Many of the OTC products are topical and only address the overt clinical manifestation of Acne (pimples). With the exception of Accutane, which helps to decrease sebaceous gland secretions systemically administered Acne treatment drugs are restricted to broad-spectrum antibiotics, which non-specifically kill bacteria associated with Acne.
Benzoyl peroxide is the single most effective topical treatment of Acne and is available over-the-counter in preparations of 2.5% to 10% strengths (Clearasil Maximum Strength Cream, Clean and Clear, Oxy-10 Balance Maximum Medicated Face Wash, etc.). Available in lotion, gel, and cleanser forms, it should be used daily in order to be effective. Benzoyl peroxide targets bacteria in the skin. Salicylic acid products, are also available over-the-counter (such as Aveeno medicated cleanser, Neutrogena Clear Pore, Noxzema 2-in-1 Maximum Strength Pads, and Stri-Dex Clear Gel).
Systemic antibiotics such as tetracycline, minocycline, are mainstays of Acne therapy. For non-inflammatory Acne, two recent medicines for skin application are available, an anti-microbial cream Azelex, azelaic acid, which requires 4 weeks of treatment. Differin Cream, adapalene, is a retinoid-based topical medication with a recommended treatment phase of 8 to 12 weeks. Exacerbation of the existing skin condition is frequently observed with Differin prior to improvement.
For severe, persistent cases of Acne, Retin-A (tretinoin) Cream ($56.72 per tube) or Accutane (isotretinoin) oral tablets ($382.33 per month) are often recommended. Both products are retinoid derivatives and have a multitude of side effects. Accutane is a known potent teratogen and strictly contraindicated in women not practicing a proven method of birth control. Topical antibiotics such as Cleocin T (clindamycin solution) or erythromycin are often combined with benzoyl peroxide.
The treatment of Acne can be divided into two separate strategies. The first is the use of antibiotics, products that kill the microbes associated with Acne. These products are either administered either topically or orally. The oral antibiotics in particular are not specific for Acne and have systemic effects and side effects. The indiscriminate use of antibiotics is being strongly discouraged in the medical field due to the increasing appearance of bacterial resistance. The second strategy includes the use of topical cleansing or drying agents, and the retinoids. Only the retinoids are thought to directly effect the over-secretion of the sebaceous glands, which are considered the primary cause of Acne. Systemic use of retinoids (Accutane) is often considered the "last option" for the treatment of Acne due to its numerous side effects and in particular its teratogenic potential.