Лікарські препарати, що використовуються для лікування акне
Medication | Adverse Effects | Comments |
|---|---|---|
Topical antibacterials | ||
Benzoyl peroxide 2.5%, 5%, and 10% gel, lotion, or wash | Dry skin Possible bleaching of clothing and hair Allergic reactions (rarely) | Comedolytic and antibacterial with very low to no development of resistance Should be used in all patients if tolerated Gel product usually preferred |
Benzoyl peroxide/clindamycin gel | Dry skin Possible bleaching of clothing and hair Allergic reactions (rarely) | One combination product mentioned in the American Academy of Dermatology 2024 guidelines of care for the management of acne vulgaris |
Benzoyl peroxide/erythromycin gel | Dry skin Possible bleaching of clothing and hair Allergic reactions (rarely) | Some forms must be kept refrigerated |
Clindamycin 1% gel, solution, or lotion | Diarrhea (rarely) | Should be avoided in patients with inflammatory bowel disease |
Dapsone 5% and 7.5% gel | Temporary skin yellowing when used in conjunction with benzoyl peroxide | Very rarely causes methemoglobinemia |
Erythromycin 1.5 to 2% (multiple vehicles) | Local irritation (rarely) | Well-tolerated, but frequent development of bacterial resistance |
Minocycline foam 4% | Irritation, dry skin, redness | Foam propellant is flammable. Avoid fire/flame and smoking immediately after application. |
Topical comedolytics and exfoliants | ||
Adapalene 0.1% gel, cream, lotion; 0.3% gel | Some redness, burning, and increased sun sensitivity | As effective as tretinoin but less irritating Requires use of protective clothing and sunscreen |
Azelaic acid 20% cream | Possible lightening of skin | Minimally irritating May be used by itself or with tretinoin Should be used cautiously in people with darker skin because of skin-lightening effects |
Glycolic acid 5–10% | Stinging Mild irritation | Over-the-counter product in cream, lotion, or solution; adjunct therapy but no longer commonly used |
Tazarotene 0.05% or 0.1% cream or gel | Skin irritation Increased sun sensitivity | When tazarotene is started, apparent worsening of acne, with improvement possibly taking 3 to 4 weeks to occur Requires use of protective clothing and sunscreen Should be avoided during pregnancy |
Tretinoin 0.025%, 0.05%, and 0.1% cream; 0.05% liquid; 0.01%, 0.025%, and 0.1% gel | Skin irritation (with dryness, erythema, and scaling) Increased sun sensitivity | Initiate treatment at a low strength (eg, 0.025% cream) and increase if ineffective; if irritation occurs, strength, frequency, or both should be reduced When tretinoin is started, apparent worsening of acne, with improvement possibly taking 3 to 4 weeks to occur Requires use of protective clothing and sunscreen Should be avoided during pregnancy |
Trifarotene 0.005% cream | Dryness, erythema, and scaling of the skin Increased sun sensitivity | Requires use of protective clothing and sunscreen |
Oral antibiotics | ||
Azithromycin | Stomach upset | Frequent development of bacterial resistance |
Doxycycline | Increased sun sensitivity | Good first-line medication in terms of efficacy and cost Requires use of protective clothing and sunscreen |
Erythromycin | Stomach upset | Frequent development of bacterial resistance |
Minocycline | Headache Dizziness Skin discoloration | Sometimes considered a more effective antibiotic, but this is not clear and it can be expensive (6) |
Sarecycline | Similar to other tetracycline medications | Narrow spectrum of activity targeting acne-specific bacteria |
Tetracycline | Increased sun sensitivity | Inexpensive and safe, but must be taken on an empty stomach Requires use of protective clothing and sunscreen |
Sulfamethoxazole/Trimethoprim, SMX-TMP, Cotrimoxazole | Rare adverse drug reactions | Development of bacterial resistance |
Oral retinoid | ||
Isotretinoin | Possible harm to a developing fetus (contraindicated during pregnancy) Possible effect on blood cells, the liver, and fat (triglyceride and cholesterol) levels Dry eyes, chapped lips, drying of mucous membranes Pain or stiffness of large joints and lower back with high dosages Associated with depression, suicidal thoughts, attempted suicide, and (rarely) completed suicide Unclear whether associated with new or worsened inflammatory bowel disease (Crohn disease and ulcerative colitis) | For sexually active women, requires a pregnancy test before the start of therapy with isotretinoin and at monthly intervals during use of the medication plus use of 2 forms of contraception or sexual abstinence, beginning 1 month before the medication is started, continued during medication use, and for 1 month after stopping the medication Requires periodic complete blood count, liver tests, fasting glucose, and lipid profile |
Antiandrogens | ||
Clascoterone 1% cream | Redness, scaling or dryness, and itching | For treatment of acne in patients 12 years of age and older |
Combined (estrogen plus a progestin) oral contraceptives | Hypertension, thromboembolic events Weight gain Nausea Breakthrough bleeding Headache | For treatment of acne in females |
Spironolactone | Light-headedness Increased urination Breast tenderness Nausea | For treatment of acne in females |