Over The Counter (OTC) acne treatments are products that do not require a doctor’s prescription to obtain (in the United States).
There are hundreds of OTC acne products available in stores, although most of these products use the same basic active ingredients. OTC treatments can be helpful for people with mild acne. However, they tend to be ineffective for people with moderate to severe acne. Individuals with significant acne symptoms should not rely solely on OTC treatments. Instead, they should work with their healthcare provider to implement an effective treatment plan.
Types of OTC Acne Treatments
Medicated face and body washes are a popular type of OTC acne treatment. Acne cleansers can be helpful for drying out oily skin. However, cleansers are not usually effective treatments for inflammatory acne (Acne Types: 2-4). This is because inflammatory acne is not caused by dirt or bacteria on the surface of the skin that can be washed away. Despite the claims in many commercials and advertisements, these cleansers do not penetrate deeply into follicles and are therefore are not capable of treating the root causes of acne.
Most cleansers contain triclosan, an antibacterial compound, as their active ingredient. In general, washing your face with a gentle cleaner once or twice a day is a good idea. Washing more than this is generally not helpful and can often cause irritation and dry skin. Detailed discussion about the various face and body cleansers can be found here.
Acne Cleanser Pads
Cleanser Pads are nice because when you are done using them you can often see the “dirt” on the pad and it feels like you have done something concrete about your acne. Unfortunately, the “dirt” that you see on the pad is unlikely to be the source of your acne symptoms. While some people do find that cleanser pads help with their oily skin and mild acne symptoms, most people experience minimal overall improvement in the condition of their skin.
Like other topical OTC treatments, the active ingredients in cleanser pads are unlikely to penetrate deeply enough into the follicle to unclog blocked pores or suppress the growth of bacteria in the skin. Most cleanser pads contain a combination of alcohol and salicylic acid, which are both antibacterial and keratolytic. Overuse of these products can cause skin irritation.
Acne Gels and Creams
Acne Creams and Gels are very popular and there are a huge number of these products on the market. The active ingredient in most of these product is either contain salicylic acid or benzoyl peroxide. Other products may contain active ingredients such as sulfur, tea tree oil or glycolic acid.
In general, pimple creams are somewhat effective for mild acne symptoms (Acne Types: 1-2). They are generally ineffective for the treatment of inflammatory acne (Acne Types: 3-4) because they do not penetrate deeply into the skin. Like other topical OTC acne treatments, overuse of these products can irritate the skin.
Pore Strips are neat. They may not actually prevent or treat acne, but it is cool to pull off a pore strip and see all of the little towers of gunk that come out of the pores with it. Pore strips are most helpful for removing mild blackheads (open comedones, horny impactions). They are best suited for people with mild acne (Acne Types: 1-2).
There is little scientific research on whether pore strips improve acne symptoms. One study did compare the efficacy of Biore pore strips to standard dermatological extraction (manual extraction) of blackheads and found that the pore strips were nearly as effective and were less invasive.
It is important to keep in mind that pore strips only work well with pores that are clogged, but open (blackheads). Acne lesions with closed pores, (eg. whiteheads, pimples, nodules and cysts) are not easily accessible to the sticky material that coats the pore strip. Thus, pore strips are generally ineffective for people with moderate to severe acne symptoms (Acne Types: 3-4).
Most OTC exfoliants are combine a gentle cleanser with some sort of abrasive ingredient. Gentle exfoliation every once in a while can even skin tone and improve areas of rough skin. OTC exfoliants are generally NOT helpful for treating active acne symptoms.
It is important to be aware that many other topical acne treatments are keratolytic agents, which are essentially chemical exfoliants. Combining these treatments can cause significant skin irritation and dryness. For dry skin, a non-comedogenic moisturizer, such as Cetaphil, is often a more effective treatment than exfoliation.
Acne Facial Masks
Facial Masks are a mainstay of spa treatments. They can also be helpful as acne treatments. But it really depends what the mask is made of. High quality facial masks may help improve mild acne symptoms and improve skin tone and moisture.
Many of the inexpensive OTC facial masks that are sold in drugstores contain a liquid polymer that dries into a thin, clear sheet that you then pull off. There is no published research on the efficacy of this type of product (but in my own experience, they did absolutely nothing helpful).
More expensive facial mask products often contain various types of clay in conjunction with other potentially active ingredients such as essential oils or colloidal metals. While there is limited scientific research on this topic, many of these products are well reviewed, particularly for improving oily skin.
Active Ingredients in OTC products
Despite the diversity of OTC acne products, most of these products use the same core set of active ingredients. The active ingredients are primarily antibacterial or keratolytic agents that are designed to kill bacteria, exfoliate the surface of the skin and remove blackheads (open comedones). The most common active ingredients in OTC acne products are discussed below.
