Jeffrey Poole

Acne Medications: OTC vs Prescription

Over the counter (OTC) acne medicines are a good first choice in mild acne, and can be fairly effective. Most all of these contain one of three ingredients, and despite what advertising and television stars may tell you, they work about the same. These ingredients are:

  • benzoyl peroxide (an excellent germ killer, but can be irritating)
  • salicylic acid (a chemical exfoliant), and
  • sulfur (the least commonly used of the 3 because of its unpleasant smell.

For moderate to severe acne, or acne that is persistent/resistant to OTC treatment, seek the help of a board-certified Dermatologist. We are the experts in the evaluation and management for diseases of the skin, hair and nails, and have access to a large arsenal of weapons to attack your acne.  Prescription therapy for acne is vastly more potent than any of the OTC options.

A good dermatologist first should initially examine your acne closely to make sure that you do, in fact, have acne!  There are a number of conditions that may mimic acne, many of which may not be easily identified by your general physician.

Secondly, it is important to assess for conditions, medicines or exposures that may effect your acne.  Examples could include hormonal conditions, steroid exposure, or prescription medicines such as lithium.  Knowing and evaluating for these problems will impact not only your acne care, but also your general health.

Third, is developing an individualized plan for your acne.  Again, this is where expertise is so critical- Dermatologist simply have more "arrows in our quiver" to treat your acne.

Acne treatments generally fall into 6 categories:

  • Comedolytics (whitehead/blackhead removers)
  • topical antibiotics
  • oral antibiotics
  • systemic retinoids (like Accutane® (Isotretinoin)
  • hormonal therapies
  • physical modalities.

As acne has 4 root causes (increased oil, sticky pores, overgrowth of germs, and inflammation), most acne requires a combination of treatments for maximum results.

Comedolytics remove the clogged up pores (comedone= whitehead/blackheads) that are initial formation of all acne bumps. The most effective are the retinoids, such as Retin-A®, Differin®, and Tazorac®.

Topical antibiotics kill the germs associated with acne, that result in inflammation.  Prescription therapies offer more options and increased effectiveness over their OTC counterparts.

Oral antibiotics not only assist in germ killing, but also decrease the inflammatory response in acne.  There are many options, often with subtle differences and differing side effects.  Your dermatologist will be able to choose the appropriate one for your personalized care.

Other, more advanced and powerful treatments, are generally solely used by dermatologists.  These include systemic retinoids (isotretinoin/accutane), hormonal therapy, and physical modalities (acne surgery, chemical peels, laser or light based therapies).

Be sure to aggressively pursue appropriate treatment for acne. Acne scarring is extremely difficult to improve and the social impact of severe acne should not be ignored. With all the options available today, your acne your be well controlled."

Mild acne describes cases of acne with minimal or no inflammation of the skin and no signs of acne scars.

Mild acne appears as superficial lesions on the surface of the skin, such as blackheads, or whiteheads. (These are also referred to as “comedones”)

Mild Acne on the Nose Mild Acne on the NoseMild acne can sometimes be controlled at home by gently washing the affected area (usually the face) with warm water and a mild soap twice daily to remove dead skin cells and excess oil. An over-the-counter acne medicine containing benzoyl peroxide, or salicylic acid may also be used.

At-home treatment of mild acne requires 6-8 weeks to see improvement. Once the mild acne clears, treatment must be continued to prevent new lesions from forming.

Stronger and more effective prescription acne medications may be required if the mild acne does not respond to at-home treatment. These may include medications applied to the skin, such as topical antibiotics or topical retinoids. These may be used alone or in combination with other medications, such as antibiotics for acne.

Oral acne medications, such as oral antibiotics (doxycycline, minocyline) or isotretinoin, are not usually recommended for the initial treatment of mild acne.

Talk to your doctor about an acne treatment best suited to your acne severity and skin type.

Whatever acne medication you use, it is important that you give it enough time to work. This may require waiting 6 to 8 weeks to see results. While the older acne lesions are healing, the medicine is hard at work keeping new acne lesions from forming. Staying on your acne medication is the most important step to getting your acne under control.

This information is for general educational uses only. It may not apply to you and your personal medical needs. This information should not be used in place of a visit, call, consultation with or the advice of your physician or health care professional.

Communicate promptly with your physician or other health care professional with any health-related questions or concerns.

Be sure to follow specific instructions given to you by your physician or health care professional.

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