Theresa Chen and Yohini Appa
Neutrogena Skincare Institute, Los Angeles, California, U. S.A.
Acne vulgaris is an extremely common condition affecting more than 80-90% of adolescents and young adults (1,2). It typically starts in late childhood or early teens, but onset may be delayed in some people well into their 20s and 30s (3). The incidence rate of acne is roughly the same in males and females but, males tend to have more serious conditions (4). Even later in adulthood, roughly 25% of adult men and 50% of adult women can have acne at some time in their adult lives.
Acne can be difficult to cope with no matter what age, and can cause depression and social anxiety in an adult the same way it can in a teen. Kellett and Gawkrodger (5) found that acne patients reported levels of social, psychological, and emotional problems as great as those reported by patients with chronic disabling asthma, epilepsy, diabetes, back pain, or arthritis. This study also reported that the impact on quality of life did not correlate with acne severity. To a teenager, acne can be one of the worse things that ever happened. Acne frequently makes teens feel embarrassed and lowers their self-esteem. A recent survey of British teenagers found that the emotional toll could be significant (6). This survey found:
• About two out of five teenagers with acne claimed to have skipped school because of embarrassment.
• Between 11- to 18-year-olds, over half said acne prevented them from having a boyfriend or a girlfriend.
• One-third indicated acne hurt their ability to make friends.
Proper care and intervention help improve the life quality by alleviating the negative emotional impacts and building up self-esteem. Treatment can also prevent acne from getting worse and deter scarring.
When it comes to treatment, one study conducted in 2000 indicated that 75% of patients waited about one year before seeking professional help for acne (7). Another survey estimates that only a third of acne sufferers consult their physicians at all. Thus, the majority of acne sufferers apparently opt for the over-the-counter (OTC) acne products to treat their acne. This is most likely due to the fact that most acne cases are mild to moderate in severity for which OTC acne products—readily available and not requiring a prescription and an appointment to the doctor’s office—are perfectly suited. And many of today’s new OTC acne products are not only clinically effective and safe but also aesthetically elegant and pleasant to use. Non-prescription products tried most frequently were medicated cleansers, washes, pads, gels, and lotions (8). A 2001 report estimates that consumers of all ages spend approximately $100 million per year on OTC remedies for acne (9). The actual market figure today is probably much higher than that as evidenced by the sheer number of OTC acne products that have since come on the market in the recent years. Given the large variety of acne OTC products, this chapter attempts to provide a comprehensive overview while focusing on the recent OTC advances of the two most-widely used acne OTC medications, salicylic acid (SA) and benzoyl peroxide (BPO).