your skin.
Unfortunately, the glands just dont stop; they keep producing oil, and the follicle becomes swollen.
Bodys natural defense system, white blood cells, rush to the area to clean up the mess, resulting in
acne
b. Boys tend to produce more of them, therefore tend to have more severe breakouts

2. Adult Hormonal Acne (less common)
a. Many women pass into adulthood without "outgrowing" their acne
b. Some may not develop it until their 20s or 30s, experiencing persistent breakouts the week before
their period
c. During the course of a normal menstrual cycle (if a woman is not taking any kind of hormonal birth
control pill), estrogen levels peak at mid-cycle, then decline as she nears her period. After ovulation,
the ovaries begin to produce progesterone, another hormone which stimulates the sebaceous glands
d. Hormones are also responsible for acne in a percentage of pregnant women. The sebaceous glands
are more active during the third trimester, causing oily skin and frequent breakouts
e. Some women experience acne after menopause, when estrogen levels begin to taper off and
testosterone becomes the dominant hormone

3. Extra sebum due to hyperactive sebaceous glands
a. When the sebaceous gland is stimulated by androgens, it produces extra sebum
b. In its journey up the follicle toward the surface, the sebum mixes with common skin bacteria and dead
skin cells that have been shed from the lining of the follicle
c. While this process is normal, the presence of extra sebum in the follicle increases the chances of
clogging and can cause acne

4. Follicle fallout - accumulation of dead skin cells
a. Normally, dead cells within the follicle shed gradually and are expelled onto the skins surface. But in
patients with overactive sebaceous glands and in nearly everyone during puberty these cells are
shed more rapidly
b. Mixed with a surplus of sebum, the dead skin cells form a plug in the follicle, preventing the skin from
finishing its natural process of renewal

5. Anaerobic bacteria Propionibacterium acnes
a. Bacteria responsible for inflamed acne breakouts
b. Regular harmless residents within the hair follicle using sebum as nutrient for growth
c. In acne prone skin the bacteria population grows out of control
d. When a comedo blocks the pore opening, it creates an anaerobic environment within the follicle. Along
with excess sebum within the pore, this creates a favorable environment where P. acnes bacteria can
thrive
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Acne // Page 3 of 14
e. As the follicle becomes filled with sebum, dead cells, and bacteria, it begins to swell. The follicle wall
ruptures and spills into the dermis. White blood cells rush in to fight the bacteria. Redness and
swelling occurs, and pus is created. The whole process takes 23 weeks, culminating in a pimple
f. If the rupture in the follicle wall happens near the surface, the pimple is usually minor and heals
quickly. It is when the break occurs deep within the dermis that more severe lesions, such as nodules
and cysts, develop

6. Inflammation
a. Chemotaxis or the inflammatory response = when your body encounters unwanted bacteria, it sends
an army of white blood cells to attack the intruders
b. This is what causes pimples to become red, swollen and painful
c. Skin irritation or scratching of any sort will activate inflammation

7. Medications
a. Some medicines cause acne as the side effect
b. Anticonvulsants (e.g. Dilantin) for epilepsy
c. Corticosteroids (e.g. Prednisone) stimulate sebum production and lead to blemishes
d. Anabolic steroids, quinine, halogen containing medicines (iodides, bromides), thyroid preparations
(e.g. Thiourea and Thiouracil), etc

8. Occupations
a. In some jobs, exposure to industrial products like oils may produce acne
b. Most industrial oils used in cars, in factories, on bicycles are comedogenic. While these substances are
not the cause of your acne, they can aggravate it
c. Airborne grease in a fast-food restaurant can create an invisible film on your skin, clogging your pores

9. Sun
a. Small amounts of sun exposure may initially improve acne, but benefit is temporary
b. Consistent sun bathing will dry your skin, causing your sebaceous glands to produce more oil. Also,
skin that has been exposed to the sun has to slough old cells more frequently. When you combine the
extra oil and extra dead cells, you create the ideal environment for comedones, or blocked pores

