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Acne Vulgaris

(Acne)

By

Jonette E. Keri

, MD, PhD, University of Miami, Miller School of Medicine

Reviewed/Revised Mar 2024
View PATIENT EDUCATION
Topic Resources

Acne vulgaris is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units (hair follicles and their accompanying sebaceous gland). Acne develops on the face and upper trunk. It most often affects adolescents. Diagnosis is by examination. Treatment, based on severity, can involve a variety of topical and systemic agents directed at reducing sebum production, comedone formation, inflammation, and bacterial counts and at normalizing keratinization.

General reference

Pathophysiology of Acne Vulgaris

Acne occurs through the interplay of 4 major factors:

  • Excess sebum production

  • Follicular plugging with sebum and keratinocytes

  • Colonization of follicles by Cutibacterium acnes (formerly Propionibacterium acnes), a normal human anaerobe

  • Release of multiple inflammatory mediators

Acne can be classified as

  • Noninflammatory: Characterized by comedones

  • Inflammatory: Characterized by papules, pustules, nodules, and cysts

Noninflammatory acne

Comedones are sebaceous plugs impacted within follicles. They are termed open or closed depending on whether the follicle is dilated or closed at the skin surface. Plugs are easily extruded from open comedones but are more difficult to remove from closed comedones. Closed comedones are the precursor lesions to inflammatory acne.

Inflammatory acne

Papules and pustules occur when C. acnes colonizes the closed comedones, breaking down sebum into free fatty acids that irritate the follicular epithelium and eliciting an inflammatory response by neutrophils and then lymphocytes, which further disrupts the epithelium. The inflamed follicle ruptures into the dermis (sometimes precipitated by physical manipulation or harsh scrubbing), where the comedone contents elicit a further local inflammatory reaction, producing papules. If the inflammation is intense, grossly purulent pustules occur.

Nodules and cysts are other manifestations of inflammatory acne. Nodules are deeper lesions that may involve > 1 contiguous follicle, and cysts are large fluctuant nodules.

Etiology of Acne Vulgaris

The most common trigger is

  • Puberty

During puberty, surges in androgens stimulate sebum production and hyperproliferation of keratinocytes.

Other triggers include

  • Hormonal changes that occur with pregnancy or the menstrual cycle

  • Occlusive cosmetics, cleansers, lotions, and clothing

  • High humidity and sweating

Associations between acne exacerbations and inadequate face washing, masturbation, eating chocolate, and sexual activity are unfounded. Some studies suggest a possible association with milk products (1 Etiology references Acne vulgaris is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units (hair follicles and their accompanying... read more Etiology references ) and high-glycemic load diets (2 Etiology references Acne vulgaris is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units (hair follicles and their accompanying... read more Etiology references ). Acne may abate in summer months because of sunlight’s anti-inflammatory effects. Proposed associations between acne and hyperinsulinism (3, 4 Etiology references Acne vulgaris is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units (hair follicles and their accompanying... read more Etiology references ) require further investigation. Some medications (eg, corticosteroids, lithium, phenytoin, isoniazid) worsen acne or cause acneiform eruptions.

Etiology references

  • 1. Adebamowo CA, Spiegelman D, Berkey CS, et al: Milk consumption and acne in teenaged boys. J Am Acad Dermatol 58(5):787-793, 2008. doi: 10.1016/j.jaad.2007.08.049

  • 2. Smith RN, Mann NJ, Braue A, et al: The effect of a high-protein, low glycemic-load diet versus a conventional, high glycemic-load diet on biochemical parameters associated with acne vulgaris: A randomized, investigator-masked, controlled trial. J Am Acad Dermatol 57(2):247-256, 2007. doi: 10.1016/j.jaad.2007.01.046

  • 3. Vora S, Ovhal A, Jerajani H, et al: Correlation of facial sebum to serum insulin-like growth factor-1 in patients with acne. Br J Dermatol 159(4):990-991, 2008. doi: 10.1111/j.1365-2133.2008.08764.x

  • 4. Nagpal M, De D, Handa S, et al: Insulin resistance and metabolic syndrome in young men with acne. JAMA Dermatol 152(4):399-404, 2016. doi: 10.1001/jamadermatol.2015.4499

Symptoms and Signs of Acne Vulgaris

Skin lesions and scarring can be a source of significant emotional distress. Nodules and cysts can be painful. Lesion types frequently coexist at different stages.

