Analyzing Efficacy of Popular Acne Treatment

Acne is one of the most common dermatological diseases. Although it is not life-threatening and only causes annoying pimples, it significantly impairs your quality of life. It does not take a life-threatening disease to understand its impact, and the mere fact that acne affects self-perception can already be considered a serious condition that must receive proper medical care as soon as possible.

It's no secret that there are thousands of interesting cosmetic products nowadays that we all want to try on. When you walk into the shop, you surprisingly need everything; a serum, a contour, under-eye patches, a cream, and so on and so forth. However, as attractive and magical as they seem, many do not work as advertised.

With this in mind, you may look for magical products that can improve acne "immediately" because, we know, it is not easy for your "business card" to look out of the norm, and it is understandable that on the road to treatment -which is neither short nor simple- you look for alternatives that can speed up the recovery process.

Acne is a challenging medical disease, and the more severe the lesions, the more difficult the treatment. Still, many cosmetics that promise benefits do not deliver on that, and far from being a benefit, they end up being a drain on your budget without you even realizing it.

Science always speaks loud when it comes to drugs, products, and treatments, but what happened to cosmetics? Knowing its mass sale, let's find out if the most popular active ingredients really offer any benefit for acne-prone human skin.

Retinoids

Retinoids are sourced from Vitamin A retinol. According to the American Academy of Dermatology AAD and the European Dermatology Forum EDF, they are the core of topical acne therapy thanks to their comedolytic, blackhead prevention, and anti-inflammatory effects. In other words, retinoids attack the crucial steps in the genesis of acne.

According to their generation, there are numerous retinoids, with retinol and tretinoin being the first generation (oldest) and adapalene, tazarotene, and bexarotene the latest. The most commonly used in acne are tretinoin, isotretinoin, adapalene, and tazarotene.

Tretinoin

It is the oldest retinoid whose clinical efficacy has been widely confirmed for decades.

Tretinoin is highly effective in mild, moderate, or severe acne in single therapy monotherapy, reducing inflammation and scarring based on clinical photographic evidence. The improvement is more evident the more inflamed the lesions are, probably due to its potent anti-inflammatory effect against Propionibacterium acnes.

Tretinoin is so effective in acne that new formulations such as nanoemulsions, 0.04% microsphere gel, and a new 0.05% lotion maintain effectiveness even in clinical trials. As with all acne treatments, its effectiveness increases, marked by better clinical results when combined with other ingredients.

Isotretinoin

Like tretinoin, isotretinoin is a first-generation retinoid widely used for acne with wonderful results but side effects. Isotretinoin is 13-cis-retinoic acid taken by mouth especially recommended in cases of severe acne where topical treatment has not been successful.

Oral isotretinoin is effective in both daily and alternate-day therapy against moderate and severe acne, with a slight but significant difference in favor of the daily regimen.

In low-dose therapy, isotretinoin decreased both the number of inflammatory lesions pimples and the number of non-inflammatory lesions blackheads/comedones.

Regarding its topical use, the solubility, formulation, stability, therapeutic action, side effects, and contraindications are similar to those of tretinoin, although it causes less irritation.

Adapalene

Adapalene is a third-generation synthetic retinoid known for its good results, few side effects, and undetectable levels in blood plasma.

Adapalene 0.3% is as effective as tretinoin 0.05% on acne during the first 30 days of the treatment regimen. However, adapalene is more tolerable than tretinoin. 0.1% adapalene, although also effective in reducing acne lesions, is not superior to the above concentrations but is to placebo and even safer.

Tazarotene

Like adapalene, tazarotene is a third-generation retinoid initially intended for use in psoriasis and is now also used in acne.

Daily tazarotene 0.1% for 12 or more days is effective in mild-to-moderate acne vulgaris. Tazarotene also achieved a greater reduction in papule count and a more rapid reduction in pustule count than tretinoin. Both drugs were equally efficacious in reducing the closed comedo count. Although tazarotene may cause further irritation, this does not exceed the tolerability levels.

Acids

Salicylic acid SSA

is beta-hydroxy acid recognized as a comedolytic that stimulates skin desquamation, normalizes keratinization, and decreases inflammation, making it an ideal exfoliating agent in acne treatment.

Depending on its concentrations, it can provide superficial or deep exfoliation. In-home products generally contain concentrations of 0.5% to 5%.

Proven clinical effectiveness in acne.

Salicylic acid 2% hydrogel is effective 44.1% in reducing papules/pustules and other inflammatory acne lesions after a 28-day treatment regimen. In addition, it is safe to use and does not cause irritation.

Higher concentrations up to 30% are even more effective about 70% in reducing blackheads, papules, pustules, and scars under controlled exfoliation in medical settings.