10. Stress
a. Stress does not play much of a direct role in causing acne.
b. The connection is purely chemical
c. When you become tense, your adrenal glands start working flooding your bloodstream with the
hormone cortisol
d. This triggers the sweat glands in your face to produce more oil. This excess oil will mix with dead skin
cells and clog your pores, trapping bacteria inside
e. The result more acne, primarily inflamed papules rather than blackheads or whiteheads

11. Cosmetics
a. Make-up does not cause true acne. It can exacerbate the condition
b. Most cosmetic and skin care products are not pore-clogging (comedogenic)
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Acne // Page 4 of 14
c. Water-based or oil-free cosmetics are generally a better choice
d. Acne cosmetica, or acne that is caused by cosmetics, is a mild and fairly common
e. Characterized by small, pink bumps on the cheeks, chin and forehead, it typically develops over the
course of a few weeks or months and may persist indefinitely
f. Mica (to put the sparkle in your eye shadow, face powder and blush) is a common mineral can cause
irritation and clogging in the follicle
g. Many of the red dyes used to put a bloom in your cheeks are coal tar derivatives comedogenic
h. Cream blushes more likely to have comedogenic ingredients than powder or gel
i. Because of the delicacy of the skin around the eyes, creams created for this area are often thicker and
greasier than regular facial moisturizers. Heavy eye creams and oily eye make-up removers can
promote milia, tiny white cysts under the eyes. These kinds of products can also migrate to
neighboring areas, creating acne on the cheeks, temples and forehead
j. Most hair products are full alcohol, adhesives and oils. So if youre prone to acne, use care when
styling your hair cover your skin when you spray, and try to keep oils, mousses, gels and pomades
away from the skin at the hairline. Dont use hair products when you exercise; perspiration from your
scalp can carry styling products onto your skin, contributing to new breakouts

12. Heredity (Partly)
a. Especially very severe acne

13. Diet (Maybe)
a. Junk food, milk, chocolate, greasy food, high sugar, high carbohydrate, seafood (iodine worsens
existing acne) may be important
b. No study linking these foods to acne, but best avoided for overall health. A healthy diet is important
for improving raw materials for healthy skin
c. Experiment with diets

14. Dirt and sweat (No way)
a. Does not cause acne
b. Misconception probably comes from the fact that blackheads look like dirt stuck in the openings of
pores. The black color is not dirt but simply oxidised keratin. In fact, this occur deep within the narrow
follicle channel, where it is impossible to wash them away

Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Acne // Page 5 of 14
Types

If the inflammation is right near the surface, you get a pustule; if it's deeper, a papule (pimple); deeper still and it's a
cyst. If the oil breaks though to the surface, the result is a "whitehead." If the oil becomes oxidized (that is, acted on by
oxygen in the air), the oil changes from white to black, and the result is a "blackhead."


Non-Inflamed Acne Blemishes

Debris in the pore leads to some form of a comedo, or blemish. But not all blemishes are alike.
Four basic types of non-inflamed breakouts are often found on acne-prone skin. With non-
inflamed comedones, there is no redness or swelling of the lesion. However, non-inflamed
comedones may turn into a "typical" pimple if bacteria invade. While not everyone who has
acne experiences inflamed breakouts, all acne sufferers have some form of non-inflamed
comedones.

1. Soft Closed Comedones
a. Appearance: Soft closed comedones present as bumpiness on the skin's surface. They are not painful
or red
b. Development: Soft closed comedones develop when a plug of cellular debris and oil becomes trapped
within the pore and are covered by a layer of dead skin cells. The oil plug itself remains liquid or soft
c. Treatment: Treatment involves reducing excess oil and dead cells. Extract comedones by exerting
gentle pressure, coaxing the trapped oil plug to the surface. Keeping the skin clear of soft closed
comedones can drastically reduce the development of inflamed acne breakouts

2. Hard Closed Comedones
a. Appearance: Hard closed comedones, called milia, have very obvious white heads. Unlike pustules,
milia are not red or painful. They are especially common in the eye area
b. Development: Hard closed comedones develop just as their soft counterparts; however the impaction
has hardened and is similar to a grain of sand. The white head is not pus, but rather a mass of dead
cells and sebum
c. Treatment: Extract milia by making a tiny incision on the lesion and carefully removing the sebaceous
plug. Even without treatment, milia can work their way to the surface over time

