Written by Sara Wilchowski PA-C & Paul M. Graham D.O.
Many people see a dermatologist only after using numerous over the counter (OTC) acne products without success. Interestingly, Americans spend an estimated $43 billion on skin care products each year. With such a high demand in OTC treatment options, we sought to provide you with a thorough list of OTC products that have demonstrated effectiveness in the treatment of acne.
Both compliance and consistency are the top two reasons for OTC acne treatment failure. Many people just don’t give these products enough time to start working before discontinuing their use. Nothing works overnight, so patience and commitment is a must. One important concept to remember is that not everyone responds in the same way to the same medications. Numerous trials with various OTC products may be needed in order to find the perfect match for your skin type. Fortunately, we have outlined the details of these OTC products to make it much easier for you to make an informed decision on what to buy the next time you are in the drug store.
Basics of Acne
First and foremost, let us start the discussion with a brief look at the four factors that play a role in acne development. For more details on the basics of acne please read our previous articles entitled: Acne Basics: Part 1 and What’s Our Secret: Your Guide to a Seamless Skincare Regimen
FOUR FACTORS PLAY A ROLE IN THE DEVELOPMENT OF ACNE VULGARIS
- Abnormal hair follicle development
- Clogging of the follicle pores due to an increased “stickiness” of the cells to each other
- Colonization of Propionibacterium acnes bacteria in the oil glands
- P. acnes is a bacteria that lives in oil glands
- This bacteria produces chemicals that break down the sebum (oil) produced by the oil glands
- The breakdown product of the sebum stimulates inflammatory chemicals to be produced causing inflammation
- Inflammation can be seen on the skin by the presence of redness and swelling
- Hormone effects on oil gland secretion
- An elevation in specific hormones causes increased production of sebum from the oil glands
- This increased sebum continues to feed the P. acnes bacteria, leading to increased inflammation
There are four different types of acne; comedonal (black and whiteheads), papular, pustular, and cystic. Typically, patients present for treatment after already trying numerous OTC products such as benzyl peroxide, salicylic acid, and several different “acne” face washes. It is a misconception by many that acne is caused by “dirty skin”, so often times patients come into the office with inflamed and irritated skin from overwashing. Acne that needs to be treated medically typically is more inflammatory with numerous papules, pustules, and cyst formation. OTC treatment works well for those patients with very mild comedonal acne and few inflammatory lesions. Those with cystic acne always require treatment, as without it, scarring may ensue.
Comedonal (open and closed comedones) type acne responds best to OTC treatment, but may be a precursor to the development of more inflammatory acne down the road. The comedomal-type acne typically begins around puberty when hormone levels begin to fluctuate. Inflammatory papular and pustular acne responds minimally to OTC products and often requires topical and possibly oral antibiotics for effective treatment. Additonally, a retinoid (which one recently has been approved as an OTC product – Differin) is very beneficial. Retinoids work by decreasing accumulation of dead cellular material that inevitably ends up clogging the hair follicle, causing acne to develop. When the follicle becomes completely clogged, it ruptures, causing a cystic acne lesions.
The length of time most patients should use OTC products before seeking a physician’s guidance will vary based on the severity of the acne. As a rule of thumb, if the acne does not improve after 2-3 months of using OTC products, treatment by a physician should be sought for proper medical guidance. Prescription topical and oral antibiotics are very beneficial in decreasing the inflammatory response usually seen in papulopustular acne.
The worse complication to waiting too long for treatment is the development of acne scarring. Very often we see teenagers and adults who have neglected proper acne treatment and have developed scarring secondary to either physical manipulation or severely inflammatory cystic acne lesions. Fortunately, there are various treatment modalities that can be used to treat acne scarring such as microneedling, chemical peels, and laser resurfacing procedures.
