Current acne treatments may not be as effective as touted according to a review published online in the medical journal The Lancet.
No shortage of treatments for acne exists making it difficult for both patients and doctors to determine which combination works best.
However, good quality evidence on the comparative effectiveness of common topical and systemic acne therapies is scarce. This had led to disparate guidelines with few recommendations being evidence-based.
Based on their interpretation of the evidence, study authors developed a treatment protocol for individuals with mild, moderate and severe acne. For mild to moderate acne, they recommended benzoyl peroxide (2-5%), topical retinoids or a combination on the basis of cost and a longer track record of safety and efficacy. In women with moderate acne, they also recommended oral contraceptives. For severe acne, researchers recommended using oral isotretinoin (Accutane).
In the review, study authors examined a wide variety of topical and oral acne products along with other treatment protocols:
Benzoyl peroxide. Works well on mild lesions, and while safe and effective, it can cause irritation. Evidence exists that this compound works well in conjunction with topical antibiotics, but the true efficacy of combination therapy has yet to be studied.
Prescription topical retinoids (Retin-A, Tazorac, Differin). These medications treat abnormal keratinization and inflammation, but with different types of retinoids available in different strengths, assessment is difficult. Retinoids are known to cause local reactions, increased sensitivity to UV light, and should not be used by pregnant women.
Topical antibiotics. This group includes clindamycin, erythromycin, and tetracycline. It is not clear how topical antibiotics work but they seem to act on the bacterial cause of acne and help reduce inflammation. They are also used in combination with other topical treatments for more severe cases of acne.
Salicylic acid. Acts as an exfoliant. No studies support routine use of salicylic acid in preference to other topical therapies.
Oral antibiotics. Most often used for more severe cases of acne, particularly in patients for whom topical treatments have been ineffective and those who are likely to scar. Antibiotics may minimize but do not completely clear acne lesions. Their negative side-effects, as well as growing concern about antibiotic resistance, make them a problematic treatment option.
Oral contraceptives. The birth control pill containing both estrogen and progesterone are prescribed for women with acne; however, any treatment option involving hormones carries with it inherent risks – certain progestins are linked to thromboembolism (blood clots).
Oral isotretinoin (Accutane). Prescribed for severe nodulocystic scarring acne and acne that has not responded to other treatments, and when taken for more than four months, it has an approximately 85% success rate. Unknown whether it would be an effective option for moderate acne. Side-effects include lip inflammation, dry skin, nose bleeds, additional infection, sensitivity to light, as well as initial worsening of lesions. In addition, further study is needed to examine a potential correlation between isotretinoin use and depression. Due to its teratogenic effects (causes birth defects), Accutane is available only under a special program called iPLEDGE.
Alternative treatments. Includes botanicals such as aloe vera, fruit-acids, herbs, and tea-tree oil (among many others) are also popular in the treatment of acne, but their effectiveness both as standalone treatments or as part of combination therapy with other treatment options needs to be further explored.
Light Based Therapies. More technologically advanced treatments such as blue light and photodynamic therapy, infrared lasers, pulsed dye lasers, intense pulsed light, and broad-spectrum light sources. Show short-term improvement but linked to unpleasant side effects such as redness, swelling, and hyperpigmentation. Long-term safety and effectiveness of these treatments has yet to be established.
Clinical trials on the cost effectiveness of different strategies for initial treatment and maintenance therapy are needed. For this reason, the Institute of Medicine has selected the issue of acne treatment as a “Top 100” research topic. More research will guide both the medical community and patients to better treatment options.
The Bottom Line
Like the weight loss market, the acne market is ripe for unscrupulous marketers. Just last week, the FDA announced a settlement with DermaApps and Acne Pwner, companies charged with marketing phone apps with unsubstantiated acne-fighting properties. Both promised to treat facial acne by controlling colored lights from smart phone display screens.
Due to the complex nature of the disease and wide variety of options available, acne treatment needs to be individualized to the patient. Medical professionals including doctors and professional skin care specialists are in the best position to evaluate your skin and determine the best treatment protocol.
Part of that treatment protocol should address diet and lifestyle. A number of studies conducted by researchers like Loren Cordain, PhD have shown the diet plays a role in acne. Other studies have found a positive association between dairy intake and acne. Finally, a more recent study indicated that supplementation with probiotics benefits patients with acne.
If you’re looking for ideas on how to improve your skin, review our Clear Skin Guidelines. We have recommended these dietary and lifestyle changes to our patients at our sister company The Wellness Center and have seem improvement in the skin.
Keep in mind that we also offer several products specifically geared for acne – Healthy Skin Formula and Clear Skin Formula. Both of these products have been our top sellers for over a decade. In fact, Tracy Anderson, the fitness guru, loves Clear Skin Formula so much she specifically mentions our product in her blog!
Although the study authors recommend the use of antibiotics, their overuse has led to resistance. Long-term antibiotic use is not practical based on their negative side-effects. Probiotics, like our new Probiotic-8, help to repopulate the GI tract with the beneficial bacteria which are killed when an antibiotic is taken. Probiotic supplementation helps to normalize the digestive tract and enhance immunity. Perhaps more importantly, probiotics have been shown to help patients with acne clear their skin.
David H. Rahm, M.D. is the founder and medical director of The Wellness Center, a medical clinic located in Long Beach, CA. Dr. Rahm is also president and medical director of VitaMedica. Dr. Rahm is one of a select group of conventional medical doctors who have education and expertise in functional medicine and nutritional science. Over the past 20 years, Dr. Rahm has published articles in the plastic surgery literature and educated physicians about the importance of good peri-operative nutrition.