3. Open Comedones or Blackhead
a. Development: A blackhead is an accumulation of dead skin cells and sebaceous matter within the
follicle. Its top is not covered by a layer of dead skin cells, but instead is exposed to air. The black
coloring is not dirt. Air causes the oil to darken
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Acne // Page 6 of 14
b. Treatment: Blackheads can usually be extracted by applying gentle pressure to the breakout.
Consistent, thorough cleansing reduces oiliness, which can help prevent the development of
blackheads

4. Microcomedones
a. Appearance: Although most acne sufferers have many microcomedones, they are too small to be seen
with the naked eye
b. Development: A microcomedo is the very beginning of an acne lesion. It occurs when the sebaceous
duct and pore opening becomes blocked by excess sebum and dead skin cells. Every blemish begins
as a microcomedo
c. Treatment: Treatment is similar to that of soft closed comedones and involves reducing excess oil on
the skin. Regular exfoliation helps avoid buildup of dead skin cells. Treating comedones at this level
helps prevent larger acne breakouts from occurring


Inflamed Acne Blemishes

Comedones, or blemishes, all begin as a blockage of oil and dead skin cells within the hair
follicle. When bacteria infect a comedone, or it is irritated by squeezing, inflammation occurs.
Inflammation is characterized by redness, swelling and pain. There are four main types of
inflamed acne blemishes.

1. Papules
a. Appearance: The mildest form of inflammatory acne, a papule is a red and inflamed lesion on the
skin's surface. It contains no pus or white head
b. Development: Papules result from a high break in the follicle wall, allowing cellular debris and bacteria
to spill into the dermis. This break may occur when a pore becomes engorged with debris and oil, or is
squeezed or otherwise irritated. A papule often progresses to a pustule
c. Treatment: Do not squeeze a papule or you may worsen the breakout. Most papules heal quickly and
without scarring, as they are not deep lesions. Benzoyl peroxide treatments may help prevent papules
from occurring

2. Pustules
a. Appearance: A pustule is a typical pimple red and inflamed with a white head. They range in size
from small to fairly large. Sometimes the brownish comedonal core can be seen as a cap on the pus
head. Like papules, pustules are small round lesions; unlike papules, they are clearly inflamed and
contain visible pus. They may appear red at the base, with a yellowish or
whitish center
b. Development: Pustules follow papules after white blood cells invade. The
white cap on a pustule is pus, sebaceous matter and cellular debris
c. Treatment: Mild acne or occasional pustules can ordinarily be treated at
home with benzoyl peroxide creams or cleansers. Dont pop a pustule
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Acne // Page 7 of 14

3. Nodules
a. Appearance: Nodules are large inflamed lesions that occur deep within the dermis. They feel like a
hard, painful lump under the skin. Where papules occur at the surface, nodules occur deep within the
skin
b. Development: A nodule occurs when the follicle wall ruptures deep within the dermis. Contaminated
debris from the follicle empties into the dermis and infects adjoining follicles. A nodule is a severe
form of an acne lesion
c. Treatment: Never squeeze or pick at a nodule. The infection is deep and the risk of scarring is high

4. Cysts
a. Appearance: Cysts are very large, inflamed lesions. They feel like soft, fluid-filled lumps under the
skin's surface. The most severe form of a pimple, cysts are very painful
b. Development: Like nodules, cysts begin as a deep break in the follicle wall. A membrane develops
around the infection in the dermis. As a cyst works its way to the surface, it damages healthy skin
tissue, destroying the follicle. The likelihood of scarring is very high
c. Treatment: Treatment usually consists of topical and systemic medications


Acne conglobata

a. This rare but serious form of inflammatory acne develops primarily on the back, buttocks and chest
b. In addition to the presence of pustules and nodules, there may be severe bacterial infection


Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Acne // Page 8 of 14
Prevention

1. Lead healthy lifestyle
a. Minimize stress. Take time out of every day to relax
b. Balanced diet, drink lots of water
c. Enough sleep
d. Exercise

2. Don't squeeze or pick
a. It can force bacteria deeper into the skin, causing greater inflammation and infection
b. Also increase the damage to the surrounding skin, so the blemish is more likely to leave a permanent acne
scar

3. Do facial
a. While not absolutely essential, steaming and deep-cleaning pores are useful, both alone and in addition
to medical treatment, especially for people with "whiteheads" or "blackheads." Having these pores
unclogged by a professional also reduces the temptation to do it yourself

4. Take nutrients for healthy skin
a. Vitamin A (retinol) fish oils, liver and dairy products. Vitamin A produced by plants (beta-carotene) -
orange fruits and vegetable such as carrots, yams, apricots as well as green vegetables like parsley and
spinach
b. Vitamin B2. Alleviates stress. Whole grains, fish, milk, eggs, meat and leafy green vegetables
c. Vitamin B3. Improves circulation, promoting healthy skin. Peanuts, eggs, avocados, liver and lean meats
d. Vitamin E. Powerful antioxidant. Almonds, peanuts, sunflower seeds, broccoli, wheat germ and vegetable
oils
e. Zinc. Boost the immune system, improving overall health. Eggs, whole grains, nuts and mushrooms

5. Use proper cleansing technique / cleanser
a. Mild cleansers to keep the skin clean and minimize sensitivity and irritation
b. Exfoliating cleansers and masques contain either fine granules or salicylic acid in a concentration that
makes it a very mild peeling agent. These products remove the outer layer of the skin, and thus open
pores
c. Use a gentle astringent/toner to wipe away oil
d. Products containing glycolic acid or one of the other alpha-hydroxy acids are also mildly helpful in clearing
the skin by causing the superficial layer of the skin to peel (exfoliate)
e. Dirt does not cause acne. Excessive scrubbing and washing won't make it go away. Excessive washing can
make healthy skin dry, and your acne-prone areas irritated. This stimulates extra oil production, which
could result in more breakouts
f. Toner avoid products with high concentrations of isopropyl alcohol, or common rubbing alcohol. A strong
astringent, alcohol strips the top layer of your skin, causing your sebaceous glands to produce more oil,
resulting in dry, red skin and possibly more blemishes
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Acne // Page 9 of 14
Treatment

1. A combination of treatments can greatly reduce the amount and severity of acne in many
cases. There is however no magic product or regimen that is right for every person and
situation. More effective treatment tend to have greater potential side effects and need a
greater degree of monitoring.
2. Treating acne requires patience and perseverance may take 2 or 3 months to start
working. Unless there are side effects such as dryness or allergy, it is important to give each
regimen or drug enough time to work before giving up on it and moving on to other
methods.
3. Crucial to begin treatment as soon as the first signs appear. The sooner you address your
acne, the less likely you are to experience permanent damage to your skin
4. In general treatments are believed to work in at least 4 different ways, with many of the
best treatments providing multiple simultaneous effects:

a. Normalising shedding into the pore to prevent blockage
b. Killing P. acnes
c. Antinflammatory effects
d. Hormonal manipulation



Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Acne // Page 10 of 14
Non-prescription Medicines / Measures

1. Benzoyl peroxide
a. Very effective in treating mild to moderate cases of non-inflammatory acne
b. Safe for children as well as adults
c. May combined with other topical or oral treatments
d. Mode of action: keratolytic and prevents new lesions by killing P. acnes
e. May be 23 weeks before you begin to see improvement
f. Unlike antibiotics, benzoyl peroxide is a strong oxidizer (essentially a mild bleach) and thus does not
appear to generate bacterial resistance
g. Kills existing P. acnes but does not increase your bodys natural resistance to bacteria. It does not affect
sebum production or the rate at which you shed your dead skin cells. Therefore, if you stop using it, the
bacteria, and your acne will return
h. Side effects: It routinely causes dryness, local irritation and redness. It can very easily bleach any fabric or
hair

