Light-based, adjunctive, and other therapies for acne vulgaris
- Jeffrey S Dover, MD, FRCPC
Jeffrey S Dover, MD, FRCPC
- Section Editor — Cosmetic Dermatology
- Associate Clinical Professor of Dermatology
- Yale University School of Medicine
- Priya Batra, MD
Priya Batra, MD
- Attending physician
- Mt. Sinai Hospital
- Section Editors
- Robert P Dellavalle, MD, PhD, MSPH
Robert P Dellavalle, MD, PhD, MSPH
- Section Editor — Dermatology
- Professor of Dermatology
- Denver VA Medical Center, University of Colorado School of Medicine and Colorado School of Public Health
- Moise L Levy, MD
Moise L Levy, MD
- Section Editor — Pediatric Dermatology
- Clinical Professor of Dermatology and Pediatrics
- Baylor College of Medicine
- Professor of Pediatrics and Medicine
- Dell Medical School/University of Texas, Austin
- Mark V Dahl, MD
Mark V Dahl, MD
- Section Editor — Acne and Rosacea
- Professor Emeritus
- Mayo Clinic College of Medicine
Acne vulgaris is a common condition, and there is significant demand for effective acne therapies. Many over-the-counter products are marketed. In addition, a number of procedural therapies are utilized for the treatment of acne vulgaris with variable effectiveness.
The use of over-the-counter and light-based therapies as well as several adjunctive therapies (office-based chemical peels, microdermabrasion, comedo extraction, intralesional glucocorticoids, and heat therapy) will be reviewed here. Conventional therapies, hormonal therapy, and isotretinoin therapy for acne vulgaris are discussed separately. (See "Treatment of acne vulgaris" and "Hormonal therapy for women with acne vulgaris" and "Oral isotretinoin therapy for acne vulgaris".)
OTHER TOPICAL MEDICATIONS
For many people with acne, treatment begins with non-prescription regimens. Numerous products are available, and non-prescription treatments are effective for some individuals. Some of the most common ingredients found in non-prescription acne products include salicylic acid, benzoyl peroxide, sulfur, and alpha hydroxy acids. Tea tree oil has also been used for treatment of acne. In July 2016, the US Food and Drug Administration (FDA) approved adapalene 0.1% gel for over-the-counter use, making it the first topical retinoid approved for distribution directly to consumers. (See "Treatment of acne vulgaris", section on 'Topical retinoids'.)
Patients with mild to moderate acne who do not respond to non-prescription products after three months of treatment should be clinically evaluated. Patients with more severe acne should be evaluated earlier, to consider the use of the most effective treatment regimens to prevent or minimize scarring.
Topical non-prescription acne therapies are generally well tolerated. However, rare but serious and potentially life-threatening hypersensitivity reactions to non-prescription topical acne products containing salicylic acid or benzoyl peroxide have been reported . Whether these active ingredients or inactive ingredients are responsible for the reactions is unclear. Symptoms may occur within minutes to one day or longer after product use and may include severe skin reactions, throat tightness, difficulty breathing, feeling faint, or swelling of the eyes, face, lips, or tongue. The US FDA recommends limiting application of these products to one or two small affected areas during the initial three days of use to test for hypersensitivity .
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- OTHER TOPICAL MEDICATIONS
- Salicylic acid
- Benzoyl peroxide
- Alpha hydroxy acids
- Tea tree oil
- LIGHT/LASER THERAPIES
- Mechanism of action
- Evidence for efficacy
- Emerging therapy
- ADJUNCTIVE THERAPIES
- Office-based superficial chemical peels
- Comedo extraction
- Intralesional glucocorticoids
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS