Topical Retinoids

Cream Based Accutane (TM) like Acne Medicines and Treatments

Cream based retinoids and vitamin A derivatives, also termed topical retinoids remain a first line of treatment for most forms of acne, with systemic retinoid therapy, Isotretinoin (Accutane TM), saved for severe acne, such as cystic and nodular forms. Isotretinoin (Accutane TM) is the most effective treatment with long-lasting effects; however, its use is limited by its many side effects, which include birth defects in newborns, elevated lipids in the blood and hair loss which can easily be reversed. Most treatment courses with Accutane TM are only 3 months in length, which limits these side-effects to being rarely seen. For some individuals, they may need to be on these drugs for a longer term, as their acne is resistant to treatment. This is rare, but when present, these individuals need therapy continuously, usually in the form of a cream. For best results, early initiation of treatment is essential. If inflammatory lesions are present, such as pustules which mean there is a large bacterial component that is causing the acne, combination with antimicrobial therapy provides the best results (1). Antimicrobial therapy can include oral and topical antibiotics, such as tetracycline and clindamycin, and benzoyl peroxide, a strong bactericidal with anticomedogenic activity.

Vitamin A derivatives in current use: tretninoin, isotretinoin, adapalene, tazarotene, and retinaldehyde.

References:

1. Gollnick H, Cunliffe WJ, Berson D, et al. (2003) Management of acne: a report from a Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol 49:Suppl:S1-S37.