Patient education about skin irritation is an integral part of acne treatment to manage expectations and improve treatment adherence. Therefore, it is important to obtain a detailed history regarding personal care products being used by SOC acne patients as some products such as toners, scrubs, and astringents and devices can be irritating. In all patients, thoughtful selection of prescription therapies and adjuvant skincare should minimize irritation. Adjusting topical treatment regimens known to cause skin irritation during the first 2–4 weeks has been shown to improve tolerability without impacting overall efficacy.64 Cleansers that do not contain soap with a near-physiological skin pH and moisturizers can be used to improve both topical treatment efficacy and tolerability.10,65
Preferred OTC products are cosmetically elegant (texture), non-irritating, well-tolerated, anti-inflammatory, and should help restore the skin barrier function. Hydrating cleansers may be the most appropriate type of cleanser for SOC acne-prone skin or those with acne as they are associated with a low risk of skin irritation. Effective moisturizers typically include ceramides, humectants, emollients, oil absorbers, or have anti-inflammatory and barrier replenishing properties.
A consensus paper stated that dryness and skin irritation resulting from acne treatment could be improved using ceramide-containing cleansers and moisturizers, enhancing treatment adherence.63 The authors proposed that the skincare regimen should be an essential part of the acne prevention, treatment, and maintenance care regimen.63 Skincare is a necessary part of acne treatment and is part of various acne guidelines.42,44-46 A vast array of OTC skincare products are available and safe for SOC acne patients (Table 3).62,63,66 The type of acne and individual patient characteristics can help determine the appropriate OTC skincare when used in conjunction with topical or systemic acne therapies.62,63,66,67 These OTC products can be especially helpful in acne maintenance care. Examples are alpha hydroxy acid (AHA) and beta-hydroxy acid (BHA) containing serum, ceramides-containing foaming cleanser, a soap-free exfoliating cleanser, adapalene, and benzoyl peroxide (BPO) containing products (Table 4).62,63,66,67 Some cleansers, scrubs, and topical medications such as retinoids and BPO may alter the skin barrier, causing irritation and dry skin.62,63,66 Especially in individuals with skin prone to irritation, these products have the potential to reduce adherence to treatment and therapeutic outcomes.62,63,66 Cleansers with gentle surfactants and hydrating ingredients and adjunctive non-comedogenic moisturizers are key to maximizing tolerability of acne regimens in acne patients, especially those with SOC, among whom irritation can result in undesirable pigmentary sequelae.
Preferred OTC products are cosmetically elegant (texture), non-irritating, well-tolerated, anti-inflammatory, and should help restore the skin barrier function. Hydrating cleansers may be the most appropriate type of cleanser for SOC acne-prone skin or those with acne as they are associated with a low risk of skin irritation. Effective moisturizers typically include ceramides, humectants, emollients, oil absorbers, or have anti-inflammatory and barrier replenishing properties.
A consensus paper stated that dryness and skin irritation resulting from acne treatment could be improved using ceramide-containing cleansers and moisturizers, enhancing treatment adherence.63 The authors proposed that the skincare regimen should be an essential part of the acne prevention, treatment, and maintenance care regimen.63 Skincare is a necessary part of acne treatment and is part of various acne guidelines.42,44-46 A vast array of OTC skincare products are available and safe for SOC acne patients (Table 3).62,63,66 The type of acne and individual patient characteristics can help determine the appropriate OTC skincare when used in conjunction with topical or systemic acne therapies.62,63,66,67 These OTC products can be especially helpful in acne maintenance care. Examples are alpha hydroxy acid (AHA) and beta-hydroxy acid (BHA) containing serum, ceramides-containing foaming cleanser, a soap-free exfoliating cleanser, adapalene, and benzoyl peroxide (BPO) containing products (Table 4).62,63,66,67 Some cleansers, scrubs, and topical medications such as retinoids and BPO may alter the skin barrier, causing irritation and dry skin.62,63,66 Especially in individuals with skin prone to irritation, these products have the potential to reduce adherence to treatment and therapeutic outcomes.62,63,66 Cleansers with gentle surfactants and hydrating ingredients and adjunctive non-comedogenic moisturizers are key to maximizing tolerability of acne regimens in acne patients, especially those with SOC, among whom irritation can result in undesirable pigmentary sequelae.
LIMITATIONS
Limitations in the number, size, and methodologies of studies do not allow for conclusive recommendations; however, the
available data suggest that strategies to improve outcomes in
acne patients should consider racial/ethnic differences.
CONCLUSION
Racial/ethnic differences in the clinical presentation, sequelae, and desired treatment outcomes for acne have been reported. Notwithstanding limitations in the number, size, and methodologies of studies to date, the available data suggest that strategies to improve outcomes in acne patients with SOC include:
I. Early initiation and maintenance of comprehensive treatment regimens that address multiple pathogenic factors of acne.
II. Careful consideration of the tolerability of active ingredients, vehicles, and dosing regimens.
III. Use of adjunctive fragrance-free, moisturizing, barrier preserving, pH balanced, non-irritating skincare to maximize tolerability and minimize the risk of irritation or dryness. Application of non-comedogenic moisturizers on top of topical prescription treatment if dryness, stinging, or burning is present.
IV. Establishing acne and PIH clearance as desired endpoints while designing regimens that address both of these concerns.
V. Consider cultural variations in skin and hair care that may contribute to acne or affect tolerability of prescribed regimens
I. Early initiation and maintenance of comprehensive treatment regimens that address multiple pathogenic factors of acne.
II. Careful consideration of the tolerability of active ingredients, vehicles, and dosing regimens.
III. Use of adjunctive fragrance-free, moisturizing, barrier preserving, pH balanced, non-irritating skincare to maximize tolerability and minimize the risk of irritation or dryness. Application of non-comedogenic moisturizers on top of topical prescription treatment if dryness, stinging, or burning is present.
IV. Establishing acne and PIH clearance as desired endpoints while designing regimens that address both of these concerns.
V. Consider cultural variations in skin and hair care that may contribute to acne or affect tolerability of prescribed regimens
DISCLOSURES
The authors disclosed receipt of an unrestricted educational grant from CeraVe USA for support with the research of this work and also received consultancy fees for their work on this project.
All authors contributed to the development and review of this work and agree with the content.
All authors contributed to the development and review of this work and agree with the content.
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2. Vos T, Flaxman AD, Naghavi M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990–2010: a systematic analysis for the Global Burden of Disease study 2010. Lancet. 2012;380:2163-2196.
3. Tan JK, Bhate K. A global perspective on the epidemiology of acne. Br J Dermatol. 2015;172(Suppl 1):3-12.
4. Rocha MA, Bagatin E. Adult-onset acne: prevalence, impact, and management challenges. Clin Cosmet Investig Dermatol. 2018;11:59-69.
5. Perkins AC, Cheng CE, Hillebrand GG, et al. Comparison of the epidemiology of acne vulgaris among Caucasian, Asian, Continental Indian and African American women. J Eur Acad Dermatol Venereol. 2011;25:1054-60. PubMedGoogle Scholar
6. Davis SA, Narahari S, Feldman SR, Huang W, et al. Top dermatologic conditions in patients of color: An Analysis of Nationally Representative Data. J Drugs Dermatol. 2012;11(4):466-73.
7. Callender VD, Alexis AF, Taylor SC, et al. Racial differences in clinical characteristics, perceptions and behaviors, and psychosocial impact of adult female acne. J Clin Aesthet Dermatol. 2014;7(7):19-31. PMC4106354/