Comedones appear as whiteheads or blackheads. Whiteheads (closed comedones) are flesh-colored or whitish palpable lesions 1 to 3 mm in diameter; blackheads (open comedones) are similar in appearance but with a dark center.

Manifestations of Acne

Papules and pustules are erythematous lesions 2 to 5 mm in diameter. Papules are relatively deep. Pustules are more superficial.

Cysts are suppurative nodules. Rarely, cysts form deep abscesses. Long-term cystic acne can cause scarring that manifests as tiny and deep pits (icepick scars), larger pits, shallow depressions, or hypertrophic scarring or keloids Keloids Keloids are smooth overgrowths of fibroblastic tissue that arise in an area of injury (eg, lacerations, surgical scars, truncal acne) or, occasionally, spontaneously. Keloids are more frequent... read more Keloids .

Hyperpigmentation may result after inflammatory acne lesions resolve.

Acne conglobata is the most severe form of acne vulgaris, affecting men more than women. Patients have abscesses, draining sinuses, fistulated comedones, and keloidal and atrophic scars. The back and chest are severely involved. The arms, abdomen, buttocks, and even the scalp may be affected.

Acne fulminans is acute, febrile, ulcerative acne, characterized by the sudden appearance of confluent abscesses leading to hemorrhagic necrosis. Leukocytosis and joint pain and swelling may also be present.

Pyoderma faciale (also called rosacea fulminans) occurs suddenly on the midface of young women. It may be analogous to acne fulminans. The eruption consists of erythematous plaques and pustules, involving the chin, cheeks, and forehead. Papules and nodules may develop and become confluent.

Diagnosis of Acne Vulgaris

  • Assessment for contributing factors (eg, hormonal, mechanical, or drug-related)

  • Determination of severity (mild, moderate, severe)

  • Assessment of psychosocial impact

Diagnosis of acne vulgaris is by examination.

Differential diagnosis includes rosacea Symptoms and Signs Rosacea is a chronic inflammatory disorder characterized by facial flushing, telangiectasias, erythema, papules, pustules, and, in severe cases, phymatous changes such as rhinophyma. Diagnosis... read more Symptoms and Signs (in which no comedones are seen), corticosteroid-induced acne (which lacks comedones and in which pustules are usually in the same stage of development), perioral dermatitis Perioral Dermatitis Perioral dermatitis is an erythematous, papulopustular facial eruption that resembles acne and/or rosacea but typically starts around the mouth. Diagnosis is by appearance. Treatment includes... read more Perioral Dermatitis (usually with a more perioral and periorbital distribution), and acneiform drug eruptions (see table ). Acne severity is graded mild, moderate, or severe based on the number and type of lesions; one example of a standardized system is outlined in table Classification of Acne Severity Classification of Acne Severity Classification of Acne Severity .

Table

Treatment of Acne Vulgaris

  • Comedones: Topical tretinoin

  • Mild inflammatory acne: Topical retinoid alone or with a topical antibiotic, benzoyl peroxide, or both

  • Moderate acne: Oral antibiotic plus topical therapy as for mild acne

  • Severe acne: Oral isotretinoin

  • Cystic acne: Intralesional triamcinolone

It is important to treat acne to reduce the extent of disease, scarring, and psychological distress.

Treatment of acne involves a variety of topical and systemic agents directed at reducing sebum production, comedone formation, inflammation, and bacterial counts and at normalizing keratinization (see figure ). Selection of treatment is generally based on severity; options are summarized in table Medications Used to Treat Acne Drugs Used to Treat Acne Drugs Used to Treat Acne . (See also the 2024 guidelines of care for the management of acne vulgaris from the American Academy of Dermatology.)

