Skin Care Medications - Retinoids, Topical Antibiotics, Dermatology
Skin conditions affect more than 1.9 billion people worldwide at any given time, making them the most common diagnoses in primary care after respiratory infections. This catalogue addresses some of the most clinically important dermatological problems: severe acne vulgaris and psoriasis (isotretinoin, acitretin), photoaging and mild-moderate acne (tretinoin / Retin-A), scabies (permethrin / Elimite), impetigo and bacterial skin infections (mupirocin / Bactroban), inflammatory skin conditions with secondary infection (betamethasone + gentamicin / Diprogenta), and vitiligo depigmentation (monobenzone / Benoquin).
Modern dermatological therapy emphasises diagnosis-specific treatment. The visible skin lesion is often the visible tip of a complex underlying biological process — whether immune-mediated (psoriasis, eczema, vitiligo), infectious (bacterial, viral, fungal, parasitic), hormonal (acne, hirsutism), neoplastic (skin cancer, actinic keratosis), or drug-induced. Empirical "try cream X" approaches without diagnosis frequently fail and can mask serious conditions; diagnostic clarity is the foundation of effective skin care.
This catalogue's most powerful agents — isotretinoin (Accutane, Accufine, Isofair) and acitretin (Actoid) — are systemic retinoids with substantial benefits for severe acne and psoriasis respectively. Both require specialist supervision, baseline blood work, pregnancy prevention, and monitoring. They are profoundly effective for the right patient and inappropriate for everyone else — matching the agent to the diagnosis matters more than ever.
👶 Conditions This Category Treats
Acne vulgaris affects roughly 85% of adolescents and many adults. Pathogenesis involves four factors: increased sebum production (driven by androgens), abnormal follicular keratinisation, proliferation of Cutibacterium acnes, and inflammation. Mild comedonal acne responds to topical retinoids (Retin-A / tretinoin) and benzoyl peroxide. Moderate-to-severe inflammatory or nodulocystic acne, or acne with scarring or psychological impact, warrants oral isotretinoin (Accutane, Accufine, Isofair) — the most effective acne treatment available, achieving sustained remission in 70-80% of treated patients.
Psoriasis — chronic immune-mediated condition affecting roughly 3% of the population — presents as well-demarcated red plaques with silvery scale, classically on extensor surfaces. Mild psoriasis responds to topical therapy (corticosteroids, vitamin D analogues, tar). Acitretin (Actoid) is a systemic retinoid for moderate-to-severe psoriasis; it normalises keratinocyte differentiation. Severe cases benefit from biologics (TNF inhibitors, IL-17 inhibitors, IL-23 inhibitors) covered in Immune category. Pityriasis rubra pilaris and ichthyoses also respond to acitretin.
Beyond acne and psoriasis, this catalogue addresses photoaging and fine wrinkles (Retin-A / tretinoin), scabies infestation (Elimite / permethrin 5% cream applied head-to-toe overnight, repeated in 1 week), impetigo and superficial bacterial skin infections (Bactroban / mupirocin topical), inflamed eczema with secondary infection (Diprogenta / betamethasone + gentamicin), and extensive vitiligo (Benoquin / monobenzone for depigmenting remaining normal skin in cases where over 50% of skin is already depigmented — a permanent decision).
💊 How Modern Skin Care Treatment Works
Topical tretinoin (Retin-A) and other retinoids bind to retinoic acid receptors (RAR), normalising keratinocyte differentiation, preventing comedone formation, and accelerating cell turnover. Result: clearer follicular openings, fewer blackheads, less inflammation, and over months smoother skin with reduced fine wrinkles and pigmentation changes. Initial "purge" (apparent worsening at 2-6 weeks) is normal as deep comedones surface. Side effects: dryness, redness, photosensitivity. Apply at night; sunscreen mandatory in daytime.
Oral isotretinoin (Accutane, Accufine, Isofair, Tretiheal) is a vitamin A derivative that dramatically shrinks sebaceous glands, reducing sebum production by 80% within weeks. It also normalises keratinisation, reduces C. acnes colonisation, and reduces inflammation. Standard course: 0.5-1.0 mg/kg/day for 4-6 months, targeting cumulative dose of 120-150 mg/kg. Side effects include severe dryness (lips, eyes, skin, nasal mucosa), lipid elevations, transient liver enzyme increases, mood changes (rare), and severe teratogenicity (pregnancy mandatory contraindication).
Acitretin (Actoid) is similar in mechanism to isotretinoin but with longer half-life and indications focused on psoriasis and pityriasis rubra pilaris. Permethrin 5% cream (Elimite) kills scabies mites by disrupting sodium channels in their neurons; applied head-to-toe overnight, washed off in morning, repeated in 1 week to catch newly-hatched mites. Treat household contacts simultaneously, wash bedding and clothing in hot water. Mupirocin (Bactroban) is a topical antibiotic with unique mechanism (inhibits bacterial isoleucyl-tRNA synthetase) and excellent activity against staphylococci and streptococci — first-line for impetigo and small bacterial skin infections.
