II. Indication

III. Approach

  1. Comedolytics result in similar effect after 90 days
  2. Start with less irritating agents (see below)
  3. Apply skin products in layers
    1. First, apply Comedolytic
    2. Next, apply Skin Lubricant (skin Moisturizer)
    3. Last, apply sun screen
    4. (2017) Presc Lett 24(1): 3

IV. Preparations: Standard Comedolytics

  1. Benzoyl Peroxide (Ambi 10, Dermoxyl, Vanoxide and other OTC)
  2. Salicylic acid (Buf-Puf and other OTC)
  3. Tretinoin (Retin-A)
  4. Adapalene (Differin, 0.1% gel is OTC as of 2017)
  5. Trifarotene (Aklief)
    1. Expensive new Retinoid (45 g for $560) released in 2020 that is pump dispensed cream
    2. Marketed as a more specific Retinoid with the presumption that it is better tolerated (but without convincing evidence)
      1. Other generic Retinoids (e.g. Differin) is preferred
    3. References
      1. (2020) Presc Lett 27(2): 8

V. Preparations: Less Irritating Comedolytics

  1. Creams are less irritating than gels
  2. Benzoyl Peroxide 2.5% water-based
  3. Tretinoin agents
    1. Retin A Micro (Tretinoin gel microsphere)
    2. Avita
  4. Adapalene (Differin)
    1. Better tolerated than Tretinoin

VI. Preparations: Combination agents (Comedolytic with antibiotic)

  1. Refrigeration required
    1. Erythromycin with Benzoyl Peroxide (Benzamycin)
  2. Refrigeration not required
    1. Benzoyl Peroxide, Glycolic Acid, Zinc (TRIAZ)
    2. Clindamycin with Benzoyl Peroxide Gel

VII. Preparations: Special indications

  1. Most irritating and potent agents
    1. Tazorac 0.1% gel qod
  2. Pregnancy
    1. Azelaic Acid (Azelex)

VIII. References

  1. Kaplan (2001) CMEA Medicine Lecture, San Diego

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Ontology: Keratolytic Agents (C0022585)

Definition (MSH) Agents that soften, separate, and cause desquamation of the cornified epithelium or horny layer of skin. They are used to expose mycelia of infecting fungi or to treat corns, warts, and certain other skin diseases.
Concepts Pharmacologic Substance (T121)
MSH D007641
SnomedCT 2871004, 280906005, 373478008
English Agents, Desquamating, Agents, Keratolytic, Desquamating Agents, Keratolytic Agents, Agents, Skin-Peeling, Skin Peeling Agents, Skin-Peeling Agents, keratolytics (medication), keratolytics, keratolytic agents, keratolytic, keratolytic agent, Keratolytic agent (product), Keratolytic, Keratolytic (product), Keratolytic agent (substance), Keratolytic agent, Keratolytic agent, NOS, Keratolytic (substance), Dermatological Keratolytics
French Agents kératolytiques, Médicaments kératolytiques, Agents desquamants, Kératolytiques
Swedish Keratolytiska medel
Czech keratolytika
Finnish Keratolyytit
Japanese 角質溶解剤, 剥離性剤, 角質溶解薬
Italian Sostanze peeling, Sostanze cheratolitiche, Desquamanti
Polish Leki keratolityczne
Portuguese Descamadores, Ceratolíticos, Agentes Ceratolíticos, Agentes Descamadores, Fármacos Ceratolíticos
Spanish Queratolíticos, Descamantes, agente queratolítico (producto), Agentes Descamantes, Fármacos Queratolíticos, Agentes Queratolíticos, agente queratolítico (sustancia), agente queratolítico, queratolítico (producto), queratolítico
German Keratolytika, Schälmittel