Getting the right combination for your skin
Your doctor will sometimes recommend a combination treatment for your acne. This is because acne can be treated in many different ways. Some treatments work to unblock pores while others decrease oil production and bacteria in the skin.
Fixed combination treatments
A fixed combination treatment is where two or more treatments have been formulated into one. This can be for convenience but also because both agents, when combined, work more effectively and provide better results. Getting the right combination for your skin is important so the best results can be achieved while limiting any side effects.
Fixed combinations with proven benefits include:
- Retinoid + benzoyl peroxide.
In Australia, there are currently two products with this combination. The difference is the strength of the retinoid component (adapalene) of the medicated gel.
- Epiduo gel (0.1% adapalene/2.5% benzoyl peroxide)
- Epiduo Forte gel (0.3% adapalene/2.5% benzoyl peroxide) - this product has a higher concentration of the retinoid
- Antibiotic + benzoyl peroxide
- Duac gel. This cream contains an antibiotic (clindamycin) 1.2% along with 5% benzoyl peroxide.
How to use
Most of the above preparations are designed to be used once daily. They should be applied to cleansed, dry skin and it's best to do this at night. As with all acne treatments, sun protection remains essential, particularly when using a topical retinoid such as the Epiduo products. Avoid direct sun if you're not wearing protective clothing. If you're unable to avoid direct sun, correct application of a broad-spectrum UV-A+UV-B sunscreen is essential.
As with all acne treatments, more cream/lotion is not better. In fact, using too much may irritate the skin and cause more problems. Use each preparation as your doctor has discussed with you. Generally, a thin smear is best. Some results will be seen within days but in general, the maximum effect will occur over 3-4 months of consistent application.
It's important to realise that your skin may take several days to adjust to the new treatment. People with sensitive skin may experience dryness in the first few days/weeks.
Potential side effects
Generally, there are fewer side effects with lower concentrations of these medications. Skin dryness or irritation are common complaints but usually can be managed using the tips listed in the section below.
Sunburn is something that really must be avoided!
Reduce the risks
Here are some simple tips to minimise the risk of skin dryness and irritation:
- After cleansing with a soap free cleanser, allow your skin to dry and settle for 10-15 minutes before applying the treatment
- Apply a light moisturiser around the eyes, mouth and nostrils plus neck (sensitive skin areas)
- Use the treatment on all acne affected areas of the face while avoiding the sensitive areas
- If you do encounter dryness or irritation, use the treatment every second or third day / night for the first three to four weeks. After four weeks, the skin usually adapts and you can then move to daily use. If your skin still won’t tolerate the treatment every night, using it every other night will still provide benefits but more likely, to a lesser degree.
Remember that even if you don’t apply the medicated cream/gel on the days you think you might be in the sun, your skin will still be more prone to sunburn because you are using a topical acne treatment. Apply a broad spectrum (SPF 50+ or higher) sunscreen with both UV-A and UV-B cover. Of course, physical barriers such as a broad-brimmed hat, sunglasses and long-sleeved shirt (high UPF) should also be used.
Fixed combination treatments + hormonal agents
A very common treatment regimen for successfully managing acne includes using a topical therapy along with a hormonal agent which is often the contraceptive pill. Topical therapies generally begin to show initial improvement within 2-3 weeks, if not sooner. While the pill may be more effective, it can take 8-12 weeks (or in some cases longer) to show improvements.
Also, the pill or other hormonal agents on their own may not be enough to control your acne, particularly if your acne is severe. If this is the case, the addition of a topical treatment rather than increasing the strength of the pill may be a better option in a bid to reduce side effects from a single mechanism of action.
How to use
Using both a topical agent and a hormonal agent (e.g. the pill) at the same time requires no extra special instructions than if each of them were used alone. More information on each treatment can be found in the relevant sections - retinoids, antibiotics or hormonal treatments
Potential side effects
When these therapies are used together they work on different pathways to help treat your acne. The combination of these therapies often allows a smaller dose of active ingredient to be used and therefore side effects are reduced.
Refer to the relevant sections for more information on side effects of these therapies.
Reduce the risks
Refer to the relevant sections for advice on reducing the side effects of these combined medications.