To obtain rapid control of mild to moderate acne a retinoid (Retin A gel 0.05%, Zorac, differin, retrieve,stieva A) nightly with a antibiotic gel ( 2% erythromycin or 1% clindamycin) in the morning. Benzyl peroxide 2.5- 5% gel (Benzac, brevoxyl, panoxyl) and salicylic acid microgel complex (neutrogenia rapid clear range) twice a day are also effective in mild-moderate acne with over 75% improvement by 8hrs after starting the treatments. At Cosmos our patients are generally placed on erythromycin gel in the morning, zorac at night , and daily 5% benzyl peroxide wash. Salicylic acids are less potent that retiniods and are used in patients with mild acne who cannot tolerate retinoids. We advise Salicylic acid as a microgel complex, which has enhanced delivery (neutrogenia rapid clear range). Azelaic acid is also less potent that retinoids but is useful in pregnant women to control acne.
Once good control is achieved usually after 6-12 weeks we usually stop the antibiotics and rely on the retinoid Retin A gel for maintaining control. Regular use of Benzyl peroxide 2.5%-5% gel (Benzac, brevoxyl, panoxyl) and/or salicylic acid microgel complex (Neutrogena rapid clear range) twice a day also helps to maintain control.
Skin irritation and dryness can occur with all these topical treatments and a light moisturiser may need to be applied. To reduce irritation that can occur with retiniods or benzyl peroxide we advise our patients to use these products sparingly. In patients with sensitive skin we may advise to start second nightly application for the first 4 weeks.
At Cosmos clinic we use Photodynamic therapy (PDT) in combination with these topical treatments. PDT requires the use of Aminolevulinic Acid (ALA) cream which is obtained from a compounding pharmacist. PDT not only helps with rapid control of the acne but it will reduce the number of oil glands in the skin making acne less likely to occur in the future For more details on PDT read our page on ALA PDT. At cosmos clinic our acne patients all undergo a 3 month program in which they receive a PDT treatments each month, a facial peel each month and the skin care appropriate for their skin.