Acne is a chronic skin disorder characterized by blackheads, whiteheads, papules, pustules, cysts, or nodules. It is the most common skin disease in the United States. The lesions of acne may or may not be accompanied by inflammation. The main cause of this disorder is the obstruction of pilo-sebaceous follicles, which produce skin oil called sebum. Acne is a common problem among teenagers, but the disease can also affect adults. Acne can occur on the face, but also on the torso and back.

Here are ten topical treatments for acne

1.Tretinoin

Tretinoin was the first topical retinoid, which is a derivative of vitamin A. Retinoids are effective in preventing the formation of closed and open comedones. In other words, they are comedolytics. Tretinoin is effective as a single treatment in individuals with non-inflammatory acne (closed or open comedones). It can also be used in combination with antibiotics in the treatment of mild to moderate inflammatory acne.

Tretinoin is available as prescription in the form of cream (0.025, 0.05 and 0.1%), gel (0.01 and 0.025%), liquid (0.05%) or microsphere gel (0.01 %). The cream is the least powerful, while the liquid is the most powerful. Regardless of the form, the treatments for acne are applied once a day. The most common side effect of tretinoin is irritation of the skin (the cream is the least irritating, the liquid is the most irritating), which can be minimized starting with low concentrations to increase as needed. The irritation of the skin due to the medication can be aggravated by too much sunlight.

2.Adapalene

Adapalene (Differin) is a topical retinoid. The US Food and Drug Administration (FDA) approved the use of this drug in the treatment of acne in 1997. It can be used in first-line treatment of non-inflammatory acne, Consisting mainly of blackheads and/or whiteheads. Differin can also be used in combination with antibiotics to treat inflammatory acne, which mainly consists of papules, pustules, cysts, and/or nodules.

Adapalene is available as prescription in the form of cream (0.1%), lotion (0.1%) or gel (0.1 and 0.3%). Alternatively, it is available as a combination of adapalene/benzoyl peroxide (Epiduo) in the gel (0.1 or 2.5%). All forms are to be applied once a day. The most common side effect is irritation of the skin, But adapalene is less irritating than tretinoin and is the best tolerated topical retinoid. The maximum effect of the drug can be seen after 8 to 12 weeks of use and the acne may paradoxically worsen during the first weeks of treatment.

3.Tazarotene

Tazarotene (Tazorac) is a topical retinoid. The FDA approved the use of this medication in the treatment of acne in 1997. Tazarotene can be used alone in the treatment of non-inflammatory acne (blackheads, whiteheads) or in combination with antibiotics in the Treatments for acne (papules, pustules, cysts, and nodules). It is also indicated in the treatment of psoriasis, another common skin disease.

Tazarotene is available as a prescription in the form of cream, gel or 0.01% foam. It is applied once a day. The most common side effect is irritation of the skin. In clinical trials, individuals using the foam had less systemic exposure than those using the gel. Less systemic exposure reduces the risk of drug toxicity or side effects. Some limited evidence from clinical trials suggests that tazarotene may be more effective than tretinoin or adapalene in treating acne.

4.Clindamycin

Clindamycin is one of the most used topical antibiotics studied for the treatment of acne. It is the most effective treatment of mild to moderate inflammatory acne, characterized by papules, pustules, nodules, and/or cysts. Clindamycin kills the bacterium Propionibacterium acnes, responsible for the inflammation associated with acne. It can be used alone but is more effective in treating acne if used in combination with topical retinoids or derived from vitamin A.

Clindamycin is available as a prescription in the form of foam, gel, lotion, or 1% solution to treat acne. The foam, lotion, and solution are applied twice a day, while the gel is applied only once. It is often used in combination with benzoyl peroxide to reduce the possibility of bacterial resistance. The most common side effect of topical clindamycin is skin irritation. Clinical trials have shown that it is the topical antibiotic tetracycline most effective in treating acne.

5.Erythromycin

Erythromycin is an antibiotic used and studied frequently in treatments to treat acne. It effectively treats mild to moderate inflammatory acne. Erythromycin fights inflammation of acne by eradicating the bacterium Propionibacterium acnes. The bacteria is a factor in the development of acne. Erythromycin can be used as first-line therapy for inflammatory acne, but it is more effective in combination with topical retinoids derived from vitamin A.

Erythromycin is available as a gel, solution and 2% ointment to be applied twice daily for the treatment of acne. The most common side effect is skin irritation. It is also available as an erythromycin/benzoyl peroxide gel (Benzamycin 3% or 5%), which is very effective. In studies, the Benzamycin gel applied once or twice a day had an effect superior to the components alone and to clindamycin alone.