Azelaic acid (AZA)

is a natural dicarboxylic acid that reduces the Propionibacterium acnes count in the skin, helps to normalize keratinization, and has an anti-inflammatory effect. You can apply it topically at concentrations of 15-20%.

Proven clinical effectiveness in acne.

It is effective in acne by decreasing inflammatory blackheads and non-inflammatory comedones, blackheads lesions when applied at 20% daily versus conventional creams placebo. It also reduces the bacterial count on the skin.

AZA also works as a chemical exfoliant and provides benefits in acne at higher concentrations in controlled medical settings. Although azelaic acid is effective as monotherapy, most physicians typically treat acne with two or more complementary agents, such as the next one.

Benzoyl peroxide

Benzoyl peroxide BPO is an over-the-counter medication with multiple functions that make it effective in acne vulgaris. This medication works as a bactericide by directly destroying the bacteria that causes acne, Propionibacterium acnes, and as a sebum regulator and keratolytic.

Proven clinical effectiveness in acne.

Benzoyl peroxide effectively improves acne approximately 50% by reducing papules and pustules at concentrations greater than 2% compared to a regular cream during an 8-week treatment regimen or longer. Its effectiveness does not increase with dosage, while tolerability decreases (causes more irritation).

In fact, skin microbiological studies after two days of treatment with 5% BPO showed a significant reduction in the Propionibacterium acnes skin count. Proving that it actually destroys the bacteria. Although these studies are anecdotal, they are accurate.

However, the use of benzoyl peroxide-based cleansers has no scientific evidence to prove their effectiveness. In addition, there is a marked difference between the leave-on method topical application and the rinse-off, where it is very likely that the immediate cleanser rinse-off has no effect on the skin barrier or bacteria.

Recent studies focus on new combined formulations and better vehicles to improve efficacy and increase the benefits.

Alpha hydroxy acids

Alpha hydroxy acids (AHAs) are a class of chemical compounds based on organic acids. The most used are lactic acid, mandelic acid, and glycolic acid. The typical indication of AHA-containing products ranges from skin moisturizing over wrinkles reduction to deep chemical peels for acne.

Lactic acid:

There is no proven scientific evidence on human skin that topical lactic acid is effective for acne.

Glycolic acid:

There is no scientific evidence on human skin that serum or any home facial care formulation alone effectively improves acne. The acne-improving chemical peel provided by glycolic acid is only effective when performed in controlled medical settings at very high doses 35%, 50% to 70% or combined with other compounds.

Mandelic acid:

There is no scientific evidence on human skin that serum or any home facial care formulation alone effectively improves acne. Like glycolic acid, mandelic acid provides benefits under controlled medical settings and at very high doses or combined with other compounds.

Hyaluronic acid

Hyaluronic acid HA plays a vital role in synthesizing extracellular matrix molecules and epidermal cell interaction with the surrounding environment. It is also the ultimate solution for moisture retention, provides hydration, and improves overall skin mechanics.

However, the way it works has nothing to do with acne, much less with the infectious processes in the skin. Besides that, there is no scientific evidence to prove that hyaluronic acid somehow improves any form of acne.

Vitamins

Vitamins are crucial substances for proper body functioning. They are in food, and their recommended daily intake ensures cell function, development, and growth. While it has been claimed that some topical vitamin serums are beneficial for the skin, not all actually provide a profit, and certainly not in acne.

Vitamin B3

Also known as niacinamide/nicotinamide, is an anti-inflammatory agent widely used in different medical conditions such as dermatitis, acne, and skin blemishes (hyperpigmentation). In laboratory settings, the benefits of niacinamide range from depigmenting, anti-inflammatory, face brightening, and sebum reduction.

Proven clinical effectiveness in acne.

Only a few studies on human facial skin prove some benefit in acne. 4% niacinamide proves to be clinically effective in decreasing acne outbreaks papules/pustules when applied to the face daily, even comparable to over-the-counter drugs such as 1% clindamycin, probably because of its anti-inflammatory effects. The remaining trials studied niacinamide in combination with other actives or for other purposes.

The data on whether or not niacinamide reduces facial sebum needs further research as the current results are not consistent.

Vitamin E

Is an antioxidant that protects the skin from solar radiation harmful effects by acting as a free radical scavenger. Although apparently, this antioxidant effect may prevent inflammation of the facial sebaceous follicle, to date, vitamin E cosmetic products are not effective in acne. In fact, dietary supplementation with vitamin E is more likely to provide benefits than a serum or any cosmetic.

Minerals

Zinc

To date, is the most related to acne, perhaps because of its antimicrobial and anti‐inflammatory actions and regulatory and inhibitory effects on many metabolic and chemical steps in the genesis of acne.

