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Diagnosis and treatment of acne Page 3
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Diagnosis and treatment of acne

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TABLE 2

 

 

Selected Topical Medications for the Treatment of Acne 

                                         Cost *

Medication              Formulation      (quantity/weight)

Retinoids

 

Adapalene (Differin)    Gel 0.1%         $42 (15 g)

                        Cream 0.1%       $42 (15 g)

                        Pledget 0.1%     $79 (60 count)

                        Solution 0.1%    $79 (30 mL)

 

Tazarotene (Tazorac)    Gel 0.05%        $74 (30 g)

                        Gel 0.1%         $78 (30 g)

                        Cream 0.05%      $74 (30 g)

                        Cream 0.1%       $78 (30 g)

 

Tretinoin (Retin-A)     Cream 0.025%     $42 (20 g)

                        Cream 0.05%      $47 (20 g)

                        Cream 0.1%       $55 (20 g)

                        Gel 0.01%        $33 (15 g)

                        Gel 0.025%       $34 (15 g)

                        Solution 0.05%   $71 (28 mL)

 

Tretinoin microsphere   Gel 0.04%        $42 (20 g)

(Retin-A Micro)         Gel 0.1%         $42 (20 g) 

Antibiotics 

Clindamycin (generic)   Gel 1%           $32 (30 g)

                        Lotion 1%        $60 (60 mL)

                        Solution 1%      $23 (30 mL)

                        Swab 1%          $46 (60 swabs)

 

Erythromycin            Gel 2%           $18 (30 g)

                        Solution 2%      $8 (60 mL) 

Other 

Azelaic acid (Azelex)   Cream 20%        $49 (30 g)

 

Benzoyl peroxide        Gel: 2.5%, 5%,   $24 (90 g)

(various)                 or 10%

                        Wash: 2.5%,      $25 to $30

                          5%, or 10%       (227 mL)

 

Sulfacetamide           Lotion 10%       $104 (118 mL)

(Klaron) 

Sulfacetamide/          Lotion 10%/5%    $51 (25 g)

sulfur (Sulfacet-R) 

Medication              Dosage                  Side effects 

Retinoids 

Adapalene (Differin)    Once or twice daily,    Same as tretinoin but

                        but can be once every   less severe

                        other day if not well

                        tolerated 

Tazarotene (Tazorac)    Once daily              Same as tretinoin but

                                                more severe 

Tretinoin (Retin-A)     Once daily, but can     Dryness, scaling,

                        use once every other    erythema, burning,

                        day if not tolerated    irritation, and

                                                photosensitivity 

Tretinoin microsphere   Once daily, but can     Dryness, scaling,

(Retin-A Micro)         use once every other    erythema, burning,

                        day if not tolerated    irritation, and

                                                photosensitivity 

Antibiotics 

Clindamycin (generic)   Twice daily             Local irritation;

                                                stains clothes 

Erythromycin            Twice daily             Local irritation;

                                                stains clothes 

Other 

Azelaic acid (Azelex)   Twice daily             Dryness, scaling,

                                                erythema, burning,

                                                irritation, pruritus;

                                                rarely,

                                                hypopigmentation 

Benzoyl peroxide        Once or twice daily     Erythema, peeling,

(various)                                       contact dermatitis,

                                                dryness 

Sulfacetamide           Twice daily             Itching, redness,

(Klaron)                                        irritation, and rare

                                                severe hypersensitivity

                                                reactions;

                                                contraindicated for

                                                those with sulfa

                                                allergies 

Sulfacetamide/          Twice daily             Same as sulfacetamide

sulfur (Sulfacet-R) 

*--Average wholesale cost, based on Red Book, Montvale, N.J.:

Medical Economics Data, 2003. 

