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There is no universally-accepted grading system for acne but in primary care, acne is considered to be mild, moderate or severe.
It is vital to examine the skin to determine the type and extent of the lesions present.
The treatment for the different levels of acne severity are summarised in Table 1.
Mainly, acne is limited to the face with a smaller subset of patients having lesions on the chest and back. Nevertheless, if acne affects the chest and back, unless it is mild, a referral to the GP is advisable since treating these areas with topical agents becomes more difficult.
Topical agents should be applied to all acne-prone areas of the skin rather the individual lesions, as most drugs target emerging rather than existing lesions.
The most effective pharmacy product for acne benzoyl peroxide (BP) and its clinical efficacy has been demonstrated in many studies.8
Benzoyl peroxide has both comedolytic (breaking down blackheads and whiteheads) and bactericidal actions. In fact, twice daily application of 5% BP gel can reduce the population of C acnes by more than 95% after five days – a feat that no antibiotic can match.9
There is currently no known resistance to BP, and this is due to its mode of action. Once in the skin, BP degrades to benzoic acid and hydrogen peroxide, generating free radicals that destroy C acnes.
The most common problems with BP are a powerful bleaching effect that will discolour material, such as clothes, pillows and bedding, and skin irritation.
One way to reduce the irritancy is to initially apply BP products for limited periods of time (say 15 minutes) before washing them off and to gradually increase the contact time.
Other treatments available through pharmacies include nicotinamide gel and salicylic acid. Nicotinamide has an anti-inflammatory action, though there is a lack of evidence for its effectiveness. Salicylic acid has mild comedolytic affects and could be used for patients with very mild acne.
Acne products are available in gels and creams and there is little evidence that any particular vehicle is more effective. While some authorities argue that patients with greasy skin benefit from using a gel (due to the drying effect) and a cream for those with dry skin, there is little evidence to support this. It is more important that the patient finds a topical formulation which they are happy to use.
Author: Rod Tucker