Affected areas should be cleansed once or twice a day, but extra washing, use of antibacterial soaps, and scrubbing confer no added benefit.

A lower-glycemic diet and moderation of milk intake might be considered for treatment-resistant adolescent acne, but the effectiveness of these measures in treating acne remains controversial (1 Treatment references Acne vulgaris is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units (hair follicles and their accompanying... read more Treatment references ).

Peeling agents such as sulfur, salicylic acid, glycolic acid, and resorcinol can be useful therapeutic adjuncts.

Various light therapies, with and without topical photosensitizers, have been used effectively, mostly for inflammatory acne, but supporting evidence is not high quality (5 Treatment references Acne vulgaris is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units (hair follicles and their accompanying... read more Treatment references ).

Treatment should involve educating the patient and tailoring the plan to one that is realistic for the patient. Treatment failure can frequently be attributed to lack of adherence to the plan and also to lack of follow-up. Consultation with a specialist may be necessary.

How Various Medications Work in Treating Acne

How Various Medications Work in Treating Acne
Table

Mild acne

Treatment of mild acne should be continued for 6 to 12 weeks or until lesions respond. Maintenance treatment is usually necessary to maintain control.

Single-agent therapy is generally sufficient for comedonal acne. A mainstay of treatment for comedones is daily topical tretinoin as tolerated. Daily adapalene gel, tazarotene cream or gel, azelaic acid cream, and glycolic or salicylic acid are alternatives for patients who cannot tolerate topical tretinoin. Adverse effects include erythema, burning, stinging, and peeling. Adapalene and tazarotene are retinoids; like tretinoin, they tend to be somewhat irritating and photosensitizing. Azelaic acid has comedolytic and antibacterial properties by an unrelated mechanism and may be synergistic with retinoids.

Dual therapy (eg, a combination of tretinoin with benzoyl peroxide, a topical antibiotic, or both) should be used to treat mild papulopustular (inflammatory) acne. The topical antibiotic is usually erythromycin or clindamycin. Combining benzoyl peroxide with these antibiotics can help limit development of resistance. Glycolic acid may be used instead of or in addition to tretinoin but is no longer used commonly. Treatments have no significant adverse effects other than drying and irritation (and rare allergic reactions to benzoyl peroxide).

Physical extraction of comedones using a comedone extractor is an option for patients unresponsive to topical treatment. Comedone extraction may be done by a physician, nurse, or physician assistant. One end of the comedone extractor is like a blade or bayonet that punctures the closed comedone. The other end exerts pressure to extract the comedone.

Oral antibiotics (eg, tetracycline, minocycline, doxycycline, erythromycin) can be used when wide distribution of lesions makes topical therapy impractical.

Clascoterone is the first topical androgen receptor inhibitor for the treatment of acne. It can be used in patients 12 years of age and older. Clascoterone 1% cream is applied 2 times a day. Adverse effects include redness, scaling or dryness, and itching; although hyperkalemia and hypothalamic-pituitary-adrenal axis suppression have been predicted based on its mechanism, these effects have not been noticed clinically (7 Treatment references Acne vulgaris is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units (hair follicles and their accompanying... read more Treatment references ).

Moderate acne

Oral systemic therapy with antibiotics is the best way to treat moderate acne. Antibiotics effective for acne include tetracycline, minocycline, erythromycin, doxycycline, and sarecycline. Full benefit takes 12 weeks.

Topical therapy as for mild acne is usually used concomitantly with oral antibiotics.

Doxycycline and minocycline are first-line medications; both can be taken with food. Tetracycline is also reasonable, but it cannot be taken with food and may have lower efficacy than doxycycline and minocycline. Doxycycline and minocycline dosage is 50 to 100 mg orally 2 times a day. Doxycycline may cause photosensitivity, and minocycline may have more adverse effects with chronic use, including drug-induced lupus and hyperpigmentation. To reduce the development of antibiotic resistance after control is achieved (usually 2 to 3 months), the dose is tapered as much as possible to maintain control. Sarecycline is a newer tetracycline antibiotic. Antibiotics may be discontinued if topical therapy maintains control.