TABLE 3

Selected Systemic Medications for the Treatment of Acne 

Medication              Dosage                       Cost * (quantity)

 

Erythromycin stearate   250 mg twice daily           $4 (30 tablets)

  (Erythrocin)          500 mg twice daily

Erythromycin base       250 mg                       $9 (30 tablets)

  (generic)             500 mg                       $8 (30 tablets) 

Doxycycline hyclate     50 mg twice daily            $70 (30 capsules

  (Doryx)               75 mg twice daily            $75 (30 capsules)

                        100 mg twice daily           $76 (30 capsules)

Doxycycline             50 mg once or twice daily    $75 (30 capsules)

  (Vibramycin)          100 mg once or twice daily   $135 (30 capsules)

Doxycycline (generic)   50 mg once or twice daily    $22 (30 capsules)

                        100 mg once or twice daily   $41 (30 capsules) 

Tetracycline            250 mg two to four times     $8 (30 capsules)

  (generic)               daily

                        500 mg two to four times     $8 (30 capsules)

                          daily 

Minocycline (Minocin)   50 mg once or twice daily    $70 (30 capsules)

                        100 mg once or twice daily   $117 (30 capsules)

Minocycline (generic)   50 mg once or twice daily    $50 (30 capsules)

                        100 mg once or twice daily   $100 (30 capsules) 

Isotretinoin            10 mg (Start 0.5 to 1 mg     $225 (30 capsules)

  (Accutane)              per kg per day;

                          therapeutic range is 0.5

                          to 2 mg per kg per day

                          divided in two doses for

                          15 to 20 weeks)

                        20 mg                        $280 (30 capsules)

                        40 mg                        $326 (30 capsules) 

Isotretinoin            10 mg                        $219 (30 capsules)

  (Amnesteem)           20 mg                        $260 (30 capsules)

                        40 mg                        $302 (30 capsules) 

Medication              Side effects 

Erythromycin stearate   Nausea, vomiting, diarrhea, anorexia,

  (Erythrocin)          abdominal pain and cramps, pruritus, rash,

Erythromycin base       stomatitis,  melena, elevated liver

  (generic)             transaminase levels, jaundice, eosinophilia 

Doxycycline hyclate     Dyspepsia, nausea, vomiting, anorexia,

  (Doryx)               diarrhea, photosensitivity, stomatitis,

Doxycycline             discolored teeth (if patient is younger than

  (Vibramycin)          eight years), esophagitis, lightheadedness,

Doxycycline (generic)   dizziness, vertigo, ataxia, headache,

                        tinnitus, drowsiness, reported pseudotumor

                        cerebri 

Tetracycline            Same as doxycycline

  (generic) 

Minocycline (Minocin)   Same as doxycycline, plus rare lupus-like

Minocycline (generic)   syndrome, or rare hypersensitivity reaction,

                        and skin and mucous membrane hyperpigmentation 

Isotretinoin            Common: cheilitis, dry skin and mucous

  (Accutane)              membranes, pruritus, epistaxis,

                          conjunctivitis, photosensitivity, arthralgia,

Isotretinoin              hypertriglyceridemia, elevated liver

  (Amnesteem)            transaminase levels, decreased night vision

                        Rare: corneal opacities, pseudotumor cerebri,

                          hyperostosis, hepatotoxicity, major birth

                          defects, cataracts, premature epiphyseal

                          closure, neutropenia,

                          thrombocytopenia, reported cases of

                          depression 

*--Average wholesale cost, based on Red Book, Montvale, N.J.:

Medical Economics Data, 2003.

The authors indicate that they do not have any conflicts of interest. Sources of funding: Dr. Feldman has received grant support from Roche Dermatology and is a speaker on the use of Roche's acitretin (Soriatane) in the treatment of psoriasis. He notes that he has not received funds for publishing articles on, or in promotion of, isotretinoin. Dr. Feldman also has received grant support from Galderma Laboratories, manufacturer of adapalene (Differin), and from Ortho Dermatological, manufacturer of tretinoin (Retin-A).

Figures 1 through 3 provided by Steven Feldman, M.D., Ph.D.

REFERENCES

(1.) Gollnick HP, Zouboulis CC, Akamatsu H, Kurokawa I, Schulte A. Pathogenesis and pathogenesis related treatment of acne. J Dermatol 1991;18:489-99.

(2.) Holmes RL, Williams M, Cunliffe WJ. Pilo-sebaceous duct obstruction and acne. Br J Dermatol 1972;87:327-32.

(3.) White GM. Acne therapy. Adv Dermatol 1999;14: 29-59.

(4.) Zaenglein AL, Thiboutot DM. Acne vulgaris. In: Bolognia JL, Jorizzo JL, Rapini RP, eds. Dermatology. New York: Mosby, 2003:533-4.
 

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