2. Mild acid solutions
a. Salicylic acid, glycolic acid
b. Safe, effective treatment for mild acne
c. Keratolytic agent encourages the peeling of the top layer of skin and the opening of plugged follicles,
which helps reestablish the normal skin-cell replacement cycle
d. Does not have any effect on the production of sebum or the presence of P. acnes bacteria
e. Salicylic acid must be used continuously, even after acne lesions have healed. Its effects stop when you
stop using it, so your skin will return to its uneven shedding; pores become clogged, and acne returns
f. Side effect: mild dryness of skin

3. Topical antibiotics
a. Erythromycin, clindamycin
b. Equally as effective as oral with lesser side effects of stomach upset or drug interactions (e.g. with oral
contraceptive pill)

4. Vitamin A derivatives
a. Tretinoin, differin
b. Treatment of choice for comedonal acne, or whiteheads and blackheads
c. May take 6-9 weeks to see a noticeable difference
d. Mode of action: increases skin cell turnover promoting the extrusion of the plugged material in the follicle.
It also prevents the formation of new comedones by preventing hyperkeratinization
e. Apply thin layer at night (it makes you more susceptible to sunburn), wash in the morning and apply
moisturizer + sunscreen (if outside)
f. Side effects: increased skin cell turnover can be irritation and flaking (initial flare up). When start using,
apply it every other night or every 3rd night flaking and irritation side effects are usually the worst in the
first 2 weeks of application. As your skin adjusts to the medicine, you can apply it more frequently

5. Oral contraceptive pills
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Acne // Page 11 of 14
a. For some female patients, treatment-resistant acne is caused by excessive production of hormones called
androgens. Extra androgens produce more sebum (oil)
b. By reducing the effect of the androgen hormones on the sebaceous glands, OCs can reduce the amount of
oil your glands produce, which means that your pores are less likely to get blocked
c. Candidate: acne that appears in adults for the first time; acne flare-ups preceding the menstrual cycle;
irregular menstrual cycles; hirsutism (excessive growth of hair or hair in unusual places); and elevated
levels of certain androgens in the blood stream
d. Common combined estrogen + progestogen have some effect. Estrogens lower levels of luteinizing
hormone (LH) and increase the sex hormone binding globulin (SHBG). This in turn lowers testosterone,
thus reducing the drive of the oil glands that are responsible for acne to produce excess oil
e. The anti-testosterone Cyproterone, in combination with an estrogen (Diane) is particularly effective at
reducing androgenic hormone levels
f. Newer product containing the progestin drospirenone (Yasmin) has fewer side effects than Diane
g. Both can be used where blood tests show abnormally high levels of androgens, but are effective even
when this is not the case

6. Herbal
a. Value of these treatments may be unknown or unverifiable
b. Come in supplements, teas, and oils or creams for topically or oral
c. Mentioned in Ayurveda such as aloe vera, aruna, haldi (turmeric) and papaya
d. Products from Rubia cordifolia, Curcuma longa (turmeric), Hemidesmus indicus (ananthamoola or
anantmula), and Azadirachta indica (neem) have been shown to have anti-inflammatory effects
e. Tea Tree Oil (Melaleuca Oil) has been used with some success, comparable to benzoyl peroxide but
without excessive drying, and has been shown to be an effective anti-inflammatory in skin infections

7. Pore Strips
a. Strips which you put on your nose, forehead, chin, etc. to "pull out" oil from your pores
b. They are inexpensive and safe, and work reasonably well if used properly

Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Acne // Page 12 of 14
Prescription Medicines / Measures