OTC Acne Treatment Options
Benzoyl Peroxide (BP) – This product is often used daily. It is available in both prescription and OTC preparations. BP works by a process called oxidation, which directly destroys bacteria that contribute to acne. Due to its unique mechanism of action, there is no risk for the development of antibiotic resistance; therefore, it is often safe to be used long term. OTC BP comes in a variety of formulations: 2.5%, 5% or 10% leave-on gel and a 4% or 10% wash. Furthermore, this medication may cause bleaching of clothing and towels, so use caution when applying.
How to use: BP gel works best by applying a small (pea size) amount the entire face. Spot treatment is often ineffective.
Common Brands: ProActive, Neutrogena Rapid Acne Repair, Acne Free, X Out, PersaGel, PanOxyl
Find it on Amazon:
ProActive – http://amzn.to/2gNWU3S
PanOxyl – http://amzn.to/2gNZGWG
Neutrogena Rapid Acne Repair – http://amzn.to/2tKvRI0
Acne Free – http://amzn.to/2uDRRsx
X Out – http://amzn.to/2gNFX9y
PersaGel – http://amzn.to/2tKIJh6
Acne Light Mask – For years this technology was only available in the dermatologist’s office, however, it is now available OTC. These masks have a combination of both blue and red light at specific wavelengths. The acne-causing bacteria is sensitive to blue light which helps to eliminate colonization. Red light works by reducing inflammation and decreasing sebum (oil) production, directly contributing to decreased acne lesions (2). In-office red/blue light treatments are more aggressive and specific, which can facilitate even better improvement of acne lesions.
How to use: Place the device on the face and turn on.
Common Brands: Neutrogena Acne Mask, Silkn’ Blue
Sulfur – This product comes in both a wash or leave-on application and is more gentle on the skin when compared to benzoyl peroxide. Additionally, there is no risk of bleaching fabric. However, if you suffer from a sulfa allergy, these products should be avoided all together. This product works by decreasing inflammation and bacterial counts involved in acne. Sulfur has keratolytic effects (loosening of cellular adhesion to each other), directly increasing the cell turnover of the skin to provide a healthy complexion and maintain unclogged pores. Sulfur typically takes up to 8-12 weeks to be maximally effective.
Common Brands: Acnomel, Murad Acne Spot Treatment, Earth’s Care Acne Spot Treatment, Acne Free Sulfur Mask
Differin – This product was newly released OTC in January 2017. Historically, Differin was a prescription and could only be obtained by visiting a physician. Now that it is available as an OTC medication, more people will benefit from its excellent acne-reduction effects. Differin is a synthetic retinoid (vitamin A derived) medication that typically takes up to 12 weeks to be effective. It directly decreases inflammation and regulates skin cell turnover. This medication can cause significant dryness and irritation if overused. However, adding a gentle cleanser and facial moisturizer is key to the product’s success and toleration.
How to use: Apply a thin layer (pea-sized drop) to the entire face at night.
Find it on Amazon:
Differin – http://amzn.to/2gNPAFp
Coal Tar – Here recently, a charcoal mask has been gaining popularity and unfortunately causing a lot of problems in regards to significant skin irritation and acne exacerbations. Historically, coal tar has been used in various aspects of medicine to absorb toxins from the gastrointestinal tract such as in alcohol or acetaminophen toxicity; however, there are no peer reviewed journals or studies on the use of this product for acne. Additionally, there is currently no evidence in the literature to suggest that coal tar helps acne.
Lastly, harsh acne scrubs should be avoided as they tend to make acne worse secondary to the trauma caused by the beads contained within these products. Consult your dermatologist before using any harsh scrubs on the face.
- Skin Care and the Aging Female: Myths and Truths.Ushma S. Neill. Journal of Clinical Investigation. 2012;122(2):473–477. doi:10.1172/JCI61978.
- Wheeland RG, Dhawan S. Evaluation of self-treatment of mild-to-moderate facial acne with a blue light treatment system. J Drugs Dermatol. 2011;10(6):596-602