If you have acne, you're certainly not alone. An estimated 85% of US adolescents and young adults have acne, making it one of the most common skin conditions in the nation.
Acne occurs after sebum, an oil produced by sebaceous glands in the skin, combines with dead cells that are shed from a person's pore. This results in an enlarged, closed pore called a comedo. Comedones create a perfect breeding ground for a bacterium called Propionibacterium acnes (P. acnes). If the walls of the pore break down, an inflammatory response is triggered, leading to pimples or, if more severe, cysts.
Now for the million dollar question: what is the most effective way to treat acne with over-the-counter (OTC) products? You should first know that treating acne is like starting a new exercise program—you won't get results right away. Since it takes a comedo 8 weeks to mature, treatment must be continued beyond this time frame to start seeing results.
While there are hundreds of products to choose from, the following are broad classes of over-the-counter ingredients found in anti-acne products. Hopefully, these groupings will help you decide which anti-acne product is right for you.
Benzoyl peroxide is arguably the most effective ingredient in over-the-counter anti-acne products. It is an antimicrobial and a comedolytic (opens clogged pores), helping to decrease the amount of P. acnes as well as slough off dead cells on the skin to allow the pores to open. Because it fights bacteria, it is a great ingredient if you have inflamed pimples. Typically, people apply benzoyl peroxide once to twice a day. It is available in prescription and non-prescription strength, ranging from 2.5% to 10% gels, lotions, creams, masks, and cleansers. Higher concentrations might not necessarily lead to better results and can actually lead to worse side effects. Benzoyl peroxide makes topical retinoids more photo-sensitive. Therefore, if you are using both ingredients, you should apply benzoyl peroxide in the morning and retinoid at night. Benzoyl peroxide can cause irritation that might make your skin red, scaly, and dry. And be aware that benzoyl peroxide can bleach clothes or hair, so plan accordingly while using this product!
Salicylic acid helps break down clogged pores. It might also slow shedding of cells inside the pores, preventing them from getting clogged. It can cause mild stinging and skin irritation. Over-the-counter acne products are available with 0.5-2% salicylic acid. Popular products that contain salicylic acid include Oxy® and Noxzema®. This ingredient is great for those with acne consisting mainly of whiteheads and blackheads, with little or no inflammation (because salicylic acid does not have an anti-inflammatory component).
Alpha hydroxy acids include glycolic acid and lactic acid. They treat acne by removing dead skin cells and reducing inflammation. Alpha hydroxy acids have the added benefit of reducing the appearance of acne scars by stimulating the growth of new, smoother skin.
Proactiv®, one of the most popular acne treatments in the US, uses a combination of benzoyl peroxide and glycolic acid. It consists of a three-part system: the first part consists of a cleanser that has tiny beads and benzoyl peroxide. The beads help to physically remove dead skin cells, and the benzoyl peroxide exfoliates the skin and kills bacteria. The second part consists of a toner that contains glycolic acid, and it works to physically exfoliate the skin, sloughing off dead cells. The third part consists of a repairing lotion that contains another dose of benzoyl peroxide, providing additional exfoliation and killing even more bacteria. Although there are other anti-inflammatories, moisturizers, and botanicals in Proactiv®, the main treatment is from the benzoyl peroxide and glycolic acid. One reason why Proactiv® works so well is that people use it twice a day, every day, even when their skin is clear.
Resorcinol and sulfur are typically found together in anti-acne treatments. Resorcinol helps break down hard, rough skin, making it a great way to reduce the amount of existing blackheads and whiteheads. Sulfur has been used for over 50 years for treating acne, but we really don't know how it works. Together, resorcinol and sulfur help decrease oil buildup and are typically found in strengths of 5-8% and 2%, respectively. Clearasil® is a popular product that contains these two ingredients.
Retinoids are vitamin A derivatives that work in two ways: they decrease shedding of the pore to prevent formation of a comedo, and they decrease inflammation by reducing the number of P. acnes within the skin. Retinoids, therefore, treat two of the four main causes of acne, making it a very effective remedy. Prescription-only retinoids include isotretinoin, adapalene and tazarotene. While they are the most effective, you can only get them after visiting your doctor. Retinol is an over-the-counter retinoid that can be used to help manage mild acne. Do know that the FDA has approved retinol to reduce appearance of wrinkles, not to treat acne. It is usually applied once a day, typically at night because it breaks down when exposed to sunlight. Because topical retinoids can actually prevent acne, you should apply a pea-sized amount over the entire face and not just to individual lesions. Keep in mind that topical retinoids make the skin more sensitive to sunlight by thinning the very top layer of the skin, the stratum corneum. So protect your retinoid-treated skin from the sun and other forms of external irritation.
Maintenance therapy is an important part of treating acne. For many, acne is a condition in which symptoms recur over years. So creating a sustainable treatment regimen is of upmost importance if you want to maintain clear skin, and you might need to try several products before finding one that works for you. Topical retinoids have been used as a main ingredient in maintenance therapy because, along with breaking down already-clogged pores and reducing inflammation, they can actually prevent comedo formation. For some, a topical retinoid might be all that's needed to maintain clear skin. If you still experience breakouts while using only a topical retinoid, adding benzoyl peroxide might help.
Acne zappers, such as ZENO®, can help treat single pimples by applying direct heat and killing bacteria. Other acne spot treatments, such as Neutrogena Rapid Clear® Fight and Fade Gel and concealers with salicylic acid in them use mild acids to help dissolve a pimple when applied directly.
The following are some home skin care regimen recommendations for maintaining clear skin:
- Cleanse your skin with a syndet, a word created by combining "synthetic" and "detergent," instead of a soap. Syndets have a lower pH than soap, minimizing skin irritation and dryness. Cetaphil® cleansers and Dove® Sensitive Skin Bar are two examples of syndets.
- Wash your face with warm, not hot, water. Gently massage your face while cleansing, and avoid scrubbing, which can cause inflammation.
- Look for cosmetics that are "noncomedogenic" or "nonacnegenic." These are generally water based and are less likely to cause breakouts.
- Refrain from picking your acne lesions, as this can spread bacteria and make a single, small pimple into several big ones.
The primary reason acne treatments fail is because people stop using them. Treatment of acne is time consuming and ongoing. Reverting back to the exercise analogy, treating acne only helps you if you keep it up.
Ofori AO. Treatment of acne vulgaris. UpToDate. www.uptodate.com. Updated September 25, 2009. Accessed June 13, 2010.