Are Over the Counter Acne Medications Good Enough?
Acne is the most common skin disease, afflicting 85% of the American population at some point in their lives.
For some individuals, acne may be persistent or severe enough to cause scarring and warrant prescription therapy. In many circumstances, however, acne is a relatively mild affliction that can be treated with over-the-counter (OTC) medications. The two main ingredients in OTC acne preparations are salicylic acid and benzoyl peroxide.
Salicylic acid is commonly found in acne washes and spot treatments. Acne lesions form when proteins, called keratin, plug hair follicles in the skin. Salicylic acid works by peeling the top layer of the skin and dissolving the keratin that is plugging the follicles. It is a relatively weak treatment, but can help in the milder forms of acne. Slight dryness and peeling skin can be side effects of salicylic acid.
Benzoyl peroxide (BP) attacks acne in several ways. The compound unplugs hair follicles, reduces inflammation and kills the skin bacteria that cause pimples to become inflamed. BP can be found in OTC products as a wash or gel formulation. Some prescription medications, such as Duac® and Epiduo®, contain benzoyl peroxide in combination with other anti-acne medications. Washes that contain BP are especially useful in treating acne on the back and trunk. Gels are best used as “leave-on” therapy for facial acne. Be careful when using benzoyl peroxide products, as they can bleach colored fabrics. Other potential side effects include skin irritation and allergy, with peeling, redness and itching.
OTC treatments come as single products, or grouped together in kits that provide a step-wise treatment regimen. There is no ideal product or kit for every patient, rather the best products are the ones that suit each individual’s preferences.
Almost all cases of acne can be effectively treated. The goal of treatment is to promote the healing of existing acne lesions, stopping new lesions from forming, and preventing the formation of acne scars.
Acne treatment aims to control one or more of the underlying causes of acne. For instance, topical retinoids unclog sebaceous glands and keep pores open, while antibiotics are used to fight the P. acnes bacteria. Isotretinoin (Accutane) and hormonal agents, such as birth control pills, are used to reduce sebum (oil) production.
What is the best acne treatment plan?
Your doctor will recommend an acne treatment plan based on these factors:
- Severity of your acne. Mild acne may respond well to the use of benzoyl peroxide or a topical retinoid only. Moderate acne may require a combination of acne medications, such as topical retinoid with an antibiotic. Severe acne with scarring may require treatment with an oral retinoid (Accutane, Sotret).
- Results of previous acne treatments. Stronger acne medications may be added to the treatment plan if previous medication do not bring acne under control.
- Degree of acne scarring. More aggressive therapies may be started earlier if acne scars have already started developing.
- Gender. Some treatments are available only for females, such as birth control pills.
Whatever your treatment plan, it is important that you give it enough time to work.
This may mean waiting 6 to 8 weeks to see results. While the older acne lesions are healing, the medication is hard at work keeping new lesions from forming.
Staying on your medication is the most important step to getting acne under control.
Many people will first attempt to treat their acne with an over-the-counter acne medication. Many brands of acne treatment share the same active ingredients. For instance, benzoyl peroxide is the active ingredient of both ProActiv™ and Clearasil™.
However, even some cases of mild acne may require prescription-strength medications for effective treatment. If no improvement is seen after 6 to 8 weeks of using a non-prescription medication, see your doctor about starting other medications. Relying on an ineffective treatment simply means enduring acne for weeks longer than necessary and increases the chances of developing permanent acne scars.
Over-the-Counter Acne Medications
Benzoyl peroxide was one of the first medications found to be effective in treating mild acne and has been used safely for decades. It is found in many over-the-counter formulas, as well as in combination with prescription medications. Benzoyl peroxide is available in different concentrations. Its primary side effect is dry skin and higher concentrations are more likely to irritate the skin.
Benzoyl peroxide may be used in combination with other prescription acne medications. For instance, your doctor may recommend that benzoyl peroxide be used along with an oral or topical antibiotic.
Sulfur and salicylic acid
These medications have some mild ability to break down whiteheads and blackheads and are found in many non-prescription acne medications. Like benzoyl peroxide, salicylic acid must be used continuously. Once these medications are stopped, acne lesions are likely to reappear.
Herbal or natural remedies
Over-the-counter products labeled "herbal," "organic" or "natural" are marketed as acne treatments but their effectiveness has rarely been tested in clinical trials. The value of these alternative acne treatments is not known.
Prescription-Strength Acne Medication
Topical retinoids are among the most effective and commonly used prescription acne medications. Topical retinoids are unique in their ability to unclog swollen pores. They may be used alone for mild acne or combined with other medications for moderate to severe acne.
Different topical retinoids are found in a variety of branded acne medications, include:
- Adapalene (Differin®, Epiduo®)
- Tazarotene (Tazorac®)
- Tretinoin (Retin A Micro®, Veltin®, Ziana®)
Antibiotics applied to the skin, such as clindamycin and erythromycin, kill the P. acnes bacteria that leads to inflammation.
Antibiotics, such as tetracycline, doxycycline, and minocycline, may be prescribed for oral use. This allows the medication to reach bacteria in the deep layers of the dermis. They are also prescribed for their ability to reduce skin inflammation.
Dapsone is a medication that that may be applied to the skin to reduce the inflammation of acne.
For women who experience hormonally triggered acne, birth control pills may be prescribed to reduce sebum production.
Isotretinoin remains the most effective treatment for severe acne or acne that does not respond to other treatments. Isotretinoin treats all causes of acne: excess sebum, clogged pores, bacterial overgrowth, and inflammation. Most patients take the medicine for periods of 15 to 20 weeks that may be repeated if necessary. Treatment requires monthly office visits, monthly lab tests, and strict contraception. It is critical that women of childbearing age do not get pregnant while taking isotretinoin because of the serious risk of birth defects. The iPledge program was developed to reduce the likelihood of birth defects and other side effects.
Some drugs used for other medical conditions are known to reduce androgen levels, such as spironolactone (Aldactone). These may be used in some cases of acne.
Side Effects of Acne Medications
Many of these acne medications have side effects, such as burning, redness, and irritation. With some medicines, such as topical retinoids, these side effects usually decrease or go away after the medicine is used for a period of time. Tell your doctor if side effects are severe or don't go away.
While the older acne lesions are healing, the medication is hard at work keeping new acne lesions from forming. Staying on your acne medication is the most important step to getting acne under control.
Procedures to Treat Acne.
For persistent acne lesions that are inflamed or unresponsive to medications, some doctors recommend additional methods, including extraction, photodynamic therapy (PDT), or corticosteroid injections.
Talk to your Doctor
It is important to talk to your doctor about the best acne treatment for you.
Ongoing use of your acne medicine may be required for several months, even after the initial acne lesions cleared up, to keep acne under control.
Reference: Vivacare, American Academy of Dermatology
Last updated: January 7, 2017