Products in the Treatment of Acne

Many of the over the counter products commonly used in the treatment of acne contain benzoyl peroxide, salicylic acid or Azelaic acid. These products can be too harsh and drying which results in the body producing more oil to compensate for the oils stripped from the skin by the harsher products. Often your skin still appears oily so you apply more of the product, which in turn causes the skin to produce more oil to protect itself from the harmful ingredients. Astringent soaps and any astringent agents that shrink the skin pores such as witch hazel, alum, oatmeal, very cold water, and rubbing alcohol should be avoided, as they shrink pores, trapping more body oils in the skin.

Salicylic acid is an ingredient commonly used to remove calluses from your feet. Salicylic acid belongs to the family of ingredients called Beta Hydroxy Acid or BHA. Beta Hydroxy Acid or BHA is a derivative of aspirin and is often used in skin care products to accelerate skin cell turnover and help clear pores. It can penetrate more deeply than Alpha Hydroxy Acid and is gentler. This occurs in nature in sweet birch and in wintergreen leaves. Its effect on the epidermis and upper dermis are similar to those of Retin-A, but with less irritation. It is soluble in oil and can exfoliate oily skin areas, even within oil-rich pores. Therefore, it has a beneficial effect on acne, pigmentary disturbances, and sun damaged skin. Because it does exfoliate, use of sun protection is needed. But too much can have a negative effect causing increased facial redness, skin irritation, and more acne.

BHA ingredients may be listed on packaging inserts under the following names: Salicylic acid, Salicylate, Sodium salicylate, Willow extract, Beta hydroxybutanoic acid, Tropic acid, or Trethocanic acid. Currently, the most commonly used BHA in cosmetics is salicylic acid. On rare occasions, citric acid is also listed as a BHA in cosmetic formulations; although, citric acid is more commonly considered to be an AHA.

The long-term safety of salicylic acid in cosmetics is being evaluated in studies initiated by FDA and sponsored by the National Toxicology Program. These U.S. government-sponsored studies are examining the long-term effects of both glycolic acid (an AHA) and salicylic acid on the skin's response to ultraviolet (UV) light. These studies have determined that applying glycolic acid to the skin can make people more susceptible to the damaging effects of the sun, including sunburn. Until these safety assessments are completed, FDA advises that similar precautions be taken for the use of cosmetics containing AHAs and BHAs. These precautions are:

1) Test any product that contains a BHA on a small area of skin before applying it to a large area.

2) If you use cosmetics with BHAs and experience skin irritation or prolonged stinging, stop using the product and consult your physician.

3) Follow the use instructions on the label. Do not exceed the recommended applications

4) Avoid using BHA-containing products on infants and children.

5) Use sun protection if you use a BHA product.

Benzoyl peroxide, like most peroxides, is a powerful bleaching agent. Contact with fabric (including clothing and bed linens) or hair can cause permanent color dampening almost immediately. At high concentrations, benzoyl peroxide is highly flammable and explosive and should be handled with care. In the United States, the typical concentration for benzoyl peroxide is 2.5% to 10% for both prescription and over the counter use.

Other common uses for benzoyl peroxide include dyeing hair, and as an active ingredient in teeth whitening systems. It is also used in the preparation of flour, and can be used as an initiator and catalyst for polyester thermoset resins (as an alternative to the much more hazardous methyl ethyl ketone peroxide). When used as an initiator, benzoyl peroxide is thought to form two identical radical molecules through homolytic cleavage of the peroxide bond.

Benzoyl peroxide breaks down in contact with skin, producing benzoic acid and oxygen, neither of which is significantly toxic. When applied to skin benzoyl peroxide has been shown to cause cancer when used in acne treatments.

Benzoyl peroxide removes the top layer of skin, which also decreases the sun protective effect (roughly SPF 3). This can cause sunburn and premature aging if sun protection is not worn. If sun protection is used, benzoyl peroxide has similar effects to glycolic acid peels, which are so-called anti-aging treatments.

Azelaic acid gel is used to clear the bumps, lesions, and swelling caused by rosacea (a skin disease that causes redness, flushing, and pimples on the face). Azelaic acid cream is used to treat acne. Azelaic acid is in a class of medications called dicarboxylic acids. It works to treat acne by killing the bacteria that infect pores and by decreasing production of keratin, a natural substance that can lead to the development of acne. The way azelaic acid works to treat rosacea is not known by medical scientist and dermatologist.

Azelaic acid may cause side effects. The following symptoms are likely to affect the skin you are treating with azelaic acid. Tell your doctor if any of these symptoms are severe or do not go away: itching, burning, stinging, or tingling. Some side effects can be serious. If you develop a rash, call your doctor immediately. Azelaic acid may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

Even though your skin may be oily in some areas, it still needs oil as a natural ‘protective barrier’ from bacteria to prevent acne. When your skin has become damaged by the use or over use of acne products containing benzoyl peroxide, salicylic acid or azelaic acid, applying jojoba oil to the skin “tricks” the skin into thinking there is sufficient oil on the skin so the body slows oil production to that area of the skin to prevent it from being too dry. When the skin is too dry, the skin pores shrink with resulting ‘clogged pores’.