Different types of antiacne drugs are used for different purposes. For example, lotions, soaps, gels, and creams containing benzoyl peroxide or tretinoin may be used to clear up mild to moderately severe acne. Isotretinoin (Accutane) is prescribed only for very severe, disfiguring acne.
Acne is a skin condition that occurs when pores or hair follicles become blocked. This allows a waxy material, sebum, to collect inside the pores or follicles. Normally, sebum flows out onto the skin and hair to form a protective coating, but when it cannot get out, small swellings develop on the skin surface. Bacteria and dead skin cells can also collect that can cause inflammation. Swellings that are small and not inflamed are whiteheads or blackheads. When they become inflamed, they turn into pimples. Pimples that fill with pus are called pustules.
Acne cannot be cured, but acne drugs can help clear the skin. Benzoyl peroxide and tretinoin work by mildly irritating the skin. This encourages skin cells to slough off, which helps open blocked pores. Benzoyl peroxide also kills bacteria, which helps prevent whiteheads and blackheads from turning into pimples. Isotretinoin shrinks the glands that produce sebum.
Benzoyl peroxide is found in many over-the-counter acne products that are applied to the skin, such as Benoxyl, Clear By Design, Neutrogena Acne, PanOxyl, and some formulations of Clean & Clear, Clearasil, and Oxy. Some benzoyl peroxide products are available without a physician's prescription; others require a prescription. Tretinoin (Retin-A) is available only with a physician's prescription and comes in liquid, cream, and gel forms, which are applied to the skin. Isotretinoin (Accutane), which is taken by mouth in capsule form, is available only with a physician's prescription. Only physicians who have experience in diagnosing and treating severe acne, such as dermatologists, should prescribe isotretinoin.
The recommended dosage depends on the type of anti-acne drug. These drugs usually come with written directions for patients and should be used only as directed. Patients who have questions about how to use the medicine should check with a physician or pharmacist.
Patients who use isotretinoin usually take the medicine for a few months, then stop for at least two months. Their acne may continue to improve even after they stop taking the medicine. If the condition is still severe after several months of treatment and a two-month break, the physician may prescribe a second course of treatment.
Minor discomforts such as dry mouth or nose, dry eyes, dry skin, or itching usually go away as the body adjusts to the drug and do not require medical attention unless they continue or are bothersome.
Other side effects should be brought to a physicians attention. These include:
- burning, redness, or itching of the eyes
- signs of inflammation of the lips, such as peeling, burning, redness or pain
Bowel inflammation is not a common side effect, but it may occur. If any of the following signs of bowel inflammation occur, stop taking isotretinoin immediately and check with a physician:
- pain in the abdomen
- bleeding from the rectum
- severe diarrhea
Benzoyl peroxide and tretinoin
The most common side effects of antiacne drugs applied to the skin are slight redness, dryness, peeling, and stinging, and a warm feeling to the skin. These problems usually go away as the body adjusts to the drug and do not require medical treatment.
Other side effects should be brought to a physician's attention. Check with a physician as soon as possible if any of the following side effects occur:
- blistering, crusting or swelling of the skin
- severe burning or redness of the skin
- darkening or lightening of the skin. (This effect will eventually go away after treatment with an anti-acne drug ends.)
- skin rash
Other side effects are possible with any type of antiacne drug. Anyone who has unusual symptoms while using anti-acne drugs should get in touch with his or her physician.
People who have certain medical conditions or who are taking certain other medicines may have problems if they use antiacne drugs. Before using these products, be sure to let the physician know about any of these conditions:
ALLERGIES. Anyone who has had unusual reactions to etretinate, isotretinoin, tretinoin, vitamin A preparations, or benzoyl peroxide in the past should let his or her physician know before using an antiacne drug. The physician should also be told about any allergies to foods, dyes, preservatives, or other substances.
PREGNANCY. Women who are pregnant or who may become pregnant should check with a physician before using tretinoin or benzoyl peroxide. Isotretinoin causes birth defects in humans and must not be used during pregnancy.
BREASTFEEDING. No problems have been reported in nursing babies whose mothers used tretinoin or benzoyl peroxide. Women who are breastfeeding babies should not take isotretinoin, however, as it may cause problems in nursing babies.
OTHER MEDICAL CONDITIONS. Before using antiacne drugs applied to the skin, people with any of these medical problems should make sure their physicians are aware of their conditions:
- eczema. Anti-acne drugs that are applied to the skin may make this condition worse.
- sunburn or raw skin. Anti-acne drugs that are applied to the skin may increase the pain and irritation of these conditions.
In people with certain medical conditions, isotretinoin may increase the amount of triglyceride (a fatty-substance) in the blood. This may lead to heart or blood vessel problems. Before using isotretinoin, people with any of these medical problems should make sure their physicians are aware of their conditions:
- alcoholism or heavy drinking, now or in the past
- diabetes (or family history of diabetes). Isotretinoin may also change blood sugar levels.
- family history of high triglyceride levels in the blood
- severe weight problems
USE OF CERTAIN MEDICINES. Using antiacne drugs with certain other drugs may affect the way the drugs work or may increase the chance of side effects.
Patients using antiacne drugs on their skin should tell their physicians if they are using any other prescription or nonprescription (over-the-counter) medicine that they apply to the skin in the same area.
Isotretinoin may interact with other medicines. When this happens, the effects of one or both drugs may change or the risk of side effects may be greater. Anyone who takes isotretinoin should let the physician know about all other medicines he or she is taking and should ask whether the possible interactions can interfere with drug therapy. Among the drugs that may interact with isotretinoin are:
- etretinate (Tegison), used to treat severe psoriasis. Using this medicine with isotretinoin increases side effects.
- tretinoin (Retin-A, Renova). Using this medicine with isotretinoin increases side effects.
- vitamin A or any medicine containing vitamin A. Using any vitamin A preparations with isotretinoin increases side effects. Do not take vitamin supplements containing vitamin A while taking isotretinoin.
- tetracyclines (used to treat infections). Using these medicines with isotretinoin increases the chance of swelling of the brain. Make sure the physician knows if tetracycline is being used to treat acne or another infection.
Acne—A skin condition in which raised bumps, pimples, and cysts form on the face, neck, shoulders and upper back.
Bacteria—Tiny, one-celled forms of life that cause many diseases and infections.
Bowel—The intestine; a tube-like structure that extends from the stomach to the anus. Some digestive processes are carried out in the bowel before food passes out of the body as waste.
Cyst—An abnormal sac or enclosed cavity in the body, filled with liquid or partially solid material.
Eczema—Inflammation of the skin with itching and a rash. The rash may have blisters that ooze and form crusts.
Pimple—A small, red swelling of the skin.
Psoriasis—A skin disease in which people have itchy, scaly, red patches on the skin.
Pus—Thick, whitish or yellowish fluid that forms in infected tissue.
Triglyceride—A substance formed in the body from fat in the diet.