💊 Drug Classes in This Category
| Class | Best For | Examples |
|---|---|---|
| Topical retinoids | Mild-moderate acne, photoaging, fine wrinkles, melasma | Retin-A (tretinoin), Tretiheal (tretinoin) |
| Oral retinoids (acne) | Severe nodulocystic acne, refractory acne, acne with scarring | Accutane, Accufine, Isofair (isotretinoin) |
| Oral retinoids (psoriasis) | Moderate-severe psoriasis, pustular psoriasis, pityriasis rubra pilaris | Acitretin Actoid |
| Topical antibiotic | Impetigo, superficial bacterial skin infections, nasal MRSA decolonisation | Bactroban (mupirocin) |
| Topical scabicide | Scabies, head lice (in some regions) | Elimite (permethrin 5%) |
| Combined steroid + antibiotic | Inflamed eczema with secondary infection, infected dermatitis | Diprogenta (betamethasone + gentamicin) |
| Depigmenting agent | Extensive vitiligo (over 50%) seeking depigmentation completion | Benoquin (monobenzone) |
✅ How to Choose
- 🦵 Mild-moderate acne (comedones, occasional papules) → Retin-A or Tretiheal (tretinoin) 0.025-0.05% cream at night; sunscreen daily; benzoyl peroxide adjunct.
- 🔥 Severe nodulocystic acne, scarring acne, treatment-resistant moderate acne → Accutane / Accufine / Isofair (isotretinoin) 0.5-1 mg/kg/day for 16-20 weeks under dermatology supervision; pregnancy mandatory contraception; monthly monitoring.
- 🥘 Photoaging, fine wrinkles, uneven pigmentation → long-term tretinoin 0.025-0.05% applied 3-5 nights per week; sunscreen mandatory.
- 🪩 Scabies (itching especially at night, finger-web burrows) → Elimite (permethrin 5%) cream head-to-toe overnight; repeat in 1 week. Treat all household contacts.
- 🪺 Impetigo, infected cuts, abrasions → Bactroban (mupirocin 2%) ointment three times daily for 5-7 days.
- 🧀 Inflamed eczema with bacterial component → Diprogenta short-term to settle inflammation; avoid prolonged face/fold use.
- 🧋 Moderate-severe plaque psoriasis → Actoid (acitretin) at specialist dose; or biologics for refractory cases.
❓ Frequently Asked Questions about Skin Care
Will my acne come back after isotretinoin?
Isotretinoin achieves long-term remission in 70-80% of treated patients after a single full course. The remainder may need a second course or maintenance therapy. Factors associated with relapse: younger age at treatment, lower cumulative dose, hormonal-pattern acne. Some patients benefit from continued topical maintenance after stopping isotretinoin.
How do I use Retin-A without irritation?
Start 2-3 nights per week with pea-sized amount on dry skin (apply 20-30 minutes after washing for less irritation). Increase frequency as tolerated over 4-6 weeks. Use moisturiser. Avoid combining with other harsh exfoliants. Sunscreen mandatory daily — tretinoin increases UV sensitivity. Initial purge (apparent worsening at 2-6 weeks) is normal.
Why does isotretinoin need monthly blood tests?
Monitoring covers lipid profile (triglycerides can rise significantly), liver enzymes, and pregnancy testing (mandatory in women). Most abnormalities are mild and transient. Severe elevations may require dose reduction or temporary discontinuation. Pregnancy testing is non-negotiable because of severe teratogenicity.
How is scabies different from eczema?
Scabies: intense itching especially at night, burrows visible between fingers and on wrists, family members affected, recent contact with infested person. Eczema: chronic relapsing itchy dermatitis, often family history of atopy, distinct distribution (flexural areas in children, hands in adults), no contact history. Mistaking one for the other delays treatment and spreads contagion.
Does mupirocin (Bactroban) cause resistance?
Yes — widespread mupirocin use has led to growing staphylococcal resistance. Use for short defined courses (5-7 days) for diagnosed infection rather than general antiseptic. For chronic nasal MRSA decolonisation, follow specific protocols including chlorhexidine body washes. Topical antibiotics should not be used as routine first-aid for clean wounds — petroleum jelly is adequate.
Can isotretinoin cause depression?
This has been debated for decades. Most studies show no clear causal link, but mood changes (depression, rarely suicidal thoughts) have been reported. Possibly there is a subset of patients more susceptible. Screen for prior mood disorder before starting; check on mood at each follow-up. Patients with active major depression may need stabilisation before isotretinoin.
🩺 When to See a Healthcare Provider
Dermatology referral is warranted for: severe acne (especially with scarring or psychological impact), suspected psoriasis or other inflammatory skin disease, skin lesions that grow or change colour (rule out melanoma), persistent skin infections that fail to respond to first-line treatment, unexplained chronic itch, severe atopic dermatitis. Self-treatment with potent topical steroids on the face or fold areas should be brief and only after diagnosis.
Inform every prescriber and dentist about your skin medications — isotretinoin and acitretin interact with vitamin A supplements, alcohol affects acitretin metabolism, retinoids increase risk of certain surgical procedures (laser, dermabrasion) for 6 months after stopping. Sunscreen is non-negotiable on any retinoid therapy. Pregnancy planning requires careful conversation before, during, and after retinoid use.