Acne treatments: topical medicines (creams, gels, solutions, ointments)
Active ingredients include: benzoyl peroxide, retinoids (such as adapalene), salicylic acid and topical antibiotics. Topical treatments with a combination of active ingredients are generally more effective. Some topical treatments can be bought from shops, including products recommended by pharmacists, and others prescribed by doctors. Most people had tried shop-bought topical treatments before going to the GP for the first time. Topical medicines were usually the first treatment prescribed to young people with acne by GPs. Doctors can prescribe topical medicines with different ingredients, forms and strengths. Most people had used a prescribed topical medicine with benzoyl peroxide as the main active ingredient. This usually came in cream or gel form in a tube. Some people had tried others topical treatment forms, such as Abbie who had used a ‘dabber’ topical solution (like a stick that you press on to the skin to apply the medicine). The first topical medicine worked well for some people and they didn’t need any further treatment for acne. Others tried a topical medicine but found it wasn’t effective or the improvements only lasted a short time. Some people talked about concerns that their acne would become resistant to topical creams that contain antibiotics. Usually the person went back to the doctor’s and was recommended another topical treatment to try, meaning repeat visits to see medical professionals). Abbie and Chris stressed that you have to be patient and wait a few weeks to see if an acne treatment is working. Sarah thinks she had unrealistic expectations that topical treatments would have quick results. It could be frustrating trying lots of different topical medicines though – Chris described having “one cream after another” with no major improvements. Using topical treatments
Topical treatments are applied to the skin to allow the main ingredients to sink in. For example, benzoyl peroxide topical treatments work by drying up the spot and killing off any bacteria around it. Most acne treatments aim to prevent new spots from developing and so are often applied to all spot-prone areas, rather than only visible spots. For this reason, it can take a few weeks to have an obvious impact. It was usual for the people we interviewed to put on the topical treatment once a day, such as before going to bed and often they kept the topical treatment on for a long time (e.g. overnight). Will’s mum encouraged him to be sparing with his topical treatments though and only occasionally put it on the parts of his skin that were badly affected by acne. Applying and washing off topical treatments can take time and alter daily routines. For some, the process was time-consuming. Deborah’s thick topical medicine was “impractical” because it took a long time to absorb into the skin. Some didn’t use topical treatments in the morning because it was visible or flaky, preferring to apply them at night before going to bed. Others, like Fatima and Ollie, said they didn’t find the time taken up by using topical treatments too bad.
It can be difficult remembering to put on the topical medicines. Tom found it a chore having to get out of bed to put on the treatment at night when he remembered. Some people found it okay to remember though and added it to their skin care routines. Nina said her routine with topical treatments and skin care was very important to her. Harriet described her skin care practices as “regimented”. Sharing bathrooms could be an added concern for some. Those with spots on their back and chest sometimes found it more difficult though. Devan can’t easily reach the spots on his back but he also doesn’t want anyone to do it for him. Ollie found it easier to target spots on his face with the topical treatments, whereas this was trickier with the acne on his shoulders.
Another practical issue with topical medicines was where to store them. This was especially the case for those people who had tried lots of different treatments. Will, Ish and Deborah said they had cupboards full of topical treatments – some of which they had tried and not found effective, but they didn’t want to throw out. Tom’s friends have seen his topical treatments when visiting his house and asked questions about the products. Abbie once had a topical treatment which she had to keep in the fridge. Rachael found it annoying having to remember to take the topical treatment with you on holiday and when staying at friends.
Downsides and side effects with topical medicines
Not everyone had side effects from topical treatments, but some did. These included:
• dry and flaking skin, making the skin feel tight or itchy
• stinging, burning or soreness when applied
• allergic reactions
• sunlight sensitivity, as for Ish and Abbie
• stickiness on the skin, as for Deborah and Rachael
• bleaching fabrics
One of the ways that topical treatments help fight acne is by drying up the skin. For this reason, many topical treatments cause skin dryness and irritation. Whilst this can shrink spots and make skin less greasy, having dry skin which peels and flakes can be unpleasant. This was especially a concern for people who also had eczema. Some people were shocked at how dry their skin became whilst using topical treatments. Marga couldn’t put make-up on because her skin was so dry. Deborah’s skin sometimes felt tight and itchy after using topicals. Moisturising was seen as especially important because of the drying side effect of topical treatments. This could be difficult as some people needed to find moisturisers and lip balms which didn’t irritate their skin or make it greasy. Lots of people said it made their skin sting when they applied topical treatments. This added to the soreness of spots for Molly. Chris says the creams burnt for the first week before his skin got used to them. Kosta puts on a topical cream before he goes to bed and finds the soreness can make it hard to get to sleep. Some people had experiences where they had come into contact with other strong chemicals whilst using a topical treatment. Harriet described swimming in pool water (with chlorine in it) as having a “searing effect”. Ish found it painful when he had put aftershave on areas where the topical cream had been. A few people had true allergic reactions to topical treatments. Deborah remembers one cream she had which caused her skin to swell up. Ollie had expected some problems with topical treatments irritating his skin, but was pleased not to have any allergic reactions. Tom did an allergy check when he first starting using a topical treatment, by putting a small dab of the cream behind his ear to see if it had any bad reaction. Although not exactly a side effect, some topical treatments contain bleaching agents which can damage fabrics. This includes bleaching or discolouring things like clothes, towels and bedding. Devan found it a problem with his shirts when he was using topical treatments on his back. Will had a “designated towel” at home which he used, so that the other towels didn’t get bleach stains. Harriet was careful when staying over at other peoples’ houses, so as not to stain their towels when drying her face. The cost of topical treatments was a concern for some people. This includes topical treatments which are shop-bought as well as those that pay for prescribed treatments. Fatima plans to look online to find a cheaper product with the same ingredient. Chris felt that the topical medicine he had was okay value as it had lasted him a long time.
Outcomes of using topical medicines
Whilst topical treatments alone cleared up some people’s acne, others didn’t find these helpful. Devan says topical medicines “didn’t really touch the sides” of his acne, and he moved on to other treatments (including isotretinoin). Naomi had been excited when she got her first topical medicine but disappointed when it didn’t clear up her acne. Chris and Ollie found topical treatments helped their acne ‘level out’ for a bit, but didn’t fully clear up.
The side effects, impracticalities and expense played a big part for some people in deciding whether to keep going with topical treatments. Devan stopped using his because it bleached his clothes. Tom had a shop-bought topical treatment which, once he had used up the whole bottle, he decided not to buy again.
Some people found they didn’t get along with using topical medicines and preferred a different form of acne treatment – often comparing topical creams with tablets. Rebecca, Molly and Fatima felt more comfortable putting creams on their skin than taking tablets (e.g. antibiotics or isotretinoin tablets). Others found tablets quicker and easier to take than applying a topical treatment. If topical treatments didn’t seem to work or caused problems for the person, GPs might suggest antibiotic tablets or a referral to dermatology (e.g. for isotretinoin tablets). Some people, such as Emma and Naomi, had tried multiple acne treatments at once – for example, topical medicines alongside other treatments like antibiotics or hormonal contraceptives. For those who no longer had acne, they sometimes still had a topical medicine to apply on occasional spots.