If you walk through any drug store you will find a wide variety of topical acne medications available without a prescription. They all declare a similar message about clear skin. If you examine the ingredients closely you will find that they all contain varying degrees of different medications and this can be very confusing. In today’s post I’m going to cover the common acne medications that are available over the counter and provide some specific recommendations about what products work best for which types of acne.
Before we jump into this, I want to take a minute to refresh the topics that I have already covered in this blog series. We started with the most important step – making the diagnosis. There are four types of acne and knowing the type of acne that you have will be key in determining the best treatment options. Next up was the best face wash for acne prone skin. Keeping your skin clean is important and in this post we covered the types of cleansers available as well as how to properly clean your face. The third post was all about oily skin – the cause of oil and what you can do to help control it. If you are new here, enter your email address below and I’ll send the prior posts to you.
Knowing the type of acne you have will help determine what products will best treat that acne. A quick review of the four types of acne: 1) comedonal acne (non-inflammatory); 2) inflammatory acne (pustular and cystic); 3) combination acne (both comedonal and inflammatory); and 4) hormonal acne.
The two main ingredients in OTC acne medications are Salicylic Acid and Benzoyl Peroxide. This summer, the Federal Drug Administration approved adapalene (aka differin), which is a topical retinoid, for over the counter sales. This is huge in the acne world, because prior to this you usually needed a prescription to procure a retinoid. Update: In January, 2017 Adapalene became available over the counter. Read on below for how to purchase. If you remember back to the 2nd post in this series, we discussed these same ingredients in face washes. It’s important to find a balance of products that will treat your acne without causing irritation. Too much of any ingredient could leave you with dry, irritated skin.
First up, Salicylic Acid. This is probably the most common solution when it comes to treating acne. Salicylic acid is comedolytic meaning that it helps declog blackheads and whiteheads so it’s great when treating comedonal acne. Salicylic acid also works as a powerful exfoliator and will slough off dead skin. Products that contain 0.5 to 2 percent salicylic acid would be recommended – anything stronger will likely cause irritation. Salicylic acid is best used as a face wash. There are many OTC salicylic acid spot treatments, but I do not believe that spot treating acne works very well. Salicylic acid can also be used in much higher strengths in chemical peels. I use these often in my acne patients. However, these peels should be performed in a doctor’s office.
Salicylic is an aspirin based product so if you are allergic to aspirin, products that contain salicylic acid should be avoided. If you are looking for a face wash that contains salicylic acid to help clear up comedonal acne, I recommend (affiliate) Neutrogena Acne Wash or (affiliate) Hydropeptide Purifying Cleanser (order from Hydropeptide with code Doctor-Ip for 15% discount!).
Next is Benzoyl Peroxide. If you have inflammatory acne, this is the product for you. Benzoyl Peroxide unclogs pores and stops bacteria (which is the cause of inflammatory acne). Typically available in strengths that range from 2.5% to 10%, starting with a low strength is recommended until you know how your skin will react to the product. People often report dry skin and some slight burning or tingling when starting to use this product. After applying the medication, I recommend using a thick cream to help retain moisture and prevent dryness. My personal favorite is OTC benzoyl peroxide is (affiliate) Obagi Clenziderm Therapeutic Lotion.
Finally, a new introduction to the OTC acne treatment options is Differin (affiliate). In July, 2016 the FDA approved Differin for OTC use. Differin is a retinoid that treats mild to moderate acne. Topical retinoids are powerful comedolytics, which means that it can help knock blackheads out of the water. They help to encourage cell turnover and reduce inflammation. Differin is usually very effective on blackheads and whiteheads (comedonal acne) and tends to be less irritating than other prescription based retinoid treatments. Only a small amount is needed nightly, a pea-sized amount for the entire face.
If you remember back to Step 2 of the Cure Your Acne blog (The Best Face Wash For Acne Prone Skin), there are many facial cleansers that contain Salicylic Acid and Benzoyl Peroxide (two of the ingredients that I’ve covered above). The key to clearing your skin is finding the correct balance of ingredients for your skin type. Below I’ve summarized my suggested routine for each type of acne. Often, I find that the best combination is a gentle cleanser with treatments applied after washing. Too much of any one ingredient could cause excessive dryness and further irritate the skin.
Comedonal acne – Wash with a gentle cleanser twice a day, followed by a moisturizer. In the evening, use a pea-sized amount of a topical retinoid (Differin) before applying moisturizer.
Inflammatory acne – Wash with a gentle cleaner and use a mild OTC benzoyl peroxide cream twice a day, followed by a moisturizer
Combination acne – Wash with a gentle cleanser twice a day. A mild OTC benzoyl peroxide cream can be used during the day and a topical retinoid like Differin can be used at night. After medication is applied a moisturizer should always be applied.
Hormonal acne – A combination of products may be effective but you will likely need a hormonal remedy.
Product Recommendations (affiliate)
OTC Retinoid: Differin
OTC Benzoyl Peroxide: Obagi Clenziderm Therapeutic Lotion or La Roche-Posay Effaclar Duo Dual Action Acne Treatment
As with most products that are applied topically, a small amount of the drug can enter your bloodstream. If you are pregnant or breastfeeding these products are not safe to use and should be avoided. When starting a new treatment for acne it is important to ease into the new routine. Start off by applying any new medications every other evening as part of your skincare routine and only increase to daily if you find that you need it. Also, these treatments tend to be very drying so you will want to make sure you are moisturizing well when using. My preferred facial moisturizers are Cerave AM, Cerave PM and Vanicream (affiliate links).
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