What causes acne and what are the best topical treatments?

Acne results from the interplay of many factors; hormones, oily skin, your genetic disposition and hair follicle design. Unfortunately, there is no cure for acne, but there are a variety of treatments once the type of acne is identified (acne is classified as non-inflammatory or inflammatory).

The basic lesion is a comedo. A blackhead, or open comedo, forms when oil and loose cells combine to form a tough insoluble protein (keratin) that is the principal matter of hair and nails.

A white head, or closed comedo, is the result of inflammation or damage to the follicle. The area surrounding the comedo may become raised, red and inflamed, thus forming a papule. If the follicle is damaged or ruptured — this includes popping zits — the contents may leak out and penetrate surrounding tissue, forming cysts and nodules.

The topical therapy recommended for non-inflammatory acne are products available over the counter, including products containing benzoyl peroxide or salicylic acid. Benzoyl peroxide is widely used and less than 1 percent of users experience adverse effects, including dryness and irritation, causing them to stop treatment.

One disadvantage to consider is that benzoyl peroxide is metabolized into hydrogen peroxide and benzoic acid, which can cause skin bleaching and can bleach hair and fabric. Keep in mind there are many strengths of benzoyl peroxide available.

Salicylic acid concentrations greater than 2 percent should be avoided because it may damage skin tissue. Do not use both benzoyl peroxide and salicylic acid together; this will increase adverse effects. These products are available in many forms at any drug store.

Inflammatory acne can be treated with a topical antibiotic (a doctors visit is required), which suppresses the acne. Unfortunately, antibiotic resistance is a concern and is seen most commonly with topical erythromycin. Benzoyl peroxide may be added in combination. Combination products are available by prescription.

Regardless of the treatment chosen, an average of six to eight weeks is the suggested time period to observe progress before switching to another treatment. Talk to the pharmacist at your local store, as they can provide treatment advice.

Should I be concerned about antibiotic resistance?

Yes, antibiotics are a unique drug class in that misuse with some patients can prevent others from using them at all. In this sense, antibiotics are societal drugs, and overuse, particularly of broad spectrum antibiotics like amoxicillin and penicillin, places us all at risk by hastening the emergence of antibiotic resistance.

The origin of many drug-resistant infections comes from hospitals into the community following increased use of antibiotics in a community. When an infection does not respond to initial treatment, antibiotic resistance begins to emerge because the initial antibiotic treatment destroyed only some of the bacteria, leaving the most resistant bacteria behind to multiply and strengthen the infection.

To reduce your risk for infection, only take antibiotics when the presence of bacteria is determined to be the cause of an illness. Taking antibiotics for colds or flu only increases the rate of drug resistance.

Another cause of antibiotic resistance is the administration of antibiotics to healthy farm animals to promote growth and prevent infections. Research indicates that antibiotic resistant strains developed on farms spread through animal feces into the water supply and from there to humans. To end non-therapeutic use of antibiotics on farm animals, Rep. Sherwood Brown, D-Ohio, has introduced the Preservation of Antibiotics for Human Treatment Act of 2002, which phases out the feeding of antibiotics to farm animals.

For more information regarding antibiotic resistance, visit http://www.apua.com (Alliance for Prudent Use of Antibiotics) orhttp://www.cdc.gov/drugresistance/healthcare/ (Centers for Disease Control).