However, topical zinc application alone has not shown significant benefit in acne compared to other conventional creams (placebo). A tea-based lotion can be even more beneficial than zinc for acne-prone skin. although several studies showed that patients with acne had lower blood levels of zinc than those without. The reason remains unclear.

Sulfur

Sulfur is a chemical element with antifungal, antibacterial, and keratolytic properties being comedolytic, although some bibliographies describe it as comedogenic the opposite.

Despite the above effects, sulfur by itself is not effective in acne. There are just a few clinical trials, but they are anecdotal and combined with other active ingredients, making it difficult to prove its individual effectiveness.

Oils and plant extracts

Acne treatment consists of many medications such as benzoyl peroxide, retinoids, antibiotics and so on. However, these medications are not side-effect-free even though their benefits are clear, so phytotherapy has been proposed as an alternative as it is not only inexpensive but can also be effective and has few side effects. Tea Tree Oil TTO, Bakuchiol, and Witch Hazel are common natural ingredients used for acne.

Bakuchiol

Bakuchiol is a phenolic derivative found in the seeds of the Psoralea corylifolia herb with various pharmacological effects, including antioxidant, antibacterial, anti-inflammatory and anti-ageing effects.

In the skin, bakuchiol has been studied mainly with other ingredients to treat photodamage. Only one study proved its effectiveness and safety by a formulated 0.5% cream on facial skin and found it effective in reducing inflammatory acne lesions and post-acne hyperpigmented lesions in monotherapy.

Tea Tree Oil

The essential oil derived from the plant Melaleuca alternifolia with anti-inflammatory and antibacterial properties is Tea Tree Oil. The term "essential oil" refers to botanicals that are volatile plant extracts with distinctive scents used in different ways, such as mixed in a gel, compounded into a paste or spray, or applied via a bath, massage, or inhalation.

Several studies have shown its effectiveness when applied to the skin:

The first comparative study evaluated 5% TTO versus 5% benzoyl peroxide BPO, showing that TTO effectively reduces acne lesions without outperforming BPO, although it is better tolerated.

Another comparative study between a common cream and 5% TTO on acne-prone skin showed that daily application for 20 min and then rinsing off decreased inflammatory acne lesions compared to placebo.

A recent uncontrolled pilot study with TTO gel 200 mg/g and a TTO-based facial cleanser 7 mg/g on mild to moderate acne showed that twice-daily use morning and evening reduced total lesions by 54% at week 12 of treatment.

Witch Hazel

According to some literature and cosmetics, witch hazel Hamamelis is a promising acne plant with very anti-inflammatory and astringent powers.

However, no clinical trials prove the herb's efficacy in acne; in fact, the only controlled clinical trial was conducted to test its anti-inflammatory power in dermatitis and did not show superiority to the placebo vehicle. In other words, it is not effective, and its anti-inflammatory properties on the skin are not real.

Tools and Patches

People with acne often look for inexpensive, ''quick-acting'' home remedies when an unexpected pimple pops up, where the famous acne patches and dermaroller come to the fore.These tools are sold as ''the effective solution'', being among the main purchased products in the new era of at-home cosmetics without medical supervision. There is little accurate information on them by physicians.

Acne patches

Most anti-acne patches are hydrocolloid or hydrogel stickers with a waterproof surface to protect pimples from secondary infection but not improve the lesion.

Several studies evaluate different types of acne patches. One of them evaluates the effectiveness of a patch of Gelatin/Chitosan Bilayer Loaded with Phellodendron amurense/Centella asiatica extracts, which effectively reduced P. acnes' bacterial load and lead to skin repair stimulation by fibroblast activation.

Another recent study showed that a water-soluble patch composed of sodium, glycerin, and A. vera, C. asiatica, C. officinalis, and P. emblica effectively reduced inflammatory acne lesions demonstrated by photographs. When used in combination, these compounds demonstrate antimicrobial, anti-inflammation, antioxidant, wound-healing, whitening, and scar reducing effects.

Dermaroller

The dermaroller is a device containing microneedles mainly used for scar improvement and not for acne-active disease. Acne scars occur as a result of abnormal wound healing following sebaceous follicle inflammation pimple.

The standard dermaroller used for acne scars is a drum-shaped roller with 192 fine microneedles in eight rows, 0.5 to 1.5 mm in length and 0.1 mm in diameter. The device is pre-sterilized by gamma irradiation and is for single use only.

It can be used safely in a clinic by any dermatologist with minimal training. It cannot be used at home under any circumstances as there is an increased risk of contamination, poor technique, disease worsening and other related complications.

Dermaroller in monotherapy is effective in improving acne scarring after three sessions. However, its effectiveness increases when combined with other methods such as Platelet-Rich Plasma PRP.

Another comparative study concluded that dermaroller is 40% effective on acne scarring with combined subcision after three sessions with monthly intervals.