From Accutane to Stridex, an overwhelming alphabet of topical anti-acne treatments exist. How do we know which ones work? These cleansers, creams, gels, and ointments usually work against mild to moderate acne like blackheads, whiteheads, and pimples. They do this by either eliminating pore blockages (comedolytic) or the bacteria that thrive inside pimples (antibacterial/antibiotic). Here’s a rundown of the different topical treatment options to every zit and pimple sufferer:
*Azelaic acid*
Azelaic acid can both kill bacteria that thrive in acne as well as manage the shedding of dead skin cells from the pore, making it an ideal topical anti-acne treatment. It has the added benefit of inhibiting pigment production to make acne “scars” appear lighter. It can be effective against mild to moderate acne. Azelex, Aziderm, Azaline, and Adarerin are some topical preparations with azelaic acid.
*Benzoyl Peroxide*
Benzoyl peroxide effectively penetrates the pores and kills the bacteria that thrive in acne. It does this by introducing oxygen to the anaerobic acne bacteria Proprionobacterium acnes, which cannot live in the presence of oxygen. With the bacteria dead, pimples become less inflamed and improve in appearance. Secondarily, benzoyl peroxide can also help get rid of dead skin cells to prevent pore blockages. A lot of over-the-counter anti-acne products contain benzoyl peroxide as their main ingredient, among them Clearasil and ProActiv
*Retinoids*
Retinoids are compounds that are chemically related and similar to Vitamin A. The most popular retinoid is tretinoin or retinoic acid. It is believed to be the most effective topical comedolytic treatment against acne. It clears up blocked pores by speeding up how cells are sloughed off the skin, promoting the exfoliation of dead skin cells. It can also reduce the inflammation of ruptured or pus-filled pimples. Tretionoin also has the added benefit of lightening pimple “scars” in darker-skinned people. The downside to this compound is that it can cause peeling and dryness on the skin. You should also not expose your skin to the sun if you are using this compound. Commercial preparations of tretinoin include Accutane, and Retin-A. Adapalene (Differin) is a third-generation retinoid that acts similar to tretinoin by clearing up pore blockages and relieving pimple inflammation. There are also topical isotretinoin gels that act similar to tretinoin.
*Salicyclic Acid*
Salicyclic acid is another treatment that is effective against mild to moderate acne. It can penetrate the pore to exfoliate and remove dead skin cells, thereby keeping it clear and acne-free. Though less effective than tretinoin, it is more favorable to people with more sensitive skin. Commercial preparations with salicylic acid include Pan-Oxyl, Noxzema, and Stridex.
*Topical Antibiotics*
Topical antibiotics work to kill the P. acnes bacteria that thrive in acne and make it worse. Common anti-acne antibiotics include clindamycin, erythromycin, and tetracycline. They can be found as gels, solutions or ointments. A side effect of relying on topical antibiotics is that it can lead to the growth of resistant P. acnes strains that are harder to eliminate.
Whatever the topical treatment, be sure to read the label first for contraindications and directions of use. Most topical anti-acne treatments are applied twice daily. You have to keep in mind that most topical treatments should be used continuously (for up to several months for tretinoin) to get favorable results. Using more than one type of topical treatment (for example, benzoyl peroxide with salicylic acid) can be done, however it can cause more irritation on the skin and is recommended to be applied alternately. Common side effects of topical treatments include stinging, burning and irritation as well as dryness and flaking of the skin. Over time most topical anti-acne treatments also lose their efficacy as the skin adapts and gets used to it.