Topical retinoids are particularly useful in patients with skin of color, due to the combined effect of comedolysis and reducing hyperpigmentation, Dr. Alexis says. Some retinoids demonstrate anti-inflammatory effects, such as adapalene. Dr. Alexis also uses benzoyl peroxide (BPO) in his therapeutic regimen because it can inhibit the P. acnes that drives a lot of the inflammatory component of acne. It indirectly reduces inflammation.
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Other agents that can be used to reduce the inflammatory component include topical dapsone 5% gel and azaleic acid, the latter of which can also help address the PIH.
“There are a range of treatment options and the key is to come up with a regimen that is tolerable. Not only should it be efficacious and have strong anti-inflammatory and comedolytic effects, but it also has to be well-tolerated. If we induce irritation with our regimen, then we can also cause more pigment alteration, leading to disgruntled patients,” Dr. Alexis says.
Choosing the appropriate vehicle and concentration of the agent used, especially when considering BPO and the retinoids, is also key in achieving positive clinical outcomes, Dr. Alexis says. The availability of new vehicles and formulations has very much helped in this regard.
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Aqueous gels in particular, which are the basis of most branded products, are preferable to the ethanolic gel formulations of some generic products.