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Acne Treatments

Adapalene (Differin ®) Azelaic acid (Azelex ®)
BenzaClin ® Benzamycin ®
Benzoyl Peroxide Clindamycin (Cleocin ®)
Duac ® Erythromycin (Topical)
Glycolic Acid - (BioMedic ® Cellex-C ® Glytone ® ) Isotretinoin (Accutane ®)
Sulfacetamide with sulfur (Sulfacet-R ®) Tazarotene (Tazorac ®)
Tretinoin (Retin-A ®)  
Please see package insert for additional information and possible updates. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.    [  Read the disclaimer    |   <<Back     ]

adapalene  (Differin ®) top of page

 Topical retinoid-like compound. Acne vulgaris (adult): after washing, apply a thin film topically to affected area(s) once daily at bedtime.
[Supplied 0.1% cream/solution/gel]

azelaic acid  (Azelex ®) top of page

 Adult (usual) Mild-to-moderate inflammatory acne: apply a thin film topically to affected area twice daily. Indications: topical treatment of vulgaris. Azelaic acid is a naturally-occurring, saturated, straight-chained dicarboxylic acid.
[Supplied 20% cream]

BenzaClin ®  top of page

Topical Gel. Apply twice daily, morning and evening, or as directed by a physician, to affected areas after the skin is gently washed, rinsed with warm water and patted dry.
[Supplied: Each gram of BenzaClin Topical Gel contains, 10 mg (1%) clindamycin as phosphate and 50 mg (5%) benzoyl peroxide]

Benzamycin ®  top of page

Topical Gel. Apply twice daily, morning and evening, or as directed by a physician to affected areas after the skin is thoroughly washed, rinsed with warm water and gently patted dry.
[Supplied: Topical gel - erythromycin 3%-benzoyl peroxide 5% ]

Benzoyl Peroxide  top of page

Children and Adults:
Cleansers: Wash once or twice daily; control amount of drying or peeling by modifying dose frequency or concentration

Topical: Apply sparingly once daily; gradually increase to 2-3 times/day if needed. If excessive dryness or peeling occurs, reduce dose frequency or concentration; if excessive stinging or burning occurs, remove with mild soap and water; resume use the next day. [2.5% - 10 %]

Mechanism of Action
Releases free-radical oxygen which oxidizes bacterial proteins in the sebaceous follicles decreasing the number of anaerobic bacteria and decreasing irritating-type free fatty acids
Benzoyl peroxide is an antibacterial, mildly comedolytic, and sebostatic agent.

[Supplied: several dosage forms - gels, creams, suspensions, ...] [2.5% - 10 %]

clindamycin (Cleocin ®) top of page

Children >/= 12 years and Adults: Topical:
Acne vulgaris: apply thin film of solution, lotion, or gel topically twice daily to affected areas.
     Note: Foam (Evoclin™): Apply once daily 

Adverse Reactions - Topical:
>10%: Dermatologic: Dryness, burning, itching, scaliness, erythema, or peeling of skin (lotion, solution); oiliness (gel, lotion).
1% to 10%: Central nervous system: Headache.
<1% (Limited to important or life-threatening): Pseudomembranous colitis, nausea, vomiting, diarrhea (severe), abdominal pain, folliculitis, hypersensitivity reactions

[Supplied: 1% gel/lotion/solution]

Duac ® top of page

 Topical Gel. Apply once daily in the evening or as directed by the physician, to affected areas after the skin is gently washed, rinsed with warm water and patted dry.

[Supplied: 1% clindamycin, and 5% benzoyl peroxide topical gel]

Erythromycin  top of page

ERYGEL® 2% Topical Gel should be applied sparingly as a thin film to affected area(s) once or twice a day after the skin is thoroughly cleansed and patted dry. If there has been no improvement after 6 to 8 weeks, or if the condition becomes worse, treatment should be discontinued, and the physician should be reconsulted. Spread the medication lightly rather than rubbing it in. There are no data directly comparing the safety and efficacy of b.i.d. versus q.d. dosing.
ERYGEL® 2% topical solution: wash skin with soap and warm water and pat dry. Apply to affected area bid with a dabbing motion.

