• See Also
  1. Keratolytic
  2. Acne Vulgaris Pharmacologic Management
  • Indication
  1. Acne Vulgaris
  • Approach
  1. Comedolytics result in similar effect after 90 days
  2. Start with less irritating agents (see below)
  3. Apply skin products in layers
    1. First, apply Comedolytic
    2. Next, apply Skin Lubricant (skin Moisturizer)
    3. Last, apply sun screen
    4. (2017) Presc Lett 24(1): 3
  • Preparations
  • Standard Comedolytics
  1. Benzoyl Peroxide (Ambi 10, Dermoxyl, Vanoxide and other OTC)
  2. Salicylic acid (Buf-Puf and other OTC)
  3. Tretinoin (Retin-A)
  4. Adapalene (Differin, 0.1% gel is OTC as of 2017)
  5. Trifarotene (Aklief)
    1. Expensive new Retinoid (45 g for $560) released in 2020 that is pump dispensed cream
    2. Marketed as a more specific Retinoid with the presumption that it is better tolerated (but without convincing evidence)
      1. Other generic Retinoids (e.g. Differin) is preferred
    3. References
      1. (2020) Presc Lett 27(2): 8
  • Preparations
  • Less Irritating Comedolytics
  1. Creams are less irritating than gels
  2. Benzoyl Peroxide 2.5% water-based
  3. Tretinoin agents
    1. Retin A Micro (Tretinoin gel microsphere)
    2. Avita
  4. Adapalene (Differin)
    1. Better tolerated than Tretinoin
  • Preparations
  • Combination agents (Comedolytic with Antibiotic)
  1. Refrigeration required
    1. Erythromycin with Benzoyl Peroxide (Benzamycin)
  2. Refrigeration not required
    1. Benzoyl Peroxide, Glycolic Acid, Zinc (TRIAZ)
    2. Clindamycin with Benzoyl Peroxide Gel
  • Preparations
  • Special indications
  1. Most irritating and potent agents
    1. Tazorac 0.1% gel qod
  2. Pregnancy
    1. Azelaic Acid (Azelex)
  • References
  1. Kaplan (2001) CMEA Medicine Lecture, San Diego