Acne Treatments: Severe Allergic Reaction Warnings

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The Food and Drug Administration (FDA) issued a warning about the possibility of severe allergic reactions to skin medicines containing two common drugs used to treat acne: benzoyl peroxide and salicylic acid.

Acne is a familiar problem for most teens and many adults. Pimples, blackheads, and other types of eruptions appear on the face, neck, back, chest, and/or arms. The causes are:

• increased sebum [oil] production;
• the presence of a bacterium called Propionibacterium acnes;
• shedding skin cells that, combined with sebum, block the pores; and 
•  inflammation.

It was once thought that acne could be brought on by diet or stress, but that is not the case. Many acne treatments exist. The goals are to treat infection, treat inflammation, and remove the sebum and cell debris that clog pores. Over-the-counter and/or prescription preparations may be used, often in combination.

Common ingredients in topical [skin] acne medicines are benzoyl peroxide and salicylic acid. With normal use, they can cause drying and redness. In some people, for unknown reasons, products containing them are associated with severe allergic reactions. According to FDA, the symptoms can include "throat tightness, difficulty breathing, feeling faint, or swelling of the eyes, face, lips, or tongue" and hives or itching. FDA notes that these symptoms are different from the skin irritation expected with normal use. (There is no proof that benzoyl peroxide or salicylic acid is the actual cause of serious effects; it also could be inactive ingredients in the products or a combination of ingredients.)

Before using a topical product, a patch test is recommended. Label instructions will tell users how to apply a small amount of product, usually on the inside of the elbow, and observe the site for a few days. Discuss any reaction with a health provider before using the product more extensively.

It is important thing is to stop using these products if allergic symptoms occur. Hives or itching, as opposed to redness and irritation, are symptoms of allergic reactions. Users should call 911 right away for symptoms of severe allergies: chest tightness, trouble breathing, feeling faint, or swelling around the face and throat.

There are other acne products which can cause side effects.

• Antibiotics are sometimes prescribed for topical use and/or internal use. The usual side effects of antibiotics can occur. Gastrointestinal effects and antibiotic resistance are possible.
• Retinoids, a type of vitamin A product, can be used on the skin. This can be effective but very irritating.
• Isotretinoin, a vitamin A product in pill form, is used for severe, persistent acne. It has been associated with birth defects, so meticulous attention to birth control is essential for women who take this drug.
• If acne in women is worsened by hormonal changes, hormone treatment may be used, too.
• Home remedies and herbal remedies have been tried. There is at least one case of lead poisoning in the literature, a woman who took a home-made Chinese medicine.

Acne medicines, like other medicines, need to be stored out of sight and reach of children. A 21-month-old child who swallowed some of her mother's isotretinoin required hospital treatment for a fast heart rate, rapid breathing, and high blood pressure.

If someone swallows an acne preparation, use the webPOISONCONTROL^® online tool for guidance or call Poison Control at 1-800-222-1222 right away. If someone is having trouble breathing from any cause, always call 911 first.

Rose Ann Gould Soloway, RN, BSN, MSEd, DABAT emerita
Clinical Toxicologist