DISCUSSION
The panel recommended similar OTC products for monotherapy for mild-to-moderate acne, to recommendations given in the therapeutic algorithm for Latin American countries, Spain, and Portugal (Table 4).7 The algorithm recommends topical retinoids, antimicrobials, or fixed combinations for comedonal acne and mild-to-moderate papulopustular acne.7
Benefits were shown of various topical OTC acne products, such as SA, niacinamide, BPO, lipohydroxy acid (LHA), AHAs, retinoid, linoleic acid (LA), and zinc-based formulations.15 BPO, available as creams, gels, lotions, and washes, can treat mild acne. The antimicrobial agent BPO is active against Cutibacterium acnes (C. acnes) by releasing reactive oxygen species (ROS) and has a slight comedolytic effect.16 Additionally, BPO, in combination with topical or systemic antibiotics, prevents and treats bacterial resistance.16 A caveat to BPO is that it stains fabric, and for that reason, patients are advised not to use it in the evening to avoid staining bed-linens.
Fixed combinations such as BPO plus antibiotics or adapalene have advantages over monotherapy because they act on a variety of pathogenic factors.16
Hormonal acne therapy may be beneficial for females with hormonal changes.7
Oral antibiotics are recommended for moderate-to-severe papulopustular acne, not responding to topical treatment, and for patients with mild nodulocystic acne.7 Patients with moderate-to-severe nodulocystic acne who lack success with topical therapeutics should be treated with oral isotretinoin, oral antibiotics, or oral dapsone.7
The algorithm emphasizes skincare importance, such as gentle cleansers and moisturizers, skin barrier repair agents, OTC keratolytic agents, and sunscreen. These OTC products can be applied as monotherapy for mild acne, adjunctive, or maintenance treatment.7
Adjunctive OTC treatment recommended by the dermatologists who completed the survey is similar to the algorithm's recommendations. This is also the case for maintenance treatment, where the algorithm recommended gentle cleansers, moisturizers, topical retinoids, and BPO as the first line and azelaic acid as the second-line option.7
Topical retinoids normalize infundibular keratinization, inhibit comedogenesis and inflammation.17 Retinoids act by binding to cytoplasmic and nuclear receptors and regulate the expression of genes related to cell differentiation, lipid metabolism, apoptosis, and cell cycle.17,18 Adverse events resulting from retinoids use such as irritant contact dermatitis, erythema, pruritus, desquamation, an increased risk of photosensitivity, and postinflammatory pigmentation may be reduced by the use of moisturizers and sunscreen.13,18
Topical antibiotics have anti-inflammatory and antimicrobial effects but should not be used as monotherapy due to bacterial resistance; combinations with BPO and antibiotics seem to be a better choice.
In mild and comedonal acne, SA-based OTC products, lipo-