Glycolic Acid  -  (BioMedic ® Cellex-C ® Glytone ® ) top of page

Glycolic Acids have been reported to improve acne, pseudofoliculites, barbae, ichthyosis/xerosis, as well as premature aging of the skin.

Seattle Dermatologist: "Glycolic Acid has been proven to be very effective in the treatment of acne as well as the cosmetic benefits one receives. I feel that the use of glycolic acid, especially for the treatment of acne, is the most exciting development in the field of facial skin care over the past decade. It is my prediction that glycolic acid will soon become the standard treatment approach for acne."

Isotretinoin (Accutane ®)  top of page

Adult (usual) : Severe recalcitrant nodular acne: 0.5-2 mg/kg/day in 2 divided doses (dosages as low as 0.05 mg/kg/day have been reported to be beneficial) for 15-20 weeks or until the total cyst count decreases by 70%, whichever is sooner. A second course of therapy may be initiated after a period of >/= 2 months off therapy.

Dosing adjustment in hepatic impairment: Dose reductions empirically are recommended in hepatitis disease

Administration
Administer with food. Capsules can be swallowed, or chewed and swallowed. The capsule may be opened with a large needle and the contents placed on applesauce or ice cream for patients unable to swallow the capsule. Whole capsules should be swallowed with a full glass of liquid.

Monitoring Parameters
CBC with differential and platelet count, baseline sedimentation rate, glucose, CPK
Pregnancy test (for all female patients of childbearing potential): Two negative tests with a sensitivity of at least 25 mIU/mL prior to beginning therapy (the second performed during the first five days of the menstrual period immediately preceding the start of therapy); monthly tests to rule out pregnancy prior to refilling prescription.

Lipids: Prior to treatment and at weekly or biweekly intervals until response to treatment is established. Test should not be performed <36 hours after consumption of ethanol.

Liver function tests: Prior to treatment and at weekly or biweekly intervals until response to treatment is established.


[Supplied 10 mg, 20 mg, 40 mg capsule]

Sulfacetamide with sulfur  (Sulfacet-R ®)  top of page

Indications: topical control of acne is, acne rosacea and seborrheic dermatitis. Clean the affected area and apply a thin layer of medication to the skin 1 to 3 times daily; or use as directed by your doctor. (Shake Well before using.)
Expiration date after reconstituting: four months. [Supplied: sodium sulfacetamide 10% and sulfur 5% topical lotion]

Tazarotene  (Tazorac ®)  top of page

CLINICAL PHARMACOLOGY:
Tazarotene is a retinoid prodrug which is converted to its active form, the cognate carboxylic acid of tazarotene (AGN 190299), by rapid deesterification in animals and man. AGN 190299 (“tazarotenic acid”) binds to all three members of the retinoic acid receptor (RAR) family: RARalpha, RARbeta, and RARgamma but shows relative selectivity for RARbeta, and RARgamma and may modify gene expression. The clinical significance of these findings is unknown.


Psoriasis: The mechanism of tazarotene action in psoriasis is not defined. Topical tazarotene blocks induction of mouse epidermal ornithine decarboxylase (ODC) activity, which is associated with cell proliferation and hyperplasia. In cell culture and in vitro models of skin, tazarotene suppresses expression of MRP8, a marker of inflammation present in the epidermis of psoriasis patients at high levels. In human keratinocyte cultures, it inhibits cornified envelope formation, whose build-up is an element of the psoriatic scale. Tazarotene also induces the expression of a gene which may be a growth suppressor in human keratinocytes and which may inhibit epidermal hyperproliferation in treated plaques. However, the clinical significance of these findings is unknown.


Acne: The mechanism of tazarotene action in acne vulgaris is not defined. However, the basis of tazarotene's therapeutic effect in acne may be due to its anti-hyperproliferative, normalizing-of-differentiation and anti-inflammatory effects. Tazarotene inhibited corneocyte accumulation in rhino mouse skin and cross-linked envelope formation in cultured human keratinocytes. The clinical significance of these findings is unknown.

