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A Multifaceted Approach to Acne

By: Lawrence Samuels, MD
Posted: January 30, 2012, from the February 2012 issue of Skin Inc. magazine.
acne patient

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Sulfur. Micronized, elemental sulfur—or sodium sulfacetamide—has antibacterial properties that are responsible for its ability to eliminate active acne lesions. A worry for some is that an allergy to sulfa drugs may cause them to have problems with products that contain natural, elemental sulfur; however, no one is allergic to natural, elemental sulfur. The sulfur atom is not an allergenic agent. However, sulfa drugs are more appropriately labeled sulfonamides. Sulfonamides are not allergenic, but they have the ability to form sulfonamide-protein complexes that can be allergenic in some individuals.

Allantoin. Allantoin is a diureide of glyoxylic acid and is a natural botanical extract of the comfrey plant. Its keratolytic effect enhances the desquamation of dead skin cells, and it forms complexes with irritating sebum and sensitizing bacteria that cause excess oil production and acne lesions. Controlling skin surface oil and reducing skin bacteria promotes skin healing. Allantoin reduces abnormal keratinization and reduces bacterial colonization in the pilosebaceous unit, but its major corrective effect is eliminating abnormal sebum production.


Client expectations are a critical step in initiating therapy for acne. Realistic expectations and time lines for improvement will encourage client compliance. Typically, mild acne will improve 30–50% in 12 weeks and 60% or better by 26 weeks with appropriate treatment.3 Moderate acne or acne rosacea will improve 20–40% in 12 weeks and 50% or better by 26 weeks.3 The treatment of acne vulgaris is a long-term process that must be individualized for each client. The two most important factors for the initial treatment of acne are based on skin type, and the severity of the acne. In addition, benzoyl peroxides can oxidize other acne medications, rendering them ineffective.3 Studies indicate that there is a synergistic effect in improving acne when benzoyl peroxides are combined with other compatible anti-acne ingredients, but these are only available by prescription.3 These studies indicate that using several active ingredients that are compatible and work together to address the various causes of acne produce better and faster results than a treatment program with a single active ingredient.3 Effective cleansers can contain ingredients such as salicylic acid and glycolic acid; effective acne treatment products can contain azelaic acid, benozyl peroxide or salicylic acid; and effective acne spot treatments can contain precipitated sulfur, benzoyl peroxide or salicylic acid.

Acne treatment requires the ability to make treatment modifications for each client based on the individual acne lesions and skin type. In clients with oily skin, reducing skin oiliness increases the effectiveness of other acne medications. Clients with significant comedones will benefit from keratolytic ingredients and certain skin peels. Acne clients are not immune to sun damage and should use a hypoallergenic, noncomedogenic sunscreen on a daily basis.

Acne is recognized as a multifactorial disease that requires clinical finesse and a multifaceted approach to therapy, and the treatment of acne requires the use of scientifically advanced skin care products, as well as clinical experience.