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What's New About Acne Medication Side Effects

ECHEMI 2022-05-13

Acne is a chronic inflammatory skin disease of the pilosebaceous unit, which is closely related to factors such as excessive sebum secretion, blockage of the pilosebaceous duct, bacterial infection and inflammatory response. The clinical manifestations are characterized by pleomorphic skin lesions such as acne, papules, pustules, and nodules that occur on the face. Topical medication is the main treatment plan for mild to moderate acne. For non-inflammatory acne, there are salicylic acid, benzoyl peroxide, vitamin A, etc., and for inflammatory acne, additional antibiotics or other antibacterial measures are required. There are also a variety of physical and chemical treatments, including photodynamic, red and blue light, laser and photon therapy, and chemical peeling treatments. There are various methods of acne treatment on the market. Some of the treatment methods are not yet certain in terms of efficacy, lack of evidence-based medical evidence to support, and some acne medication side effects can even be harmful to the body. To this end, the acne medication side effects are sorted out in combination with clinical guidelines for readers' reference.

Topical retinoic acid

Common clinical retinoic acid preparations include retinoic acid (1st generation), tazarotene (3rd generation), and adapalene (3rd generation). Common adverse reactions are exfoliation, erythema, dryness, burning or itching, and the severity is dose-related. Among them, tazarotene is the most irritating, and about half of the patients who use it daily have local skin irritation symptoms; adapalene has fewer adverse reactions and is highly tolerated by patients. In addition, external use of retinoic acid will increase the sensitivity of the skin to ultraviolet rays, so it is necessary to use sunscreen in daily life. Symptoms of retinoic acid-mediated skin irritation tend to be self-limiting, generally peaking in the 4th week after dosing, and then gradually improving. When benzoyl peroxide and salicylic acid are used in combination, retinoic acid-mediated adverse reactions, such as exfoliation and erythema, are exacerbated. Mild skin irritation reactions such as erythema and scaling may occur locally, accompanied by tightness and burning sensation, which can be gradually tolerated over time. It is recommended to discontinue the drug if the irritation reaction is severe.

Oral retinoids

Representative drugs include isotretinoin and viaminate, which are used to inhibit sebaceous gland lipid secretion, regulate abnormal keratinization of pilosebaceous ducts, improve the anaerobic environment of hair follicles to reduce the reproduction of Propionibacterium acnes, anti-inflammatory and prevent scarring, etc. It is the only oral drug currently targeting the four key pathophysiological links in the pathogenesis of acne. The common adverse reaction is dry skin and mucous membranes. It is recommended to use it with skin barrier repairing agents. Long-term use before puberty may cause premature epiphysis closure, bone hyperplasia, and osteoporosis, so children under 12 should not use it as much as possible. Isotretinoin may cause mental system disorders, and it should be used with caution in patients with obvious depressive symptoms or depression. Isotretinoin may be related to benign intracranial pressure elevation, and its combination with tetracyclines may increase the occurrence of this adverse reaction, and simultaneous use should be avoided. Isotretinoin may be associated with dyslipidemia, including elevated serum triglyceride and cholesterol levels, and blood lipid levels should be monitored regularly. In view of the case reports of severe skin damage after the use of isotretinoin in foreign countries, such as erythema multiforme, it is recommended that patients should seek medical attention in time when severe skin damage occurs.

Benzoyl peroxide

The representative drug is benzoyl peroxide gel, which is a kind of non-antibiotic bacteriostatic drug. By releasing new ecological oxygen and benzoic acid, it inhibits and kills Propionibacterium acnes, anti-inflammatory and mildly dissolves acne. Topical drug of choice for acne. The drug can be used alone or in combination with topical retinoids or topical antibiotics. Common adverse reactions include local erythema, dryness, and exfoliation, which are self-limited.

Topical antibiotics

Commonly used topical antibiotics include clindamycin and erythromycin, which are less irritating. Common skin irritation symptoms include erythema, dry and burning pain, and systemic adverse reactions such as diarrhea or pseudomembranous colitis are rare.


Isotretinoin is a metabolite of vitamin A. It is usually used to treat severe inflammatory acne, nodular cystic acne, or intractable diseases. The adverse reactions are similar to those of hypervitamin A syndrome. Symptoms of eyes, gastrointestinal tract, nervous system, mental and rheumatic diseases.


The above are the common acne medication side effects. When using various drugs, patients must be aware of the various acne medication side effects to avoid aggravating the condition.

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