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.
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 Food and Drug Administration recommends limiting application of these products to one or two small affected areas during the initial three days of use to test for hypersensitivity .