Tips for reducing side effects of topical acne creams, gels and lotions

Reducing the Dryness, Flaking and Peeling from Acne Creams, Gels and Lotions

Using topical treatments for acne can be frustrating. Most of them are drying to the skin, causing flaking, redness and sometimes irritation. They may appear to make acne worse in the beginning as the acne is brought to the surface sooner than if no treatment is used. Small percentages of patients are allergic to benzoyl peroxide and develop immediate redness, swelling and itching after it is applied. Benzoyl peroxide bleaches colored clothing and pillowcases. Retinoids (Retin A, Differin, and Tazorac) cause sun sensitivity. Most of them are expensive. I am always amazed that patients tell me that they saw another physician and were given a surface treatment, but no instructions about how to use them, the initial side effects, how to prevent them and what to do if they occur. However, I hear it often enough, that I have to believe it.

The side effects from surface acne medications tend to cause patients more distress than the side effects from oral acne medications. The initial dryness, flaking and peeling is frustrating, especially when the acne has not yet begun to improve. This can look even worse if foundation makeup is applied. However, some initial dryness and flaking with the use of acne creams, gels and lotions is normal, discomfort is not.

Dryness, Flaking and Peeling from Acne Creams, Lotions and Gels

Dryness and flaking can be reduced by applying Oil Free Moisturizer twice a day and on top of your medication, and changing from Balancing to Gentle Toner. Flaking can also be reduced by using our Antioxidant Enzyme Peel first thing in the morning before washing your face. I am not a fan of granular exfoliant scrubs and facial brushes for patients using topical acne treatments as it disrupts the epithelial barrier and can actually cause more flaking and peeling.

These side effects usually get better over time. It is best to try the above strategies, and/or to use them every other or every third night than to use them for a week then stop for a week when the side effects get bad. If you use them consistently, over time your skin usually gets used to them and the dryness, peeling and flaking gets much better. If you stop when your skin peels, and restart when it seems normal, it will just start peeling again because the skin layer has built up. If you work into it by using them every other or every third night, over time, the reaction will be less and you can slowly move up to every night or every other night. Even if you can’t move up, it is better to use them every third night than one week on, two weeks off or stop them all together. That’s because they really will help prevent and treat acne, and make the red and brown marks left over from old acne blemishes go away more quickly.

Discomfort, Itching, Stinging and Burning Acne Creams, Lotions and Gels

Discomfort can be reduced by applying Oil Free Moisturizer underneath your medication, or applying medication only every other night. Therefore, if you are having just dryness and flaking when using acne creams, gels and lotions, you should apply an oil free moisturizer on top of the medication, and twice a day. If you are having irritation, stinging, burning then buffer the medication by applying an oil free moisturizer before you apply the medication. Whatever you apply to your skin first is preferentially absorbed into the skin, so you are in effect diluting the medication until your skin becomes used to it. Sometimes we even have patients do what we cleverly call “a retinoid sandwich” which is moisturizer—retinoid—moisturizer. If that doesn’t help enough, then use the every other or every third night strategy. If you are still having problems, call your dermatologist for further instructions; don’t just stop your medicine.

Where to Apply Acne Creams, Gels and Lotions

Another very important point about using surface acne treatments---they work best and are meant to be applied daily to the entire area that is acne prone. They are not meant to dry out an individual acne blemish. They will dry out the blemish and leave you with a nice little “collar” of peeling; however, the goal is to prevent acne blemishes from appearing at all two to three months later. We take great pains to educate patients about this, and ask patients at every visit whether they are applying their treatments to the whole area or “spot treating.” Even with this, I am astonished at how often the reply is that patients are spot treating only. Moreover, almost all patients who have seen other physicians are spot treating their acne too.

APPLY YOUR SURFACE ACNE TREATMENTS TO THE ENTIRE AREA AFFECTED BY ACNE TO PREVENT NEW ACNE AND KEEP YOU CLEAR. Pretty please.

Risks with Acne Creams, Gels and Lotions

The retinoids tretinoin (Retin-A or generic tretinoin), adapalene (Differin or generic adapalene), and tazarotene (Tazorac) and to a lesser degree salicylic acid, glycolic acid and benzoyl peroxide all make you more sensitive to the sun. You should always wear a non-comedogenic, non-acnegenic sunscreen with a SPF of 30 or higher, like DCL Super Sheer Sunscreen SPF 50, every day. If you are planning extended sun exposure don’t use these medications the night before, or morning of, your activity.

Another important point—Retin A, Tazorac, Differin, salicylic acid, glycolic acid and benzoyl peroxide should be stopped 3-5 days before facial waxing, hair removal, facial procedures or chemical peels, unless you are instructed otherwise by your dermatologist. If you don’t, you will be sorry. Waxing will pull of the skin along with the wax, as in my post Bride waxes 3 days before wedding—disaster ensues. Chemical peels will penetrate deeper than planned, causing crusting, and may even cause pigment problems or scarring. If you are not having these procedures done in your dermatologist’s office, the technician should always ask you if you are using any topical acne treatments or taking isotretinoin. If they don’t, be wary.

Final Points About Topical Acne Treatment

Sometimes, acne worsens during early treatment. This is frustrating but normal and means that treatment is working. As pores open, next month's pimple is brought out earlier. Judge the effectiveness of any acne treatment program after 2- 3 months, by the decrease in new acne pimples. Old pimples and brown or red discoloration may take months to fade. Treatment must be continued to maintain improvement. Do not stop your program because you are better.

Keep up the good fight and don’t get discouraged.

Elaine Cook MD