Erythromycin and azithromycin are other options, but they are more likely to cause gastrointestinal adverse effects and antibiotic resistance develops more often. Some physicians also use sulfamethoxazole/trimethoprim, SMX-TMP, Cotrimoxazole. However, antibacterial resistance may develop, and this combination can cause rare adverse drug reactions.

Long-term use of antibiotics may cause a gram-negative pustular folliculitis Folliculitis Folliculitis is an infection of hair follicles. Diagnosis is clinical. Treatment for most cases of bacterial folliculitis is with topical mupirocin or clindamycin. (See also Overview of Bacterial... read more Folliculitis around the nose and in the center of the face. This uncommon superinfection may be difficult to clear and is best treated with oral isotretinoin after discontinuing the oral antibiotic. Ampicillin is an alternative treatment for gram-negative folliculitis. In women, prolonged antibiotic use can cause candidal vaginitis Candidal Vaginitis Candidal vaginitis is vaginal infection with Candida species, usually C. albicans. Symptoms are usually a thick, white vaginal discharge and vulvovaginal pruritus that is often... read more Candidal Vaginitis ; if local and systemic therapy does not eradicate this problem, antibiotic therapy for acne must be stopped.

If the patient is female and unresponsive to oral antibiotics, a trial of oral antiandrogens (combined oral contraceptives and/or spironolactone) may be considered.

Severe acne

Oral isotretinoin is the best treatment for patients with moderate acne in whom antibiotics are unsuccessful and for those with severe inflammatory acne. Dosage of isotretinoin is usually 1 mg/kg once a day for 16 to 20 weeks, but the dosage may be increased to 2 mg/kg once a day. If adverse effects make this dosage intolerable, it may be reduced to 0.5 mg/kg once a day. After therapy, acne may continue to improve.

Many patients do not require a second course of treatment; when needed, it is resumed only after the medication has been stopped for 4 (a few) months, except in severe cases when it may be resumed earlier. Retreatment is required more often if the initial dosage is low (0.5 mg/kg). With this dosage (which is very popular in Europe), fewer adverse effects occur, but prolonged therapy is usually required. Cumulative dosing has gained support; a total dosage of 120 to 150 mg/kg resulted in lower recurrence rates, and some experts suggest a higher cumulative dose of 220 mg/kg (8 Treatment references Acne vulgaris is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units (hair follicles and their accompanying... read more Treatment references ).

Isotretinoin is nearly always effective, but use is limited by adverse effects, including dryness of conjunctivae and mucosae of the genitals, chapped lips, arthralgias, depression, elevated lipid levels, and the risk of birth defects if treatment occurs during pregnancy. Hydration with water followed by petrolatum application usually alleviates mucosal and cutaneous dryness. Arthralgias (mostly of large joints or the lower back) often occur. Increased risk of depression and suicide is much publicized but probably rare. Although risk of new or worsened inflammatory bowel disease (Crohn disease and ulcerative colitis) has been proposed to be associated with use of isotretinoin, such an association now appears unlikely (9 Treatment references Acne vulgaris is the formation of comedones, papules, pustules, nodules, and/or cysts as a result of obstruction and inflammation of pilosebaceous units (hair follicles and their accompanying... read more Treatment references ).

Complete blood count, liver tests, triglyceride, and cholesterol levels should be determined before treatment. Each should be reassessed at 4 weeks and, unless abnormalities are noted, need not be repeated until the end of treatment. Triglycerides rarely increase to a level at which the medication should be stopped. Liver function is seldom affected. Because isotretinoin is teratogenic, women of childbearing age are told that they are required to use 2 methods of contraception for 1 month before treatment, during treatment, and for at least 1 month after stopping treatment. Pregnancy tests should be done before beginning therapy and monthly until 1 month after therapy stops.

