Hydroxy acids are present in over-the-counter and prescription formulations (Table 5). Alpha – hydroxy acids, such as glycolic acid and lactic acid, are water-soluble, and therefore penetrate to the dermis. Glycolic and lactic acids are derived from sugar cane and sour milk, respectively. Beta-hydroxy acids, such as salicylic acid, are lipid-soluble, and penetrate into the […]

Treatment with retinoids, and acne itself, will cause dysfunction of the skin barrier. Facial cleansers also interact with proteins and lipids on the stratum corneum, and may further disrupt the skin barrier. However, acne patients need to use cleansers to control the level of skin oils and microbial levels. It is important to utilize facial […]

Although effective for different types of acne, topical retinoids commonly cause adverse effects. These are generally mild in severity and usually during the start of therapy. Within the first month of treatment many patients experience a “retinoid dermatitis.” This may consist of erythema, burning, scaling, pruritus, and dryness. These effects tend to decrease with continued […]

Tazarotene, a synthetic retinoid, exerts it action through its metabolite tazarotenic acid that binds RAR-beta and gamma. Studies have shown that tazarotene 0.1% gel is more effective than tretinoin 0.025% gel (40) or tretinoin 0.1% microspheres (41). Tazarotene can be used once daily overnight similarly to tretinoin or it can be applied for a brief […]

Adapalene and tazarotene are topical medications that are formulated to bind the to the RAR without affinity for the RXR. Adapalene is a naphthoic acid derivative that was manufactured to be structurally similar to a naturally occurring hormone, retinoic acid. It works by directly binding to the RAR gamma and beta. A multi-center trial comparing […]

Tretinoin, the original topical retinoid, has been formulated in different vehicles in an attempt to decrease the irritation associated with the original formulations (Table 1). One delivery system involves the use of inert microspheres impregnated with tretinoin to allow for a slower delivery of tretinoin (Retin-A Micro® 0.04%, and 0.1% gel). Another formulation involves the […]

All acne lesions begin as non-inflammatory lesions, either open or closed codemos. Topical retinoids are a mainstay of acne treatment due to their ability to hamper the primary acne lesion, the microcodemo. Additionally, retinoids have fairly potent anti-inflammatory effects. Retinoids are structural and functional analogs of vitamin A that exist in both topical and systemic […]

Clinically, acne can present as non-inflammatory or inflammatory lesions or both. Non­inflammatory acne is marked by the presence of codemos. Codemos are follicular-based papules that may be either open or closed. Open codemos, commonly called blackheads, are papules with prominent dilated follicular ostia. Closed codemos, or whiteheads, are flesh colored papules without an evident follicular […]

As mentioned above, P. acnes also plays an active role in the process of inflammation. P. acnes is a gram-positive, anaerobic, and microaerobic bacterium found in the sebaceous follicle. Adolescents with acne have higher concentrations of P. acnes compared to non­acne controls. However, there is no correlation between the raw number of P. acnes organisms […]