anti-inflammatory, reductant of sebum, dryness, irritation), may improve the penetration of prescribed topical medications, or may help mitigate side effects of treatments.22 Appropriate use of OTC products may help improve the effectiveness of acne treatment, minimize side effects, and reduce the need for topical antibiotics. This is of growing importance in a world where C. acnes resistance progresses at an alarming rate due to continued antibiotic use.4 The need for alternative, non-antibiotic treatments for acne is now widely accepted.5
Several groups have produced independent acne treatment guidelines, but few have previously considered practices specific to the APAC region. A group of global experts, including from nine Asian countries and the United States, have previously gathered to review clinical trial data and local practice patterns. This resulted in the development of a best practice algorithm and recommendations for the treatment of acne in Asian patients.15 The experts concluded that physicians and other care providers should be educated on non-pharmacological options for effective acne therapy.
In 2015, twenty-one Asian dermatologists from Hong Kong, India, Indonesia, Malaysia, Philippines, Singapore, Taiwan, Thailand, Vietnam, and Italy met to discuss and provide insight into current treatment practices in acne therapy and OTC product recommendations. The advisors reviewed the perspectives of dermatologists from different centers around APAC that regularly treat acne patients and achieved a general consensus that OTC agents can target various etiopathogenic factors relevant to acne.23 This may include antibacterial and antiinflammatory properties, reduction of sebum, dryness, irritation, photosensitivity, and enhancing the penetration of prescribed topical medications.22 Most of the OTC products reviewed by the experts were found to include components that target inflammation, wound healing, photoaging, hyperpigmentation, or uneven skin texture.23
Recent advances in understanding normal skin physiology and the pathophysiology of acne should allow for the development of OTC therapies capable of offering a broad spectrum of treatment targets.6,24 For example, OTC products can now be manufactured in such a way as to make them especially suitable as an acne treatment/monotherapy or an adjunct to mitigate side effects of another treatment. Previous studies have found that moisturizers can improve disease severity in patients with mild-to-moderate acne,13,25 and that a greater reduction in lesion counts, papules, pustules, C. acnes colonization, and sebum production is observed after eight weeks of adjunctive use, compare to treatment alone.26 Since there is an overwhelming amount of OTC products available, clinicians should be wellequipped with the knowledge base to advise patients on the products best suitable for their skin.
Future Directions
Product development
There is a need to consider the unique characteristics of acneprone Asian skin to identify better therapeutic strategies, management techniques and improve clinical outcomes.17 OTC acne products targeting Asian skin should be suitable for sensitive skin, susceptible to post-inflammatory hyperpigmentation. Moreover, given the skin barrier disruptions observed in acne, there may be unique benefits of ceramide-containing cleansers and moisturizers for patients with this chronic, relapsing disorder.27 OTC products targeted for acne-prone skin should also promote the maintenance of an acidic skin surface, which may help to ensure skin barrier integrity and reduce dry, irritated skin.28,29 This can be achieved by the product being compatible with a pH of 4 to 5.
Education
Physicians and patients should be educated on the varied uses of OTC products for acne-prone skin (Figure 2). Educating physicians may encourage them to recommend these products to patients being prescribed acne treatments known to be topically irritating to help mitigate side effects, improve treatment compliance, and improve the effectiveness of prescription medications. Conversely, efforts to directly educate the general population on the proper use of adjunctive OTC acne care may be particularly important, as many acne sufferers selfmanage their condition and do not consult with clinicians.30,31 For example, a study on treatment-seeking behaviors showed that most Korean patients primarily sought skin care advice from different media outlets; and had a tendency to favor traditional medicine methods. Moreover, as acne treatment in Asia comes from various providers [e.g., dermatologists, primary care physicians, non-healthcare personnel (beauticians)], publishing recommendations for managing Asian patients with acne can be helpful to many professionals offering aesthetic and cosmetic care.15 In fact, in many Asian countries, the proportion of dermatologists to the overall population is low; therefore, most patients are not managed by specialists. A survey of 200 participants revealed that 41% of acne sufferers use a moisturizer to cope with the unwanted side effects of their topical acne treatments.32 Therefore, there are many nonmedical care providers and patients that would benefit from the guidance of dermatologists regarding the armamentarium of OTC products.15
Several groups have produced independent acne treatment guidelines, but few have previously considered practices specific to the APAC region. A group of global experts, including from nine Asian countries and the United States, have previously gathered to review clinical trial data and local practice patterns. This resulted in the development of a best practice algorithm and recommendations for the treatment of acne in Asian patients.15 The experts concluded that physicians and other care providers should be educated on non-pharmacological options for effective acne therapy.