Cystic acne

Intralesional injection of 0.1 mL triamcinolone acetonide suspension 2.5 mg/mL (the 10 mg/mL suspension must be diluted) is indicated for patients with firm (cystic) acne who seek quick clinical improvement with reduced scarring. Local atrophy may occur but is usually transient. For isolated, very boggy lesions, incision and drainage are often beneficial but may result in residual scarring.

Other forms of acne

Pyoderma faciale is treated with oral corticosteroids and isotretinoin.

Acne fulminans is commonly treated with oral corticosteroids and systemic antibiotics.

Acne conglobata is treated with oral isotretinoin and systemic corticosteroids if severe and if systemic antibiotics fail.

For acne caused by endocrine abnormalities (eg, polycystic ovary syndrome, virilizing adrenal tumors in females), antiandrogens are indicated. Spironolactone, which has some antiandrogen effects, is sometimes prescribed to treat acne. Cyproterone acetate is used in Europe. When other measures fail, an estrogen/progestin–containing contraceptive may be tried; therapy 6 months is needed to evaluate effect.

Scarring

Small scars can be treated with chemical peels, laser resurfacing, or dermabrasion. Deeper, discrete scars can be excised. Wide, shallow depressions can be treated with subcision or injection of collagen or another filler. Fillers, including collagen, hyaluronic acid, and polymethylmethacrylate, are temporary and must be repeated periodically.

Treatment references

  • 1. Dall'Oglio F, Nasca M, Fiorentini F, Micali G: Diet and acne: Review of the evidence from 2009 to 2020. Int J Dermatol 60(6):672–685, 2021. doi: 10.1111/ijd.15390

  • 2. Koltun W, Maloney JM, Marr J, et al: Treatment of moderate acne vulgaris using a combined oral contraceptive containing ethinylestradiol 20 μg plus drospirenone 3 mg administered in a 24/4 regimen: a pooled analysis. Eur J Obstet Gynecol Reprod Biol 2011 Apr;155(2):171-5. doi: 10.1016/j.ejogrb.2010.12.027. Epub 2011 Feb 2.

  • 3. Grandhi R, Alikhan A: Spironolactone for the Treatment of Acne: A 4-Year Retrospective Study. Dermatology 233(2-3):141-144, 2017. doi: 10.1159/000471799

  • 4. Roberts EE, Nowsheen S, Davis MDP, et al: Treatment of acne with spironolactone: A retrospective review of 395 adult patients at Mayo Clinic, 2007-2017. J Eur Acad Dermatol Venereol 34(9):2106-2110, 2020. doi: 10.1111/jdv.16302

  • 5. Barbaric J, Abbott R, Posadzki P, et al: Light therapies for acne. Cochrane Database Syst Rev 9(9):CD007917, 2016. doi: 10.1002/14651858.CD007917.pub2

  • 6. Bienenfeld A, Nagler AR, Orlow SJ: Oral antibacterial therapy for acne vulgaris: An evidence-based review. Am J Clin Dermatol 18(4):469–490, 2017. doi: 10.1007/s40257-017-0267-z

  • 7. Hebert A, Thiboutot D, Stein Gold L, et al: Efficacy and safety of topical clascoterone cream, 1%, for treatment in patients with facial acne: Two phase 3 randomized clinical trials. JAMA Dermatol 156(6):621–630, 2020. doi:10.1001/jamadermatol.2020.0465

  • 8. Blasiak RC, Stamey CR, Burkhart CN, et al: High-dose isotretinoin treatment and the rate of retrial, relapse, and adverse effects in patients with acne vulgaris. JAMA Dermatol 149(12):1392–1398, 2013. doi: 10.1001/jamadermatol.2013.6746

  • 9. Lee SY, Jamal MM, Nguyen ET, et al: Does exposure to isotretinoin increase the risk for the development of inflammatory bowel disease? A meta-analysis. Eur J Gastroenterol Hepatol 28(2):210–216, 2016. doi: 10.1097/MEG.0000000000000496

Prognosis for Acne Vulgaris

Acne of any severity usually remits spontaneously by the early to mid 20s, but a substantial minority of patients, usually women, may have acne into their 40s; options for treatment may be limited because of childbearing. Many adults occasionally develop mild, isolated acne lesions. Noninflammatory and mild inflammatory acne usually heals without scars. Moderate to severe inflammatory acne heals but often leaves scarring. Scarring is not only physical; acne may be a huge emotional stressor for adolescents who may withdraw, using the acne as an excuse to avoid difficult personal adjustments. Supportive counseling for patients and parents may be indicated in severe cases.

