INTRODUCTION
Although many quality prescription products exist for the treatment of acne, we continue to search for ways to improve patient care. Our patients search as well, often adding or substituting internet finds for proven regimens, occasionally with deleterious consequences. It is incumbent upon clinicians to be well-versed in ways in which nonprescription active skin care ingredients can improve patient outcomes. It is the clinician’s responsibility to guide patients in their quest for self-care, helping them to choose quality products, improve safety and reduce cost.
In a previous study, the results of a modified Delphi consensus meeting were reported where the term “acneceutical” was coined to encompass nonprescription formulations with ingredients efficacious in acne.1 A thorough literature search resulted in the identification of candidate ingredients that were divided into categories based on the pathophysiology of acne: sebum inhibitors, anti-inflammatory agents, antibacterial agents, keratolytic agents, and those that repair the deficient barrier (Table 1). These candidates were vetted for those that were studied in patients with acne in double or single-blind, vehicle-controlled, or active-compared designs. Combination products and proprietary blends to which patients would not have access were omitted as were benzoyl peroxide and adapalene, viewing them as drugs, not acneceuticals.
In this paper, we present an algorithm incorporating these acneceuticals into acne management as monotherapy, adjunctive therapy (to pharmaceuticals or procedures), and maintenance therapy following discontinuation of prescription medications.
Algorithm Development
The algorithm focuses on integrating acneceuticals into an acne management and maintenance regimen. The algorithm went through numerous iterations as individual acneceuticals were evaluated for quality of data, proposed mechanism of action, and their likely role in acne care. This information guided the panel to crystallize the most salient subdivisions and branchpoints of the algorithm. The panel reviewed and edited the final algorithm in a consensus conference.
