Over-the-Counter Treatments Effective Against Acne

They work as well as antibiotics and cost less, study finds

FRIDAY, Dec. 17, 2004 (HealthDayNews) -- Over-the-counter products for mild-to-moderate facial acne are just as effective as prescription antibiotics -- and they can cost much less, a new study finds.

The big difference between the products is price, with over-the-counter preparations containing benzoyl peroxide sometimes costing one-tenth the price of some prescription antibiotics. Benzoyl peroxide is found in dozens of over-the-counter acne treatments, the researchers said.

"There were no vast differences [in effectiveness] between different treatments, including the treatments you can get over-the-counter," said Dr. Tony Avery, co-author of the study that appears in the Dec. 17 issue of The Lancet. Avery is head of the division of primary care, School of Community Health Sciences, Queen's Medical Centre, University of Nottingham, in England.

Avery said he felt many doctors did not have good comparative information about the different acne products. But some dermatologists said the study's conclusions weren't particularly new and would not lead to substantive changes in their clinical practice.

"Basically if someone with mild acne presents for treatment, your first line of defense will be a topical regimen. Most dermatologists don't prescribe an oral antibiotic for someone with just mild-to-moderate acne," said Dr. Sumayah Jamal, an assistant professor of dermatology at New York University School of Medicine in New York City.

According to the study authors, most adolescents have acne at some point; many adults also suffer from the condition. Antibiotics have been an important part of treatment for the past 40 years.

However, concerns exist about increasing antibiotic resistance due to overuse of the drugs.

Avery and his colleagues compared five treatment options for acne in about 650 participants. The treatments were: the oral antibiotics oxytetracycline or minocycline; the topical antibiotic erythromycin; the antimicrobial lotion benzoyl peroxide; or a combination of topical erythromycin and benzoyl peroxide.

Effectiveness was similar in all groups: 55 percent of those individuals in the oxytetracycline group reported moderate or greater improvement at 18 weeks; 54 percent in the minocycline group reported similar improvement. So did 60 percent of those taking benzoyl peroxide alone, 66 percent of those taking topical erythromycin plus benzoyl peroxide in a combined formulation, and 63 percent of those taking topical erythromycin and benzoyl peroxide separately.

It's not entirely clear how the different therapies actually work against acne, said study co-author Hywel C. Williams, a professor of dermato-epidemiology at Queen's Medical Centre, University of Nottingham.

"Oral antibiotics probably work partly as anti-inflammatory agents, as well as having a direct antibiotic effect in killing the bacteria," he explained. "Topical antibiotics and topical benzoyl peroxide also decrease inflammation and kill bacteria. But they also have a beneficial effect in preventing a build-up of dead skin that clogs up the pores (blackheads), the first step in the development of an acne lesion."

Benzoyl peroxide was the cheapest treatment (12 times less expensive than minocycline) and was as effective as the combination that included erythromycin and benzoyl peroxide. That was a surprise, Avery said. "In most areas of health care and in most areas of life, you expect to get something more for something more expensive," he said.

The effectiveness of the oral antibiotics appeared to have been compromised as a result of bacterial resistance, the researchers said.

"One useful thing that comes from this study is that benzoyl peroxide is useful because it overcomes the need to determine the antibiotic resistance," Jamal said.

Even so, doctors and patients need to be mindful that different people respond to different treatments. "There are always differences between individuals," Avery said.

More information

Visit the American Academy of Dermatology for more on acne.

SOURCES: Sumayah Jamal, M.D., assistant professor, dermatology, New York University School of Medicine, New York City; Tony Avery, M.D., head, division of primary care, School of Community Health Sciences, the Medical School, Queen's Medical Centre, University of Nottingham, England; Hywel C. Williams, Ph.D., professor, dermato-epidemiology, Centre of Evidence-Based Dermatology, Queen's Medical Centre, University of Nottingham, England; Dec. 17, 2004, The Lancet
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