1. Isotretinion (oral vitamin A)
a. For severe, resistant acne, chiefly of the cystic variety which has been unresponsive to conventional
therapies
b. Prescribed for 5-6 months, it inhibits sebaceous gland function and keratinization by altering DNA
transcription
c. Even though isotretinoin does not remain the body after therapy is stopped, improvement is often long-
lasting
d. Treatment requires close medical supervision by a dermatologist
e. Side effects:
dry skin common
occasional nosebleeds
initial flare up of acne within a month or so, which can be severe
can damage the liver
can elevate level of triglycerides
high risk of inducing birth defects if taken by pregnant women
risk of depression and suicide in patients taking isotretinoin
f. About 25% of patients may relapse after one treatment. In those cases, a second treatment for another 4-
6 months may be indicated to obtain desired results. It is often recommended that one lets a few months
pass between the two treatments, because the condition can actually improve somewhat in the time after
stopping the treatment and waiting a few months also gives the body a chance to recover

2. Oral Antibiotics
a. For moderate to severe acne
b. Mode of action:
kill P. acnes
anti-inflammatory (therefore doses are sometimes sub-antimicrobial this reduces chances of
resistance)
reduce the irritating chemicals produced by white blood cells
c. Antibiotics do not reduce the oil secretion
d. May take weeks or months to see effects
e. Acne generally reappear after the end of treatment days later (topical) or weeks later (oral)
f. Taking them more frequently or more than prescribes does not improve acne faster, but will cause greater
side effects such as photosensitivity (higher risk of sunburn), upset stomach, dizziness or lightheadedness,
hives, skin discoloration and higher incidence of vaginal yeast
g. Tetracycline
twice a day
must be taken on an empty stomach to be the most effective
not be given to pregnant women or children under 9 years of age - can discolor developing
teeth
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Acne // Page 13 of 14
h. Erythromycin
twice a day
has anti-inflammatory properties that help reduce redness in lesions
can and should be taken with food
can cause stomach upset and nausea
can be used in pregnant women
i. Minocycline
once a day
a tetracycline derivative
especially useful for pustular type acne
absorption of minocycline is decreased with food, but not as significant as tetracycline. Must be
taken after food, otherwise nausea
side effects of minocycline include dizziness, nausea, vomiting, skin pigmentation changes (long
term), and tooth discoloration (long term)
j. Doxycycline
once a day
doxycycline is more likely than tetracycline to increase sensitivity to the sun, or cause sunburns
k. Clindamycin
once a day
major side effect is serious intestinal infection called pseudomembranous colitis caused by the
bacteria, Clostridium difficile
l. Other antibiotics - cefadroxil, amoxicillin, and the sulfa drugs

3. Cortisone Injections
a. Prednisone, dexamethasone
b. For large pimples and cysts
c. Injected direct to reduce redness and inflammation almost immediately
d. Most effective when used in combination with oral contraceptives
e. Side effects are minimal temporary whitening of the skin around the injection point
f. In some acne sufferers, corticosteroids may actually aggravate acne

4. Laser treatments
a. New
b. The laser is used to produce one of the following effects:
to burn away the follicle sac from which the hair grows
to burn away the sebaceous gland which produces the oil
to induce formation of oxygen in the bacteria, killing them
c. Since lasers and intense pulsed light sources cause thermal damage to the skin there are concerns that
laser or intense pulsed light treatments for acne will induce hyperpigmented macules (spots) or cause long
term dryness of the skin

Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Acne // Page 14 of 14
Less widely used treatments

1. Sodium Sulfacetamide
2. Sulfur (commonly combined with other ingredients in facial products)
3. Resorcinol
4. Spironolactone, a high blood pressure medicine with anti-androgenic properties, has proven
quite effective in the treatment of acne
5. Azelaic acid suitable for mild, comedonal acne
6. Tazorotene
7. Photodynamic therapy
8. Zinc: Orally administered zinc gluconate has been shown to be effective in the treatment of
inflammatory acne, although less so than tetracyclines
9. Nicotinamide (Vitamin B3) used topically study showed more effective than a topical
antibiotic as well as having fewer side effects. The property of topical nicotinamide's benefit
in treating acne seems to be its anti-inflammatory nature. It is also purported to result in
increased synthesis of collagen, keratin, involucrin and flaggrin
10. Rofecoxib was shown to improve premenstrual acne in a placebo controlled study
11. Naproxen or ibuprofen are used for some moderate acne for their anti-inflammatory effect

















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