In 2015, twenty-one Asian dermatologists from Hong Kong, India, Indonesia, Malaysia, Philippines, Singapore, Taiwan, Thailand, Vietnam, and Italy met to discuss and provide insight into current treatment practices in acne therapy and OTC product recommendations. The advisors reviewed the perspectives of dermatologists from different centers around APAC that regularly treat acne patients and achieved a general consensus that OTC agents can target various etiopathogenic factors relevant to acne.23 This may include antibacterial and antiinflammatory properties, reduction of sebum, dryness, irritation, photosensitivity, and enhancing the penetration of prescribed topical medications.22 Most of the OTC products reviewed by the experts were found to include components that target inflammation, wound healing, photoaging, hyperpigmentation, or uneven skin texture.23
Recent advances in understanding normal skin physiology and the pathophysiology of acne should allow for the development of OTC therapies capable of offering a broad spectrum of treatment targets.6,24 For example, OTC products can now be manufactured in such a way as to make them especially suitable as an acne treatment/monotherapy or an adjunct to mitigate side effects of another treatment. Previous studies have found that moisturizers can improve disease severity in patients with mild-to-moderate acne,13,25 and that a greater reduction in lesion counts, papules, pustules, C. acnes colonization, and sebum production is observed after eight weeks of adjunctive use, compare to treatment alone.26 Since there is an overwhelming amount of OTC products available, clinicians should be wellequipped with the knowledge base to advise patients on the products best suitable for their skin.
Future Directions
Product development
There is a need to consider the unique characteristics of acneprone Asian skin to identify better therapeutic strategies, management techniques and improve clinical outcomes.17 OTC acne products targeting Asian skin should be suitable for sensitive skin, susceptible to post-inflammatory hyperpigmentation. Moreover, given the skin barrier disruptions observed in acne, there may be unique benefits of ceramide-containing cleansers and moisturizers for patients with this chronic, relapsing disorder.27 OTC products targeted for acne-prone skin should also promote the maintenance of an acidic skin surface, which may help to ensure skin barrier integrity and reduce dry, irritated skin.28,29 This can be achieved by the product being compatible with a pH of 4 to 5.
Education
Physicians and patients should be educated on the varied uses of OTC products for acne-prone skin (Figure 2). Educating physicians may encourage them to recommend these products to patients being prescribed acne treatments known to be topically irritating to help mitigate side effects, improve treatment compliance, and improve the effectiveness of prescription medications. Conversely, efforts to directly educate the general population on the proper use of adjunctive OTC acne care may be particularly important, as many acne sufferers selfmanage their condition and do not consult with clinicians.30,31 For example, a study on treatment-seeking behaviors showed that most Korean patients primarily sought skin care advice from different media outlets; and had a tendency to favor traditional medicine methods. Moreover, as acne treatment in Asia comes from various providers [e.g., dermatologists, primary care physicians, non-healthcare personnel (beauticians)], publishing recommendations for managing Asian patients with acne can be helpful to many professionals offering aesthetic and cosmetic care.15 In fact, in many Asian countries, the proportion of dermatologists to the overall population is low; therefore, most patients are not managed by specialists. A survey of 200 participants revealed that 41% of acne sufferers use a moisturizer to cope with the unwanted side effects of their topical acne treatments.32 Therefore, there are many nonmedical care providers and patients that would benefit from the guidance of dermatologists regarding the armamentarium of OTC products.15
LIMITATIONS
Asians represent extensive populations that are not well
defined. Relationships between age, skin type, geographical
area, specific acne symptoms, skincare, and acne treatment are
not extensively studied
CONCLUSION
The advisors agreed that OTC products, such as cleansers and
