Acne Vulgaris Drug Summary

• Usually dose-related and reversible upon discontinuation: Dry mucous membranes and skin, scaling, erythema, fragility of the facial skin, pruritus, epistaxis, dry sore mouth, palmo-plantar exfoliation, visual disturbances, dry eyes, corneal opacities, skeletal hyperostosis and musculoskeletal symptoms
• Elevated erythrocyte sedimentation rate (ESR), hepatic enzymes, triglycerides and blood glucose have occurred; pancreatitis may occur especially if hypertriglyceridemia is present; hair thinning, photosensitivity, changes in skin pigmentation, GI symptoms, jaundice, drowsiness, mood changes, depression, suicidal tendencies, hypersensitivity reactions, etc

• Should be taken with food especially high-fat meal to increase absorption
• Contraindicated in pregnant patients because it is teratogenic
  • Female patients should start using contraception 1 month prior to starting Isotretinoin treatment and continue for 1 month after discontinuation of Isotretinoin
• Avoid in patients with renal or hepatic impairment, hyperlipidemia, taking excessive amount of vitamin A and in breastfeeding
• Monitor liver function tests (LFTs) and lipids prior to therapy, after the first month and as required thereafter; blood glucose throughout treatment
• Avoid excessive exposure to sunlight or UV radiation
• Should not be combined with oral tetracyclines because the chance of pseudotumor cerebri is increased
• Repeated courses of treatment should not be given but if acne continues may repeat course of treatment after 2 months of drug-free period

Apply 12 hourly 

• Apply on moistened skin, lather and rinse thoroughly

Apply 12 hourly 

Adverse Reactions

• Usually resolve with continued use or by decreasing frequency of application: Skin irritation, pruritus, burning
• Hypopigmentation, photosensitivity

• Avoid exposure to excessive sunlight or UV radiation
• Time to therapeutic response: 4 weeks with exacerbation of acne during early treatment

Apply 12-24 hourly 
Bar and wash: Wash 12-24 hourly, rinse with water and dry 

Adverse Reactions

• Usually resolve with continued use or by decreasing frequency of application: Sensation of skin tautness, local irritation, burning, dryness, erythema, pruritus
• May bleach hair or clothing
• Contact allergy

• Avoid repeated exposure to excessive sunlight or UV radiation

Apply over affected areas then rinse thoroughly

Adverse Reactions

• Patient may become hypersensitive after repeated exposure

• Adjunctive treatment of acne

• Dermatologic effects (burning, itching, dry skin, erythema, oily skin, peeling, skin irritation, folliculitis); GI effects (GI disturbances, abdominal pain)

• Use with caution in patients with atopic disease
• Contraindicated in patients with regional enteritis, ulcerative or antibiotic-associated colitis

• Dermatologic effects (rash, pruritus); Other effect (peripheral neuropathy)

• Use with caution in patients with sulfa allergy
• Reassess therapy if without improvement after 12 weeks 

• Wash off with cold water, followed by sunscreen
• Avoid direct contact with eyes

• Dermatologic effects (burning, dry skin, erythema, rash)

• Used to treat inflammatory acne

• Dermatologic effects (skin irritation, dermatitis)

• Keratolytic, mild antiseptic, mild antifungal and parasiticide used in the treatment of acne 

• Dermatologic effects (skin irritation, dermatitis) 

• Avoid contact with eyes and other mucous membranes
• Avoid exposure to sunlight or UV radiation 

• Avoid contact with eyes
• Use with caution in patients with thyroid disease, methemoglobinemia

• Dermatitis; skin ulceration can occur with increased concentrations

• Use with caution in patients with diabetes and peripheral neuropathy
• Avoid contact with mucous membranes, use on broken skin or large skin areas, use of high concentrations and for long periods of time 

• Dermatologic effect (skin irritation)

• Avoid contact with eyes; discontinue if irritation occur

• Discontinue use if excessive discomfort occurs

• Usually resolve with continued use or by decreasing frequency of application: Erythema, dryness, scaling, pruritus and burning following application

• Avoid exposure to excessive sunlight or UV radiation
• Time to therapeutic response: 8-12 weeks with exacerbation of acne during early treatment 

• Usually resolve by decreasing frequency of application: Stinging, feeling of warmth, erythema, peeling
• Edema, blister, crusting of the skin, temporary hypo- or hyperpigmentation, photosensitivity

• Avoid exposure to excessive sunlight or UV radiation
• Time to therapeutic response: 8-12 weeks with exacerbation of acne during early treatment 

• Usually resolve by decreasing frequency of application or discontinuing treatment until skin integrity returns: Pruritus, burning, peeling, skin redness
• Discoloration, fissuring, rash, contact dermatitis, photosensitivity

• Avoid exposure to excessive sunlight or UV radiation
• Time to therapeutic response: 6-8 weeks with exacerbation of acne during early treatment 

• Usually resolve with decreasing frequency of application: Stinging, feeling of warmth, erythema, peeling
• Edema, blistering, crusting of the skin, temporary hypo- or hyperpigmentation, photosensitivity

• Start with weaker formulation and increase concentration as tolerated
• Avoid exposure to excessive sunlight or UV radiation
• Time to therapeutic response: 6-8 weeks with exacerbation of acne during early treatment

• Dermatologic effects (application site irritation, pruritus [itch], sunburn)

• Do not use on cuts, scrapes, abraded or eczematous skin
• Use with caution on sensitive areas of the skin (eg neck or armpits)
• Avoid exposure to excessive sunlight or UV radiation 

• GI disturbances, hypersensitivity reactions

• Drug interactions with medications metabolized by cytochrome P450 eg anticoagulants, Cyclosporine, etc

