Retittoic Acid. Tretinoin (Retin-A) may be used as n solution, cream, or gel. It is available In 0,01, 0.025, 0.05, and 3.

1 pr cent concentrations. A popular form is 0.C5 per cent tretinnin in a vanishing cream base. This is especially effective against comedones too small to express. It is less effective for the treatment of pustular and cystic acne. Retinoic acid may produce severe irritation of erythema at the onset of treatment; if it does, it should be used only once daily or even every other day until the shin becomes tolerant. Therapy is generally started with daily application of the 005 per cent cream. It may take eight to 12 weeks before marked improvement (Kant In cases slow to respond to topical retinoic acid cream, swabs moistened with retinoic acid solution may be necessary. Its ability to profoundly affect follicular keratinization makes this an excellent comedolytic medication. Topical Antibacterials. In addition to the benzoyl peroxide already mentioned above, the antibiotics are effective in reducing the levels of free fatty acids in the comedonic follicle. CLINDAMYCIN. Cleocin T Topical Solution gel, and lotion, 1 per cent clindamycin, are in a "roll-on" dispenser, or a 1 per cent solution in 70 per cent alcohol. Their use is the same as that of tetracycline and erythromycin. Of these three antibiotics, clindamycin is believed to be the most effective in decreasing the count of P. acnes. Stoughton found it was the only antibiotic that 3ctually sterilized the follicles. There is considerable difference of opinion regarding the efficiency of these lotions in the treatment of acne vulgaris. It is mostly effective against pustules and small papulopustular lesions, but has little effect on cystic lesions and comedones. ERYTHROMYCIN. Staticin Lotion, Erygel, Erymax, Erycette, and A/T/S are available. Thomas et at conducted a double-blind study comparing topical erythromycin 1.5 per cent with topical clindamycin 1.0 per cent and found the two equally effective: two thirds of the patients had a good or excellent response in 12 weeks. Shalita et at confirmed this finding in 1984. MECLOCYCLINE. One per cent meclocycline sulfosalicylate cream (Medan) is another topical antibacterial agent for acne. It is applied twice daily. SULFUR. Although benzoyl peroxide, retinoic acid, and antibiotic topical lotions have largely supplanted the older medications, sulfur, resorcin, and salicylic acid preparations are still useful and moderately helpful. Some of the more elegant preparations available are Dermik's Klaron Acne Lotion, containing 2 percent salicylic acid and 5 per cent colloidal sulfur; Rezamid lotion, containing 1 per cent resorcinol and 5 per cent sulfur, and Sulfacet-R lotion, containing 10 per cent sodium sulfacetarnide and 5 per cent sulfur. Westwood produces Fostril lotion, containing 2 per cent sulfur and 6 per cent laureth-4, and Transact, containing 2 per cent sulfur and 6 per cent laureth-4 in a medical gel.

Azelizic Acid. Newest drug on the topical acne therapy scene is this dicarboxylic acid, believed to.be the agent responsible for the hypopigmentation induced by pityriasis versicolor. Nazzaro-Porro has worked with it for several years. It is remarkably free from adverse actions of any kind, and its effect on all forms of acne is good, in a 15 percent cream. It has the intriguing property of gradually destroying malignant melanocytes, as well. A double-blind comparison with vehicle study is needed to better assess efficacy.