6. Sulfacetamide

Sulfacetamide is a topical antibiotic used to treat acne. It comes from the family of antibiotics sulfa. Sulfacetamide is effective in the treatment of mild to moderate acne. It works by killing the bacteria Propionibacterium acnes associated with inflammatory lesions of acne. Sulfacetamide is often combined with sulfur to treat inflammatory acne. Sulfur is used to treat skin disorders since the time of the Greeks of Antiquity.

Sulfacetamide is available under prescription as a 10% lotion or suspension to treat acne. It is applied twice daily. The most common side effect is skin irritation. Individuals allergic to sulfa should not take this medication. A clinical trial of sulfacetamide and sulfur lotion combination resulted in an 83% reduction in inflammatory acne lesions after 12 weeks of therapy. The use of sulfacetamide in the treatment of acne has decreased over the years and has been replaced by other topical antibiotics such as clindamycin and erythromycin.

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7. Azelaic Acid

Azelaic acid (Azelex) is a topical agent used in the treatment of acne. The FDA approved the use of this drug to treat mild to moderate inflammatory acne in 1996. It kills the P. acnes bacterium that infects the pores and causes acne. It is also used to break down keratin (keratolytic agent), a skin protein that clogs pores. In clinical trials, azelaic acid has been shown to be as effective as tretinoin or benzoyl peroxide in the treatment of mild to moderate inflammatory acne.

Azelaic acid is available under prescription in the form of 20% cream for the treatment of acne. It is applied twice daily. The most common side effect is skin irritation. Azelaic acid should be used with caution in individuals with a darker complexion as it may result in reduced pigmentation (hypopigmentation). The improvement of the acne is not immediate and it may be necessary to wait 4 weeks before to see the effects of the azelaic acid.

8. Benzoyl peroxide

Benzoyl peroxide is a topical agent that has been used in the treatment of acne since the 1950s. It kills the P. acnes bacteria that cause acne and prevents the formation of blackheads and whiteheads (comedolytic agent ). Benzoyl peroxide is effective in the treatment of mild to moderate inflammatory and non-inflammatory acne, especially in combination with topical retinoids. It can also be used in combination with topical antibiotics to reduce the risk of bacterial resistance.

Benzoyl peroxide is available in a wide range of forms (liquid or cleansing bar, lotion, cream, or gel) and concentrations (2.5 to 10%). It is applied once or twice a day. No form or concentration is proven more effective than another. Skin irritation is the most common side effect of benzoyl peroxide. It is an oxidizing agent that can potentially bleach hair, clothing, and bed linens. The drug can take up to 6 weeks to take effect.

9.Salicylic acid

Salicylic acid is a topical agent indicated in the treatment of acne. It is a form of beta-hydroxy acid that slightly peels the skin and helps to unclog the pores. Those types of acid fight acne with inhibiting the pattern of blackheads furthermore whiteheads. Treatment is effective for mild non-inflammatory acne. Salicylic acid is less potent than topical retinoids.

Salicylic acid is an ingredient present in multiple non-prescription anti-acne preparations (cream, lotion, foam, gel, ointment, and solution) in various concentrations (0.5 to 3%). It is applied once or twice a day. Skin irritation is the most common side effect of salicylic acid. It can also increase the sensitivity of the skin to the sun. In clinical trials, salicylic acid has shown similar efficacy to benzoyl peroxide in the treatment of acne with comedones.

10. Dapsone

Dapsone is an antibiotic that has been used since the 1940s for the oral treatment of acne. Its use gradually ceased after the development of oral tretinoin. The FDA approved the dapsone gel (Aczone) for the treatment of acne in 2005. It kills P. acnes bacteria and fights inflammation. Dapsone is effective in the treatment of mild to moderate inflammatory and non-inflammatory acne, although it seems more effective in treating inflammatory acne.

Dapsone is available under prescription in the form of a 5% gel for topical treatment of acne. It is applied twice daily. The most common side effect is skin irritation. Applying the dapsone gel followed by benzoyl peroxide may cause temporary yellow-orange discoloration of the skin. In clinical trials, dapsone gel has been shown to be more effective in reducing inflammatory lesions (papules, pustules, cysts, and nodules) than no inflammatory lesions (blackheads and whiteheads), with up to 50% reduction after 12 weeks of use.