Adverse Reactions

• GI effects (nausea/vomiting, abdominal discomfort, diarrhea, antibiotic-associated diarrhea/colitis); Other effects (candidal infections, hypersensitivity reactions)
• Dose-related tinnitus/hearing loss have occurred with some macrolides

Special Instructions

• May take with food to decrease gastric distress
  • Erythromycin and Roxithromycin: Should be taken at least 30 minutes before meals
• Continue initial doses until there is obvious improvement in acne (usually 3-6 weeks)
• Drug interactions with medications metabolized by cytochrome P450 eg Theophylline, Digoxin, Carbamazepine, etc
• Use with caution in patients with hepatic impairment, altered cardiac conduction, and myasthenia gravis 

• GI effects (nausea/vomiting, abdominal pain, diarrhea); Other effects (transient leukopenia or neutropenia)

• Swallow whole with a full glass of water and in an upright position
• Use with caution in patients with colitis or other GI diseases 

Adverse Reactions

• GI effects (nausea/vomiting, diarrhea); Other effects (photosensitivity, fungal overgrowth, benign intracranial hypertension, discoloration of forming teeth)
• Minocycline: Hyperpigmentation, rarely severe drug reactions (eg lupus-like reaction)

Special Instructions

• Lincomycin, Lymecycline: Should be taken on an empty stomach
• Oxytetracycline and Tetracycline: Should be taken on an empty stomach
• Continue initial doses until there is obvious improvement in acne (usually 3-6 weeks)
• Use with caution in patients with hepatic or renal impairment
• Contraindicated in patients <8 years old, pregnant or nursing women, concurrent use of oral retinoids
• Avoid exposure to excessive sunlight or UV radiation

• Discontinue if irritation or sensitization occurs

Adverse Reactions

• Dermatologic effects (pruritus, irritation, redness/flushing, feeling of facial warmth, papules, contact dermatitis, dry skin, hot flushes)

• Dermatologic effects (erythema, dryness, desquamation, pruritus)

Adverse Reactions

• Hypersensitivity reactions

• GI effects (nausea/vomiting, GI disturbances, unpleasant metallic taste, diarrhea, constipation, furred tongue, glossitis, stomatitis); Dermatologic effects (dry skin, erythema, burning/stinging, skin irritation, worsening of rosacea, contact dermatitis); CNS effects (dizziness, ataxia, headache, drowsiness, insomnia, changes in mood or mental state eg, depression or confusion); Hematologic effects (temporary moderate leukopenia, thrombocytopenia); GU effects (urethral discomfort, darkening of the urine); Other effects (weakness, peripheral neuropathy [high doses or prolonged treatment], hypoesthesia, dysgeusia, paresthesia, tearing of the eyes)

• Use with caution in patients with evidence of, or history of, blood dyscrasia

• Use with caution in patients with superinfection

Adverse Reactions

• Minor side effects occur during the first 3 cycles (nausea, breast tenderness, headache); Irregular menstrual bleeding (breakthrough bleeding or spotting most likely, amenorrhea in 2-3% of cycles); Other effects (acne, mood changes, increase in weight and BP)
• Relative risk of VTE can increase with COC use but risk is still low and considerably lower than VTE risk associated with pregnancy
• COC users with hypertension or those who smoke ≥15 cigarettes/day have an increased relative risk of MI and stroke

• COCs should not be used in women with known contraindication to the estrogen component (pregnancy, lactation, undiagnosed vaginal bleeding, venous/arterial thrombosis, coagulopathy, migraine, stroke, heart attack, hypertension, angina pectoris, high lipid levels, DM with vascular injury, pancreatitis, severe liver disease, liver tumor, cancer of the breast and genital organs, kidney failure) or where the risks usually outweigh the advantages
• Complete medical history should be done to check for risk factors of thrombus formation
• Avoid excessive sun or UV exposure in women with propensity for chloasma

• Local effects (post-injection flare, sterile abscess, thrombophlebitis, skin atrophy, pigmentary changes, telangiectasia)

• Systemic absorption should always be considered
• Contraindicated in patients with systemic fungal infection
• Administration of live virus vaccines is contraindicated
• Use with caution in patients with pre-existing psychiatric conditions, heart failure, DM, GI diseases, hepatic impairment including cirrhosis, myasthenia gravis, cataracts and/or glaucoma, osteoporosis, renal impairment, history of seizure disorder, thyroid disease, following acute myocardial infarction

• CNS effects (headache, depressive moods); GI effects (nausea, other GI complaints); Gynecologic effects (mastodynia, irregular menstrual cycles, spotting); Other effects (tiredness, increased weight, diminished libido, thrombotic phenomena)

• Contraindicated in patients with liver diseases, Dubin-Johnson syndrome, Rotor syndrome; previous or existing liver tumors; presence or history of meningioma; wasting diseases; severe chronic depression; previous or existing thromboembolic processes; severe diabetes with vascular changes; sickle-cell anemia; history of jaundice or persistent pruritus during a previous pregnancy, herpes of pregnancy; inoperable prostatic carcinoma
• Use with caution in patients with history of thromboembolic events, anemia, DM, rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption, serious organic causes of androgenization (eg Cushing’s syndrome, ovarian tumors, adrenal carcinoma and androgenital syndrome)
• Regularly monitor liver and adrenocortical function and RBC count during treatment; perform gynecological exam in case of persistent or recurrent bleeding at irregular intervals

Wet the skin and work enough amount into lather; rinse thoroughly

Adverse Reactions

• Local irritation

• Not to be combined with cosmetic products and other topical antiseptics
• Use with caution on mucous membrane and prolonged use

Apply 8-12 hourly 

Adverse Reactions

• Local irritation

• Use with caution in patients at risk for Iodine idiosyncrasy

Apply on affected area 12 hourly

Adverse Reactions

• Redness, mild transient stinging, burning sensation, local pain