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Topical Treatments

Select Treatments:
  • What is it?
  • How does it work?
  • Who is this for?
  • Who is this not for?
  • How well does it work?
  • What are the possible side effects?
  • Will it inconvenience me?
  • How much does it cost?
  • Other

Topical Treatments

What is it?

Azelaic Acid

Azelaic acid comes as a gel, foam, or cream. A thin film should be gently but thoroughly massaged into the skin twice a day.

Benzoyl Peroxide

Benzoyl peroxide is available on its own, or in combination with topical antibiotics or topical retinoids. It often comes as a gel, foam, or cream to wash the skin, or to leave on after washing.

Salicylic Acid

Salicylic acid often comes in foams, creams, and gels. It can be used to wash or moisturize the face, or as spot treatment.

Topical Antibiotics

These treatments come as a gel, cream, or lotion to spread on or massage into the skin. They can also come in a pledget, which is a small piece of wet cotton or gauze that can be wiped on the skin.

The topical antibiotics used for acne are:

  • Clindamycin
  • Combinations with benzoyl peroxide
  • Erythromycin

Topical Dapsone (Aczone)

Dapsone comes as a gel and is applied to the skin.

Topical Retinoids

These products are made from vitamin A. They often come in gels or creams. To use them, apply a thin layer to your skin daily in the evening.

These are the topical retinoids used for acne:

  • Adapalene
  • Tazarotene
  • Tretinoin

How does it work?

ExampleFoamFaceWash
e.g. Foam face wash

Azelaic Acid

Azelaic acid kills the bacteria that trigger acne. It also reduces inflammation of acne spots. It also helps the skin shed dead skin cells without blocking pores.

Benzoyl Peroxide

Benzoyl peroxide kills the bacteria that trigger acne, and reduces inflammation of acne spots. It can also help shed dead skin cells without blocking pores.

Salicylic Acid

Salicylic acid helps the skin shed dead skin cells without blocking pores.

Topical Antibiotics

These kill the bacteria that trigger acne. They also help to reduce inflammation of acne spots.

Topical Dapsone (Aczone)

Dapsone reduces inflammation of acne spots. It may also kill the bacteria that trigger spots.

Topical Retinoids

These kill the bacteria that trigger acne and reduce inflammation of acne spots. They also help the skin shed dead skin cells without blocking pores.

Who is this for?

Azelaic Acid

Mild to moderate acne.

Benzoyl Peroxide

Mild to moderate acne. It can also be used in combination with other treatments for moderate to severe acne.

Salicylic Acid

Anyone with acne.

Topical Antibiotics

Mild to moderate acne.

Topical Dapsone (Aczone)

Dapsone is often for people with moderate acne and particularly for adult women with acne.

Topical Retinoids

Very mild to moderate acne. They are sometimes combined with other products for more severe acne.

Who is this not for?

Azelaic Acid

Some people are sensitive or allergic to azelaic acid. Check with your doctor to make sure this treatment is right for you.

Benzoyl Peroxide

Some people are sensitive or allergic to benzoyl peroxide. Check with your doctor to make sure this treatment is right for you.

Salicylic Acid

Not for anyone with a high sensitivity or allergy to salicylic acid.

Topical Antibiotics

Some people are sensitive or allergic to antibiotics. People who have had colitis may not be able to take this treatment. Check with your doctor to make sure this treatment is right for you.

Topical Dapsone (Aczone)

Not for anyone with a high sensitivity or allergy to dapsone.

Topical Retinoids

Some people are sensitive or allergic to topical retinoids. Check with your doctor to find out if this treatment is right for you.

How well does it work?

Azelaic Acid

Compared to people taking no treatment, people taking azelaic acid saw 29% fewer acne spots.

(4/4 stars evidence)

Benzoyl Peroxide

Compared to people taking no treatment, people taking benzoyl peroxide saw 13% fewer acne spots.

(4/4 stars evidence)

Benzoyl peroxide works quickly, and people often see improvement after 3 weeks.

Salicylic Acid

There is not enough evidence to show how well this works. It has been used for decades to treat acne and is very well trusted.

Topical Antibiotics

Compared to people taking no treatment, people taking topical antibiotics saw 21% fewer acne spots.

(Evidence ranged from 3 to 4 stars depending on the type of antibiotic)

Topical Dapsone (Aczone)

Compared to people taking no treatment, people taking dapsone saw 7% fewer acne spots. (The quality of this evidence is not yet graded by clinical practice guidelines)

Topical Retinoids

Compared to people taking no treatment, people taking topical retinoids saw 19% fewer acne spots.

(4/4 stars evidence)

What are the possible side effects?

Azelaic Acid

Serious: None.

