Choosing the Right Partner: Complementing Prescription Acne Medication With Over-the-Counter Cleansers and Moisturizers

November 2020 | Volume 19 | Issue 11 | Original Article | 1069 | Copyright © November 2020


Published online October 30, 2020

Edward Lain MD FAAD,a Anneke E. Andriessen PhDb

aSanova Dermatology, Austin TX; Austin Institute for Clinical Research, Austin, TX
bRadboud UMC Nijmegen, Andriessen Consultants, Malden, NL

Abstract
Background: Acne is the most common dermatological disorder. An impaired barrier function in acne vulgaris has been reported, as well as decreased amounts of epidermal ceramides. Also, many of the systemic and topical medications prescribed for the treatment of acne exacerbate these skin barrier disruptions and can lead to irritation and dry skin conditions.
Aim: The review explored the importance of maximizing adjunctive skincare, such as over-the-counter products for managing acne and avoiding adverse effects.
Methods: A literature review was conducted and included clinical acne guidelines, clinical studies, and review articles on acne prevention, treatment, and maintenance. Searches were made in PubMed and Google Scholar for English-language literature published between Jan 1, 2010, and Apr 1, 2020. Two clinicians manually reviewed selected publications.
Results: Seventy-four articles were included in the analyses. A variety of specialized cleansers and moisturizers are available as suitable adjunctive therapies for acne-prone skin. Lipid-free cleansers were found to be the most appropriate type of cleanser for acne-prone skin as they were associated with a low risk of skin irritation, and a near-physiological stratum corneum pH. Moisturizers typically included ingredients such as humectants, emollients, oil absorbers, and those with anti-inflammatory and/or barrier replenishing properties. Given the various adjunctive products available, decision frameworks were created for clinicians to use when selecting over-the-counter cleansers and moisturizers for acne-prone patients.
Conclusion: Informing clinicians about skin barrier dysfunction in acne and the benefits of adjunctive skincare may help them to choose the right product(s) to complement prescription therapy.

J Drugs Dermatol. 2020;19(11): doi:10.36849/JDD.2020.5536

BACKGROUND

Acne is the most common dermatological disorder.1 Psychological and emotional distress due to acne, including poor self-esteem, social anxiety, depression, and suicidal ideation have been reported in various studies.2,3,4 Acne is a complex, multifactorial disease, and its pathophysiology is incompletely elucidated. An impaired barrier function in acne vulgaris has been reported, as well as decreased amounts of ceramides.5 The structural and functional integrity of the stratum corneum is highly dependent on adequate hydration in the skin barrier. However, in acne-prone skin, barrier integrity is compromised both functionally (sebum excretion is higher, sebaceous glands are larger and subclinical inflammation is present) and via ultrastructural properties (filaggrin expression is enhanced, free fatty acids are reduced, linoleic acid, free sphingosine, and total ceramides are altered).6

Many of the systemic and topical medications prescribed for the treatment of acne, such as retinoids, antibiotics, and benzoyl peroxide, are associated with skin barrier alteration.7 This, in turn, can cause irritation and dry skin conditions.8 These unwanted effects can reduce adherence to treatment, and therapeutic outcomes.8,9 Over-the-counter (OTC) non‐comedogenic cleansers and moisturizers have been used successfully to reduce skin irritation.9 However, some of these products, such as those with a high pH, have been shown to interfere with the efficacy of topical treatments for acne.8 Managing the irritation potential of topical acne medications through the selective use of adjunctive, OTC skincare is an important strategy for improving treatment adherence and outcomes.

Aim of review
A literature review was conducted to explore clinical insights into skin barrier dysfunction in acne and the role of cleansing and moisturizers as adjunctive to prescription acne treatment. Informing health care providers about skin barrier dysfunction in acne and the benefits of adjunctive skincare may help them to choose the right OTC product(s) when complementing prescription therapy.