Topical medications are the foundation of therapy for the majority of acne patients. However, use of these products is usually regarded by patients to be time-consuming, difficult, irritating, and comparatively less effective than oralmedications.

Adherence to topical agent use is also compromised by the delay in time to effect, the potential complexity of treatment procedures, and the need to incorporate cosmetics such as foundations, moisturizers, and sunscreen. Although adherence rates to the use of topical acne medications have previously been reported to be as high as 48%-49% [Flanders PA, et al. Behav Res Ther 23:225-7 (1985); Flanders P, et al. J Psychol 118:31-6 (1984)], a recent Canadian observational study of acne patients provided a rate of only 24% (Tan J. unpublished data).

In this group of patients, the most common reasons for poor adherence were absent-mindedness, side-effects, didn’t feel the need, and hassle. Poor adherence to topical acne therapy results in treatment failure, wasted health care resources, and discontent with physician care. This article offers tips to maximize adherence and efficacy of topical acne therapy.

While choosing topical acne products, the following considerations may promote the degree of adherence:

• convenience of anatomical site for topical therapy (i.e., face, chest and shoulders are accessible; the back is harder to treat)
• effectiveness
• acceptability, e.g., facial erythema, irritation, dryness, redness, and scaling
• cosmetic suitability
• simple regimen
• convenience and
• easy application.

Patients should then be examined at 2-4 weeks to encourage adherence and to check for potential side effects; then every 2-3 months to assess treatment effectiveness.

Types of Treatment Vehicles: With a view to determine the most appropriate topical treatment regime for each patient, physicians must carry out an individualized assessment including disease severity, skin type, formulation availability, patient preference, and considerations like delivery vehicle. Active agents are prepared in a variety of vehicles to sort out the possible combinations.

Normally, patients with drier skin prefer creams for their moisturizing effect while those with an oily skin prefer gels and solutions. The use of foams may be mostly well suited for application to relatively larger regions and hair bearing sites.

Creams are available in oil and water base formulations, tend to be less irritating, help to retain moisture in the skin, are most suitable for patients with dry or sensitive skin, and may result in an oily feel due to thicker consistency.

Lotions can have either water or alcohol base, are the most versatile, can be used for all skin types, can cause skin irritation, e.g., burning and dryness, have a lighter feel, which patients may prefer, and preferred for treatment of large or hairy areas.

Solutions usually contain an alcohol base, which can aggravate dryness and irritation.

Gels contain high water content, are most suitable for oily skin types, have a cooling effect on the face, may leave a surface residue, and tend to cause skin irritation, e.g., burning and dryness.

Foams spread easily, especially helpful if treating larger areas of the body and leave minimal residue on skin surface.

The range of effective topical acne medications can be grouped into the following:

Antibiotics that include Clindamycin, Erythromycin, and Sodium sulfacetamide

Combination Products that include Benzoyl peroxide (BPO) + antibiotic and Topical retinoid + antibiotic and

Retinoids. It includes Adapalene. It is photostable, can be applied in the morning. Tazarotene; It is also photostable, can be applied in the morning. And Tretinoin; It is photolabile, best to apply in evening. Its Micronized version may be less irritating, but is a little more costly.