Generally speaking, treatments of Acne can be divided into 1) Systemic treatments (oral medication) 2) Topical (applied to skin )

Systemic treatments:

Isotretinoin (Brand name Roaccutane)

This works by actually shrinking the sebum-producing glands and can result in curing Acne. 

It is a radical, highly effective treatment, which requires hospital referral & management.

This is because orally take Isotretinoin can damage the Liver & Blood cells. It is also highly toxic (Teratogenic –foetal defects) to the unborn baby & therefore has to be avoided in pregnancy and for up to one year after treatment is stopped.

Another problem is that it causes very dry, flaky skin, making  that the whole body itchy & irritated.

Therefore, it has to be administered with great caution & the patient has to be fully aware of these potentially serious side effects.

For these reasons, its use is restricted to severe cystic & nodular varieties of Acne, when other treatments have failed.

Some patients do not succeed with the first course and may need another course of treatment.

Oral antibiotics:

These work by reducing the bacteria in the sebaceous glands. However, they have to be taken for at least 3-6 months & resistance to the antibiotics can develop, when a low dose antibiotic is used for a long time. In addition stomach upsets and secondary oro-genital candida (thrush) can also be a problem.

Topical Treatments :

Retinoids: These are usually prescription medicines like Tretinoin (Retin A), Adapalene etc.

They work by reducing sebum production & unblocking the sebum draining ducts.

However, a major problem with these, is that it causes redness, dryness & irritation of the skin.

These retinoids also cause photosensitivity so that the skin can darken more easily when exposed to sunlight.

Therefore, dark-skinned Acne sufferers are at risk of skin darkening unevenly.

Benzoyl Peroxide (BPO)

This is a cheap, non-prescription agent that works by releasing oxygen into the skin.

Oxygen is toxic to P Acnes, which is the main infecting bacteria in Acne.

However, it is a Peroxide & therefore can irritate & cause redness of skin.

In addition, it bleaches any clothes or pillows it comes into contact with.

Its only action is anti bacterial, without addressing sebum over-production or blocked sebum ducts in Acne.

Azaleic acid

This acid works in Acne by unblocking the sebum-draining  ducts & killing the bacteria.

However, it is a weak anti microbial and can take a long time to become effective.

In addition, it is very insoluble & therefore very difficult to make high concentration solutions, which are necessary to make it effective.

Salicylic acid 2 %.

This is a fat-soluble acid and therefore easily penetrates the skin to the sebum present in Acne.

It is bactericidal in that it kills the bacteria causing the acne.

In addition, it removes the dead keratin that blocks the ducts.

It also has a strong anti-inflammatory action to reduce the redness & swelling caused by Acne.

It is non-irritating.

Niacinamide 4%.(Vitamin B3).

This vitamin has FDA license in the USA & a Medical license in the UK for use in mild to moderate acne.

It works in acne by reducing sebum production & has a powerful anti-inflammatory action to settle the redness & swelling. It does not irritate the skin.

Clindamycin 1%.

This topical antibiotic reduces the acne causing bacteria in skin.

It has been shown to be as effective a Niacinamide 4% in clinical studies. However, a major shortcoming in this product is the ease of resistant organisms that develop, so that it becomes ineffective after a very short time.

Octadecene-dioic acid (ODA or Dioic acid).

This is a new molecule that is structurally similar to Azelaic acid, but with major advances.

It has been clinically shown to be 50 times stronger than Azelaic acid in killing the Acne causing bacteria. It reduces sebum production, unblocks sebaceous ducts & has anti-inflammatory action as well.

An additional benefit is that it reduces melanin production.

Acne frequently leaves dark marks deep in skin.  ODA has the additional benefit of preventing & treating this hyperpigmentation.

It is clear from the above description that single ingredient topical products will not succeed in addressing all four components of acne, namely sebum over-production, blockage of sebum ducts, Infection & Inflammation.

Generally speaking, Retinoids & Benzoyl Peroxide should be avoided in young people with dark skin-tones because of irritation & risk of skin darkening.

Azelaic acid alone is too weak & Clindamycin stops working after one month.


Ideally, a combination of Niacinamide 4%, Salicylic acid 2 % and Dioic acid 2 % should be chosen for a young dark skinned person to cover all four components of acne.

One such product with the above combination is Acnex® cream by Pharmaclinix® that can be used safely and for a long time without irritation or resistance developing.

*Results may vary in every individual.*

Shashi Gossain
Skin care expert