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Topical: Note: In patients experiencing excessive pruritus, burning, skin redness, or peeling, discontinue until integrity of the skin is restored, or reduce dosing to an interval the patient is able to tolerate.
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Children >/= 12 years and Adults:
Acne: Tazorac® cream/gel 0.1%: Cleanse the face gently. After the skin is dry, apply a thin film of tazarotene (2 mg/cm 2 ) once daily, in the evening, to the skin where the acne lesions appear; use enough to cover the entire affected area

Psoriasis: Tazorac® gel 0.05% or 0.1%: Apply once daily, in the evening, to psoriatic lesions using enough (2 mg/cm 2 ) to cover only the lesion with a thin film to no more than 20% of body surface area. If a bath or shower is taken prior to application, dry the skin before applying. Unaffected skin may be more susceptible to irritation, avoid application to these areas.
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Children >/= 17 years and Adults:
Palliation of fine facial wrinkles, facial mottled hyper/hypopigmentation, benign facial lentigines: Avage™: Apply a pea-sized amount once daily to clean dry face at bedtime; lightly cover entire face including eyelids if desired. Emollients or moisturizers may be applied before or after; if applied before tazarotene, ensure cream or lotion has absorbed into the skin and has dried completely.
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Adults:
Psoriasis: Tazorac® cream 0.05% or 0.1%: Apply once daily, in the evening, to psoriatic lesions using enough (2 mg/cm 2 ) to cover only the lesion with a thin film to no more than 20% of body surface area. If a bath or shower is taken prior to application, dry the skin before applying. Unaffected skin may be more susceptible to irritation, avoid application to these areas.
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[Supplied 0.05%, 0.1% cream. 0.05%, 0.1% gel]

Tretinoin  (Retin-A ®)  top of page

Topical:   Children >12 years and Adults:
Acne vulgaris: Begin therapy with a weaker formulation of tretinoin (0.025% cream, 0.04% microsphere gel, or 0.01% gel) and increase the concentration as tolerated; apply once daily to acne lesions before retiring or on alternate days; if stinging or irritation develop, decrease frequency of application
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Adults >/= 18:  
Palliation of fine wrinkles, mottled hyperpigmentation, and tactile roughness of facial skin
: Pea-sized amount of the 0.02% or 0.05% cream applied to entire face once daily in the evening
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Elderly: Use of the 0.02% cream in patients 65-71 years of age showed similar improvement in fine wrinkles as seen in patients <65 years. Safety and efficacy of the 0.02% cream have not been established in patients >71 years of age. Safety and efficacy of the 0.05% cream have not been established in patients >50 years of age.

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Administration
Palliation of fine wrinkles, mottled hyperpigmentation, and tactile roughness of facial skin: Cream: Prior to application, gently wash face with a mild soap. Pat dry. Wait 20-30 minutes to apply cream. Avoid eyes, ears, nostrils, and mouth.
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Retin-A Micro (tretinoin gel) microsphere, 0.1% and 0.04% - this formulation uses patented methyl methacrylate/glycol dimethacrylate crosspolymer porous microspheres (Microsponge® System) to enable inclusion of the active ingredient, tretinoin, in an aqueous gel.
Retin-A Micro should be applied once a day, in the evening, to the skin where acne lesions appear, using enough to cover the entire affected area lightly. Application of excessive amounts of gel may result in "caking" of the gel, and will not provide incremental efficacy.

Supplied: cream/gel/liquid - various concentrations.



 

Reference(s)

National Institutes of Health, U.S. National Library of Medicine, DailyMed Database.
Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Please review the latest applicable package insert for additional information and possible updates.  A local search option of this data can be found here.

Disclaimer

Listed dosages are for - Adult patients ONLY. PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER. GlobalRPH does not directly or indirectly practice medicine or provide medical services and therefore assumes no liability whatsoever of any kind for the information and data accessed through the Service or for any diagnosis or treatment made in reliance thereon.

David F. McAuley, Pharm.D., R.Ph.  GlobalRPh Inc.
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