Key Points

  • If noninflammatory, acne is characterized by comedones and, if inflammatory, by papules, pustules, nodules, and cysts.

  • Mild and moderate acne usually heals without scarring by the mid 20s.

  • Recommend that patients avoid triggers (eg, occlusive cosmetics and clothing, cleansers, lotions, high humidity, some medications, chemicals, possibly a high intake of milk products or a high-glycemic diet).

  • Consider the psychological as well as the physical effects of acne.

  • Prescribe a topical comedolytic (eg, tretinoin) plus, for inflammatory acne, benzoyl peroxide, a topical antibiotic, or both.

  • Prescribe an oral antibiotic for moderate acne and oral isotretinoin for severe acne.

  • Treat cystic acne with intralesional triamcinolone as needed for acute lesions.

More Information

The following English-language resource may be useful. Please note that THE MANUAL is not responsible for the content of this resource.

Drugs Mentioned In This Article

Drug Name Select Trade
Eskalith, Eskalith CR, Lithobid
Dilantin, Dilantin Infatabs, Dilantin-125, Phenytek
Nydrazid
Afrezza, Exubera
Altinac, Altreno, Atralin, AVITA, Refissa, Renova, Retin-A, Retin-A Micro, Tretin-X, Vesanoid
Acne Medication, Acne-10, Acneclear, Benprox , Benzac AC, Benzac W, Benzac-10, Benzac-5, Benzagel, Benzagel-10 , Benzagel-5, BenzaShave, BenzEFoam, BenzEFoam Ultra , BenzePrO, Benziq, Benziq LS, BP Cleanser, BP Cleansing Lotion, BP Foaming Wash, BP Gel, BP Topical , BP Wash, BP Wash Kit, BPO, BPO Creamy Wash, BPO Foaming Cloth, Brevoxyl-4, Brevoxyl-8, Clean&Clear Persa-Gel, Clearplex , Clearplex X, Clearskin, Clinac BPO, Del Aqua, Delos, Desquam-E, Desquam-X, EFFACLAR, Enzoclear, EPSOLAY, Ethexderm BPW, Inova, Inova Easy Pad, Lavoclen-4 , Lavoclen-8, NeoBenz Micro, NeoBenz Micro Cream Plus Pack, NeoBenz Micro SD, NeoBenz Micro Wash Plus Pack, Neutrogena Acne Cream, OC8, Oscion, Pacnex, Pacnex HP, Pacnex LP, Pacnex MX, PanOxyl, PanOxyl 10 Maximum Strength, PanOxyl 5, PanOxyl AQ, PanOxyl Aqua, PanOxyl-10, PanOxyl-5, PanOxyl-8, Peroderm, RE Benzoyl Peroxide , Riax, SE BPO, Seba, Seba-Gel, Soluclenz Rx , Theroxide, TL BPO MX, Triaz, True Marker Lintera, Zaclir, Zoderm Cleanser , Zoderm Cream, Zoderm Gel, Zoderm Redi-Pads , Zoderm Wash
Absorica, Absorica LD, Accutane, Amnesteem , Claravis , MYORISAN, Sotret, ZENATANE
Aristocort, Aristocort A, Aristocort Forte, Aristocort HP, Aristo-Pak, Aristospan, Arze-Ject-A, Azmacort, Children's Nasacort Allergy 24HR Nasal Spray, Cinalog, Cinolar, Flutex, Hexatrione, Kenalog, Kenalog in Orabase, Kenalog-10, Kenalog-40, Kenalog-80, Nasacort, Nasacort AQ, Oralone, SP Rx 228 , Tac-3 , Triacet , Triamonide , Trianex , Triderm , Triesence, XIPERE, Zilretta
