Acne medications come in topical and oral forms, each targeting different aspects of acne formation. Topical treatments like retinoids and benzoyl peroxide work locally, while oral medications like antibiotics and isotretinoin provide systemic effects.

Nurses play a crucial role in patient education and monitoring. They must assess acne severity, teach proper application techniques, and watch for side effects. Patient education focuses on consistent use, realistic expectations, and managing potential skin irritation.

Acne Medications

Main types and mechanisms of action

• Topical treatments target acne locally
  • Retinoids (tretinoin, adapalene) normalize follicular keratinization prevents comedone formation and reduces inflammation
  • Benzoyl peroxide has antibacterial properties reduces Propionibacterium acnes (P. acnes) and has mild keratolytic and comedolytic effects unclogs pores
  • Topical antibiotics (clindamycin, erythromycin) reduce P. acnes and inflammation
  • Salicylic acid is a keratolytic agent unclogs pores and has mild anti-inflammatory properties
• Oral treatments work systemically
  • Oral antibiotics (tetracyclines, macrolides) reduce P. acnes and inflammation commonly prescribed are minocycline and doxycycline
  • Hormonal therapies (combined oral contraceptives, spironolactone) decrease androgen production and sebum secretion
  • Isotretinoin reduces sebum production normalizes follicular keratinization and has potent anti-inflammatory effects

Effectiveness and potential side effects

• Topical treatments
  • Effectiveness for mild to moderate acne provides localized treatment may take several weeks to show improvement
  • Side effects include skin irritation dryness peeling and redness benzoyl peroxide may bleach fabrics
• Oral treatments
  • Effectiveness for moderate to severe acne provides systemic treatment may take several weeks to months to show improvement
  • Side effects include gastrointestinal upset photosensitivity (antibiotics) hormonal side effects thromboembolism risk (hormonal therapies) teratogenicity dry skin and mucous membranes elevated liver enzymes hypertriglyceridemia (isotretinoin)

Key nursing considerations

• Patient assessment
  • Evaluate acne severity and type (comedonal, inflammatory, nodulocystic)
  • Assess for contraindications and drug interactions
• Medication administration
  • Educate patients on proper application techniques for topical treatments
  • Emphasize the importance of consistent use and patience for results
  • Monitor for adverse effects and treatment response
• Special considerations for oral treatments
  • Obtain baseline liver function tests and lipid panel before starting isotretinoin
  • Counsel female patients on teratogenic risks and pregnancy prevention (isotretinoin, hormonal therapies)
  • Advise patients on photosensitivity and sun protection (antibiotics)

Patient education plan

• Topical treatments
  • Demonstrate proper application techniques start with a small amount and gradually increase as tolerated
  • Apply to entire affected area not just individual lesions
  • Use non-comedogenic and oil-free moisturizers (CeraVe, Neutrogena) and sunscreens (Elta MD, La Roche-Posay)
  • Expect mild irritation and dryness which usually subsides with continued use
• Oral treatments
  • Take medications as prescribed with food if needed to minimize gastrointestinal upset
  • Use sun protection (SPF 30+) and avoid excessive sun exposure (antibiotics)
  • Be aware of potential side effects and report any concerns to the healthcare provider
  • For isotretinoin emphasize the importance of pregnancy prevention and monthly monitoring with pregnancy tests and contraception
• General advice
  • Maintain a gentle skincare routine avoiding harsh scrubs or excessive washing
  • Be patient as improvement may take several weeks to months
  • Follow up with the healthcare provider regularly to assess progress and adjust treatment as needed