Salicylic Acid is widely used in OTC acne products, particularly face washes and cleanser pads. At the low concentrations found in OTC acne products, salicylic acid works as mild keratolytic and comedolytic agent.
The majority of the scientific research indicates that salicylic acid is moderately effective for the treatment of mild acne symptoms (Acne Types: 1-2). Salicylic Acid tends to have efficacy rates that are similar to Benzoyl Peroxide. However, because salicylic acid treatments do not penetrate deeply into the skin, they are poor options for people suffering from nodular and cystic acne (Acne Types 3-4).
Salicylic Acid weakens the bonds between the keratinized cells on the outer surface of the epidermis, causing them to shed more rapidly and encourages new cell growth. At higher concentrations, salicylic acid is toxic and is used in chemical peels and wart removal treatments.
Salicylic Acid is usually well tolerated, but some people are allergic to it. Salicylic acid is a molecular cousin of aspirin, and people who are sensitive to aspirin are more likely to be sensitive to salicylic acid. The primary side effects of salicylic acid treatments are dry skin, sensitivity and redness. Excessive use of salicylic acid treatments, or combinations with other topical acne treatments, can exacerbate these side effects.
Benzoyl peroxide is both a keratolytic agent and antibacterial agent. Keratolytic agents cause the outer layer of the skin (epidermis) to shed. Antibacterial agents kill bacteria.
When benzoyl peroxide comes into contact with the skin it breaks down into benzoic acid and oxygen, which are toxic to many types of bacteria (including the acne-causing Propionibacterium acnes bacteria). Benzoyl peroxide is a very common ingredient in face washes and pimple creams.
Extensive research has shown that benzoyl peroxide can be a beneficial treatment for many people suffering from non-inflammatory acne (Acne Types: 1-2). However, because of its limited penetration into the skin, benzoyl peroxide is largely ineffective in treating cystic and nodular forms of acne (Acne Types: 3-4).
Benzoyl peroxide is commonly combined with antibiotics, such as clindamycin and erythromycin, in prescription topical medications. Benzoyl peroxide can be combined with many other types of treatments in a comprehensive acne treatment regimen.
Most people tolerate benzoyl peroxide treatment well, with side effects most commonly associated with higher dosages and excessive use. Common side effects of benzoyl peroxide treatment include dry skin, flaking, redness and sensitivity. Benzoyl peroxide is also a potent bleaching agent, and contact with clothes or furniture can cause permanent bleach damage.
Triclosan is an antibacterial agent that is found in many OTC acne treatment products, such as soaps and cleansers. Triclosan is toxic to many bacteria, including the acne-causing Propionibacterium acnes.
Clinical research and patient reports indicate that face washes with Triclosan are somewhat helpful for people with mild acne symptoms (Acne Types: 1-2). Like salicylic acid and benzoyl peroxide, triclosan does not penetrate deeply into the skin and is a poor option for inflammatory acne (Acne Types: 3-4).
Use of triclosan containing washes is usually well tolerated by the user with minimal side effects.Excessive use of any face wash (with our without Triclosan) can cause dryness and skin irritation.
There are some concerns that triclosan can degrade into toxic substances such as chlorophenol, dioxin and formaldehyde. However, normal use of topical antibacterial products that contain Triclosan is unlikely to generate toxic concentrations of these molecules. There is currently no evidence that demonstrates a specific health risk from the exposure associated with normal use of Triclosan-containing products.
Astringents are used primarily to tighten the skin, diminish redness and relieve oily skin. Astringents are also one of the oldest acne treatments in existence, with their use going back hundreds (or even thousands) of years.
Astringents, particularly Witch Hazel, are generally well-reviewed by acne patients, particularly for mild acne symptoms (Acne Types: 1-2). Astringents tend to be most useful for cleansing the skin and for providing a fast-acting, short term improvement in redness and inflammation.
There are many different types of astringents including tannins, gallic acid, witch hazel and alum. The most common OTC astringent is Witch Hazel, which can be found at most stores and pharmacies. Interesting fact: Astringents, particularly tannins, are what gives unripe fruit and banana peels to create that puckering, sand-papery mouth feel.
Astringents work by denaturing and/or precipitating proteins. How this helps to improve acne symptoms is uncertain. However, there is very little scientific research on the efficacy of astringents as a treatment for acne.
Astringents are not expected to be effective acne treatments when used alone. Astringents are unlikely to have a significant effect on the fundamental causes of acne and are generally considered to be short-acting, symptomatic treatments. They can be used by patients with all types of acne (Acne Types: 1-4) and can be combined with many other types of acne treatment.