Other: Mild skin irritation.

Pregnancy: Category B. No risk has been shown during pregnancy while taking this drug. We do not yet know if there is a risk of taking this drug while breastfeeding. If you are breastfeeding, let your doctor know.

Benzoyl Peroxide

Serious: None.

Other: Skin irritation or sensitivity.

Pregnancy: Category C. We do not yet know if there is a risk of taking this drug while pregnant or breastfeeding. If you are pregnant or planning to get pregnant, let your doctor know.

Salicylic Acid

Serious: None.

Other: Mild skin irritation.

Pregnancy: Category C. We do not yet know if there is a risk of taking this drug while pregnant. If you are pregnant or planning to get pregnant, let your doctor know. Salicylic acid is not safe for breastfeeding women. Breastfeeding women should not apply it to the breast area.

Topical Antibiotics

Serious: There are no serious side effects associated with erythromycin.

There are possible risks of serious side effects with clindamycin, including severe digestive system infections or allergic reactions (anaphylaxis). Partial hearing loss may be a side effect of clindamycin on its own. There is not enough evidence to know exactly what the chances of these serious side effects are.

The bacteria in your body can become resistant to these medications if they are taken alone. This means that over time they can stop working to clear up your acne or cure other sickness. That is why they are prescribed with benzoyl peroxide or topical retinoids.

Other: Mild skin irritation, sensitivity to sunlight.

Pregnancy: Category B. No risk has been shown during pregnancy while taking this drug. We do not yet know if there is a risk of taking this drug while breastfeeding.

Topical Dapsone (Aczone)

Serious: People taking this drug have reported methoglobinemia, a blood disorder. We cannot know for sure if the drug caused this side effect.

Other: Dry skin.

Pregnancy: Category C. We do not yet know if there is a risk of taking this drug while pregnant. Dapsone is not safe for breastfeeding women. If you are breastfeeding, pregnant, or planning to get pregnant, let your doctor know.

Topical Retinoids

Serious: None.

Other: Mild skin irritation, sensitivity to cold and sun.

Pregnancy: Adapalene and tretinoin are Category C. We do not yet know if there is a risk of taking this drug while pregnant or breastfeeding.
Tazarotene is Category X and is not considered safe during pregnancy. We do not yet know if there is a risk of taking this drug while breastfeeding. If you are pregnant, planning to get pregnant, or breastfeeding let your doctor know.

Will it inconvenience me?

Azelaic Acid

Applying azelaic acid may be inconvenient when acne covers a lot of your skin, is hard to reach, or is covered by clothing.

Benzoyl Peroxide

Benzoyl peroxide needs to be taken for as long as you have acne to keep seeing results.
Benzoyl peroxide should be used once or twice daily. This may be inconvenient when acne covers a lot of your skin, is hard to reach, or is covered by clothing.

Salicylic Acid

Salicylic acid can be applied to the skin once, twice, or three times a day. This may not be practical if acne covers a lot of your skin, is hard to reach, or is covered by clothing.

Topical Antibiotics

These treatments should be used once or twice daily. This may be inconvenient when acne covers a lot of your skin, is hard to reach, or is covered by clothing.

Topical Dapsone (Aczone)

Dapsone should be applied to the skin twice a day. This may not be practical if acne covers a lot of your skin, is hard to reach, or is covered by clothing.

Topical Retinoids

These products need to be applied daily. This may be inconvenient when acne covers a lot of your skin, is hard to reach, or is covered by clothing.

How much does it cost?

Azelaic Acid

Azelaic acid starts at $1000 USD for a three month supply and is often covered by insurance.

Benzoyl Peroxide

Benzoyl peroxide is available over-the-counter (no prescription needed). Costs for over-the-counter products vary, and they are often not covered by insurance; however, they can be much cheaper than similar prescription products. When a prescription is given, benzoyl peroxide is often covered by insurance.

Salicylic Acid

Salicylic acid is available over-the-counter (no prescription needed). Costs vary but can be much cheaper than similar prescription products.

Topical Antibiotics

Topical antibiotics start around $25 USD for a three month supply and are often covered by insurance.

Topical Dapsone (Aczone)

Dapsone starts at $650 USD for a three month supply and is often covered by insurance.

Topical Retinoids

Topical retinoids start around $90 USD for a three month supply and are often covered by insurance. Topical retinoids need a prescription, other than Adapalene, which is available over-the-counter (no prescription needed).

Prices as of 2016 and may vary by region.

Other

Benzoyl Peroxide

Benzoyl peroxide can bleach clothing and fabrics.

Be careful not to use topical products more often than prescribed or to wash with harsh cleansers or scrubs. This can irritate your skin.