Acne can come and go throughout one’s life—from the teen years all the way through middle age. The quest to find the best treatment to keep persistent acne at bay is top of mind for many patients. When acne flares, patients often turn to over-the-counter (OTC) products as they are convenient to purchase and inexpensive. Since there are so many OTC products to choose from, dermatologists can help patients navigate the drugstore shelves and select the products with the most effective ingredients for their specific acne symptoms.
American Academy of Dermatology (AAD) expert
Information provided by Emmy M. Graber, MD, FAAD, a board-certified dermatologist and assistant professor of dermatology and director of the Cosmetic and Laser Center at Boston University School of Medicine in Boston, Massachusetts.
OTC acne ingredients that work
There are many types of OTC ingredients that treat at least one of the underlying factors that cause acne. Dermatologists often say the key is to find the OTC ingredients best suited to treat acne in a product form that you like and use the product as directed. Graber also noted that many dermatologists recommend OTCs in conjunction with prescription acne therapies. Here are the most common OTC active ingredients and their benefits and limitations.
- Works by effectively killing bacteria that cause acne, which can control acne and reduce flares when used daily.
- Available in many different types of products, including washes, creams, gels or pre-moistened cloths.
- Strength of benzoyl peroxide varies considerably—between 2–10%.
- Studies show products with higher benzoyl peroxide concentrations—above 2.5%—do not necessarily increase the effectiveness of products and can irritate the skin.
- Can make some prescription acne medications work better, such as topical clindamycin, which patients can often become resistant to over time. When used together, benzoyl peroxide and clindamycin attack bacteria differently—preventing the bacteria from continuing to grow.
Salicylic acid (also known as beta hydroxy acid)
- Works by exfoliating (removing) the layer of dead skin cells on the surface of the skin that can clog pores.
- Available in washes, creams, facial scrubs, cleansing cloths and cleansing pads.
- Can be used together with benzoyl peroxide to fight acne, but in some cases this combination can make the skin dry and irritated.
- Works by suppressing the bacteria that causes acne and also can unclog pores.
- Available in leave-on acne products, such as spot treatments.
- Very targeted treatment that is intended to be applied to a single pimple rather than covering a large area of acne.
OTC ingredients that help acne fighters work better
There are a number of supporting ingredients that can work in conjunction with OTC acne fighting ingredients. While these inactive ingredients may not attack the root causes of acne, they can provide extra benefits to the skin that allow active ingredients to work more effectively.
Alpha hydroxy acids (AHAs)
- Work similar to salicylic acid by exfoliating the skin.
- Widely available in cleansers, creams, lotions and in cleansing cloths.
- Can be used twice a day, but some patients find this too drying for their skin.
- A derivative of vitamin A that works by unclogging pores and making skin appear brighter (more radiant).
- Available in OTC leave-on acne products and by prescription.
- Often found in anti-aging products, which also can help acne in older adults.
- Retinol can be drying, so patients should be careful using this ingredient, especially in combination with other OTC ingredients.
Natural ingredients not as successful in clearing acne
Some patients prefer “natural” products to fight acne, but Graber doesn’t recommend them as a first line treatment as they have not been proven to be as effective as other OTC ingredients.
- Topical tea tree oil possesses some antibacterial properties that could kill bacteria associated with acne. However, Graber explained that tea tree oil takes longer to work on acne than benzoyl peroxide. In addition, some people can become allergic to it.
- Zinc is a natural anti-inflammatory that can be taken orally to reduce the redness and bumps caused by acne inflammation. Graber advises patients to talk with their dermatologist about proper dosage.
Mechanical devices gaining popularity
Designed to clean the skin and exfoliate dead skin cells, mechanical acne treatments—brushes, scrubs, and cleansing cloths—can be used in conjunction with OTC products as well as medications. A dermatologist can advise patients on how to select the best device for their skin and type of acne.
- Hand-held devices that use an oscillating motion to remove makeup and dead skin cells, deeply cleansing the skin.
- Currently no studies are available to determine how much benefit these devices have on acne. As such, it is unknown if this deep cleansing allows acne-fighting ingredients to better penetrate the skin and provide quicker and better clearing of acne.
- Different types of abrasive particles are found in scrubs, such as polyethylene beads, aluminum oxide or ground fruit pits. Scrubs may help to exfoliate the skin, removing dead skin cells that could clog pores and cause acne lesions.
- Graber noted that some scrubs can be too harsh and irritate inflamed skin. She recommends products with smooth synthetic beads (such as polyethylene beads) that are not as rough.
- Offer a less abrasive cleansing alternative while providing exfoliation in a simple, quick process.
- Available in two forms—cloths that lather with water and require rinsing the skin afterward; and moist cloths that do not require rinsing after use.
- Graber recommended that patients look for cloths that contain acne-fighting ingredients, such as salicylic acid or benzoyl peroxide.
AAD expert advice
“If an individual tries OTC products to fight acne and improvement isn’t seen within four to eight weeks, then it is time to contact a dermatologist to determine the most appropriate treatment – which may include both OTCs and prescription medications,” said Graber. “OTCs can be effective for some patients with mild acne, but they must be used continuously to clear acne and prevent flares.”