Akurza , Aliclen, Bensal HP, Clear Away, Clear Away Liquid, Clear Away One Step, Clear Away Plantar, Clearasil Rapid Rescue Deep Treatment, Compound W, Compound W Total Care Wart & Skin, Corn/Callus Remover, Curad Mediplast, DermacinRx Atrix, DermacinRx Salicate, Dermarest Psoriasis Moisturizer, Dermarest Psoriasis Overnight Treatment, Dermarest Psoriasis Scalp Treatment, Dermarest Psoriasis Shampoo plus Conditioner, Dermarest Psoriasis Skin Treatment, DHS, Dr. Scholl's Callus Removers, Dr. Scholl's Corn Removers, Dr. Scholl's Extra Thick Callus Remover, Dr. Scholl's One Step Callus Remover, Dr. Scholl's One Step Corn Removers, Dr. Scholl's Ultra, Dr.Scholl's Dual Action FREEZE AWAY, Dr.Scholl's Duragel, DuoFilm Wart Remover, Freezone, Gold Bond Psoriasis Relief, Gordofilm , Hydrisalic, Ionil, Ionil Plus, Keralyt, Keralyt 5, Keralyt Scalp Complete, MOSCO Callus & Corn Remover, MOSCO One Step Corn Remover, Neutrogena Acne Wash, Neutrogena T/Sal Scalp, Occlusal-HP, P&S, RE SA , SalAC, Salactic Film , Salacyn, Salex, Salimez, Salimez Forte, Salisol , Salisol Forte , Salitech, Salitech Forte, Salitop , Salkera, Salvax, Salycim, Scalpicin 2 in 1 Anti-Dandruff, Selsun Blue, Thera-Sal , Trans-Ver-Sal, UltraSal-ER, VIRASAL, Wart-Off, XALIX
Aldactone, CAROSPIR
Differin, Differin Pump, Plixda
ARAZLO, Avage, Fabior, TAZORAC
Azelex, Finacea, Finacea Plus, Finevin
A/T/S, Akne-mycin, E.E.S., Emcin Clear , EMGEL, E-Mycin, ERYC, Erycette, Eryderm , Erygel, Erymax, EryPed, Ery-Tab, Erythra Derm , Erythrocin, Erythrocin Lactobionate, Erythrocin Stearate, Ilosone, Ilotycin, My-E, PCE, PCE Dispertab , Romycin, Staticin, T-Stat
Cleocin, Cleocin Ovules, Cleocin Pediatric, Cleocin T, CLIN, Clindacin ETZ, Clindacin PAC, Clindacin-P, Clinda-Derm , Clindagel, ClindaMax, ClindaReach, Clindesse, Clindets, Evoclin, PledgaClin, XACIATO
Emtet-500, Panmycin, Sumycin
Amzeeq, Arestin, Cleeravue-M, Dynacin, Minocin, minolira, Myrac, Solodyn, Ximino, Zilxi
Acticlate, Adoxa, Adoxa Pak, Avidoxy, Doryx, Doxal, Doxy 100, LYMEPAK, Mondoxyne NL, Monodox, Morgidox 1x, Morgidox 1x Kit, Morgidox 2x , Morgidox 2x Kit, Okebo, Oracea, Oraxyl, Periostat, TARGADOX, Vibramycin, Vibra-Tabs
Winlevi
Seysara
Azasite, Zithromax, Zithromax Powder, Zithromax Single-Dose , Zithromax Tri-Pak, Zithromax Z-Pak, Zmax, Zmax Pediatric
Bacter-Aid DS , Bactrim, Bactrim DS, Septra, Septra DS, Sulfatrim, Sulfatrim Pediatric, Sultrex Pediatric
Principen
Slynd
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