Topical Treatments

Benzoyl Peroxide

How does it work?

Benzoyl peroxide works by:

  • killing the bacteria that are associated with the development of acne
  • reducing surface oil production and helping to prevent dead skin plugging up hair follicles

How is it used?

Benzoyl peroxide is available as a cream, gel or wash. It should be applied to all parts of your face affected by acne.  Either once or twice a day (following instructions on the pack). It should be used sparingly as too much can lead to redness peeling and irritation.

Most people need a six-week course of treatment to clear most or all of their acne. You may be advised to continue using the treatment, but less frequently, to prevent acne returning.

What are the side-effects?

Common side effects of benzoyl peroxide include:

  • dry and tense skin
  • a burning, itching, or stinging sensation
  • some redness and peeling of the skin.

Side-effects are usually mild and should pass once you have finished treatment and can be improved by using an oil free moisturiser alongside the BPO and/or cutting down the frequency and duration of application. Contact your GP if the side-effects become troublesome, as your dose may need to be adjusted.

Benzoyl peroxide makes your face more sensitive to sunlight, so you should avoid excessive exposure to sunlight and ultraviolet (UV) light, or wear a sun blocker, while you are using it.

Avoid contact with hair, clothes, towels and bed linen, as benzoyl peroxide can bleach these materials. Wash your hands after you finish applying the medication.

BPO can be used safely in pregnancy.

Topical Retinoids

How do they work?

Topical retinoids are vitamin A derivatives that work by preventing dead skin cells plugging hair follicles and reducing inflammation.  Examples of topical retinoids used to treat acne include: adapalene, tretinoin and isotretinoin.

How are they used?

Topical retinoids are available in gels or creams, which are usually applied once a day before going to bed, to all parts of your face affected by acne.  A six-week course is usually required, but you may be advised to continue medication after this, but on a less frequent basis.  It is important to apply topical retinoids sparingly, and avoid excessive exposure to sunlight and UV.

What are the side-effects?

Topical retinoids should not be used during pregnancy as they carry a theoretical risk of causing birth defects. The most common side effects of topical retinoids are mild irritation and stinging of the skin

Topical Antibiotics

How do they work?

Topical antibiotics reduce the bacteria on the skin that cause acne and reduce inflammation.

How are they used?

Topical antibiotics are available as lotions or gels, and should be applied to the affected skin once or twice a day. A six to eight-week course is generally recommended alongside a treatment that will prevent the bacteria on your skin becoming resistant to the antibiotics. This could make your symptoms worse and cause additional infections.

What are the side-effects?

Side effects are uncommon but can include:

  • minor irritation of the skin
  • redness and burning of the skin
  • peeling of the skin.

Azelaic Acid

Who is it for?

Azelaic acid can be used as an alternative treatment for acne if the side-effects of benzoyl peroxide or topical retinoids are particularly irritating or painful.

How does it work?

Azelaic acid works by getting rid of dead skin cells and killing bacteria.

How is it used?

It is available in creams or gel, and is usually applied twice a day (or once a day if your skin is particularly sensitive).  You will usually need to use azelaic acid for 6 weeks before you notice a significant improvement in your acne symptoms.  Azelaic acid does not make the skin sensitive to sunlight, so you do not have to avoid sun exposure if you are using it.

What are the side-effects?

The side effects of azelaic acid are usually mild and include:

  • burning or stinging skin
  • itchiness
  • dry skin
  • redness of the skin.

Salicylic Acid

How does it work?

Salicylic acid helps to break down blackheads and whiteheads. It also reduces the shedding of the cells lining hair follicles.

How is it used?

Salicylic acid is available in many over-the-counter acne products, including lotions, creams and pads. It should be used regularly, according to the instructions on the pack.

What are the side-effects?

Salicylic acid can cause skin irritation, burning or redness.

Sulphur

How does it work?

Sulphur has been used in topical treatments for acne for more than 50 years, in combination with other agents such as alcohol or salicylic acid. It is not known precisely how it works, but it seems to help break down blackheads and whiteheads.

What are the side-effects?

As with other topical acne treatments, products containing sulphur can cause skin irritation, burning or redness. Sulphur products are not now very popular due to malodour.

Nicotinamide

Who is it for?

Nicotinamide is a topical treatment for mild to moderate acne, which is inflamed ie where the spots are red.

How does it work?

Nicotinamide is related to Vitamin B3 and reduces the inflammation (redness), which is helpful in the treatment of acne.

How is it used?

After cleaning and drying the skin, apply a thin film of nicotinamide gel, enough to cover the affected area, twice daily.

What are the side-effects?

If excessive dryness, irritation or peeling occurs, reduce the dosage to one application per day or every other day.  Other less frequent side-effects include itching, redness, burning sensation or irritation.  Nicotinamide does not make the skin sensitive to sunlight and will not bleach clothing.

Combination Treatments

Combination topical treatments available on Prescription from your Doctor may include:-

  • Adapalene plus benzoyl peroxide: This is a combination of a topical retinoid and an anti-microbial with no antibiotic.  This combination treats both inflamed acne spots as well as non inflamed blackheads and whiteheads. Benzoyl peroxide is particularly effective at reducing the bacteria called propionibacterium acnes that are involved in acne.
  • Clindamycin and benzoyl peroxide: This is a combination of a topical anti-biotic and an anti-microbial. This product is very effective at reducing acne bacteria and inflamed acne spots but also has some effect on blackheads and whiteheads. The benzoyl peroxide helps to avoid acne bacteria getting resistant to the antibiotic.
  • Erythromycin and zinc acetate: Is a combination of a topical antibiotic with  zinc. This product is very effective in reducing inflamed spots