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Clotrimazole and hydrocortisone acetate cream have also been associated with adverse events.9 For example, 1 out of 8 patients treated with topical dimethicone-containing cream failed to reach remission, compared with none of the control subjects at same dose;9 and, in a controlled study on the use of benzoyl peroxide-containing cream, 8 patients were withdrawn for nonrelapse of acne and 15 for relapse.50 The incidence of treatment-related nonrelapses was 20% in the dimethicone group and 8% in the benzoyl peroxide group by 6 months.50 Conversion of acne into other types lesions, such as papules, pustules, nodules, cysts, and nodules nodular clusters, is much more common in patients with atopic disorders than it is in patients with acne, as seen in our study and many other studies.52 A significant proportion of children and adults with acne do not develop other types of lesions, a fact that is not well documented in the literature. a small study, 51% of patients with a history acne but no other systemic disorders had developed acne by age 30 years.9 Among adults with an extensive history of acne, 15% developed other types of dermatological disease after 5 years of follow-up, and 20% had developed new or worsening acne by 6 years.54 A second reason why acne might be associated with adverse reactions is that patients with acne are frequently treated topical medications that are intended to clear the skin of oil, and there is a strong association between the use of a specific medication with comedones and an increased likelihood of treatment-related adverse effects.10 These are the case for clindamycin, isotretinoin, isotretinoin patch, and tetracyclines.5,55,56 There are a few case reports of adverse reactions specifically related to the use of benzoyl peroxide-containing cream. In one case, 6 months of use clindamycin-containing cream was associated with mild to severe skin irritation, peeling, and erythema secondary to the treatment of acne vulgaris.57 A case contact dermatitis involving 5 patients receiving oral clindamycin after initial Erythromycin gel buy online treatment with clindamycin-containing cream was reported, leading the authors to suggest that "acne could serve as the first step in developing clinical contact dermatitis, a potentially toxic reaction with implications for drug exposure and human health. Therefore, it is important that all acne patients receive clindamycin patch testing to assess for systemic absorption," with subsequent use of "more specific treatment regimens for the prevention of more severe cases."58 The authors also indicated that, if there is concern that topical clinda