2.5 percent liquid. This agent inhibits comedogenesis by promoting the desquamation of follicular epithelium. Do not use more or less of it or use it more often than prescribed by your doctor.This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.Unless your doctor tells you otherwise, continue your normal diet.Apply the missed dose as soon as you remember it. Recent findings in the epidemiologic evidence, classification, and subtypes of acne vulgaris. The strength of the chosen formulation should be titrated upward as needed, and patients should be instructed that maximal benefit may not be achieved for four to six months.Patients with mild inflammatory acne should be started on a twice-daily regimen of an antibacterial agent such as benzoyl peroxide, azelaic acid or a topical antibiotic. Heenen M, This adverse effect may be influenced by the vehicle used.Combination therapy is often employed when patients have a mixture of comedonal and inflammatory acne lesions. Ross JI, Bass J, Topical treatment is sufficient in most patients with acne, but systemic therapy is required in patients who have deep acne with nodules and cysts In most situations, the physician does not need to look for an underlying cause of acne. Sulfur revisited. These molecules are visualized, downloaded, and analyzed by users who range from students to specialized scientists. Cost to the patient may be greater, depending on prescription filling feeAddress correspondence to John J. Russell, M.D., Abington Family Medicine, 817 Old York Rd., Jenkintown, PA 19046. Walker R, Textbook of dermatology. Keskinen R, Foster RH, Always check the actual product label in your possession for the most accurate ingredient information due to product changes or upgrades that may not yet be reflected on our web site. The RCSB PDB also provides a variety of tools and resources. St. Louis: Facts and Comparisons, 1999:3031–68*—Cost estimated by the author based on product information for once-daily application to face for one month—Estimated cost to the pharmacist based on average wholesale prices (rounded to the nearest dollar) in Red book. It can also be used to treat acne, and some cases of methicillin-resistant Staphylococcus aureus (MRSA). It is important to dispel the many myths about this disorder.Patients need to know that acne is not a disease of hygiene. Acne and its therapy. It may be that the acne itself causes stress, not vice versa.Cosmetics have long been blamed for the development of acne lesions. Consequently, it is important to assess the patient's skin type.Creams are appropriate for patients with sensitive or dry skin who require a nonirritating, nondrying formulation. Krowchuk DP, First trimester topical tretinoin and congenital disorders. Dunlap FE, They have been a mainstay of acne treatment for the past 25 years.Until recently, tretinoin was the only available topical retinoid. Therapy should be continued until new lesions no longer appear.In patients with more moderate inflammatory acne, the physician needs to decide whether to use topical therapy, systemic therapy, or both. JOHN J. RUSSELL, M.D., Abington Memorial Hospital, Abington, PennsylvaniaAcne is a common problem in adolescents and young adults. Boston: Blackwell Scientific, 1992:1699–744.Leyden JJ. Agent Common brand names Common formulations Dosage Side effects; Benzoyl peroxide. Shaughnessy AF. Salicylic acid is a less effective but more affordable alternative. Webster GF. The disorder is caused by abnormal desquamation of follicular epithelium that results in obstruction of the pilosebaceous canal. Skin irritation usually decreases with continued therapy.Patients should be warned that they may suffer a pustular flare during the first few weeks of tretinoin therapy.