to avoid alcohol-based or fragrance-loaded skincare and makeup products.
As discussed above, it’s also helpful to avoid any product with a thick, heavy, or creamy texture, such as some moisturizers and makeup products. If you’re acne-prone, thick or solid makeup products such as stick, pancake, cream, or cream-to-powder compact foundations and concealers should be on your “must avoid” list—or at least avoid using them on areas where you’re prone to breaking out. The problems with these kinds of products are that they’re harder to remove from skin and because the heavier waxes they contain can become stuck inside the pore lining, creating a clog.
The same goes for bronzers or blushes in stick, cream, or cream-to-powder forms. The types of ingredients that keep these products in a solid form are iffy for use by those with breakout-prone skin.
Over-the-Counter Acne Treatments That Work
When you’re battling acne breakouts, the key is to look for ingredients that are proven to combat acne effectively, yet gently. The two best over-the-counter acne-fighting ingredients, as demonstrated by peer-reviewed medical and scientific research, are salicylic acid (also known as beta hydroxy acid or BHA) and benzoyl peroxide. [33,68] Research has shown that these two ingredients are as beneficial, if not more so, as prescription-only acne medications for mild to moderate acne.
Salicylic Acid: Also known as beta hydroxy acid (BHA), salicylic acid is an amazing multifunctional ingredient that treats acne in several ways. It not only has potent anti-inflammatory properties, but also exfoliates to remove the buildup of dead skin cells on the surface of the skin as well as inside the pore. Salicylic acid also has mild antibacterial properties. [33,34]
Because salicylic acid is a derivative of aspirin (both are salicylates; aspirin’s technical name is acetylsalicylic acid), it also has some of aspirin’s anti-inflammatory properties. That means it reduces inflammation, redness, and swelling, helping skin heal. [33] This in turn helps prevent scarring, while also decreasing the chance of further breakouts. Salicylic acid’s antimicrobial properties also help kill the bacteria that cause acne. [69] Together, these properties make salicylic acid an MVP in the game of you versus your acne—a game we want you to win!
For salicylic acid formulas to be effective, they must have a concentration of at least 0.5%, although 1% to 2% is far more effective; plus, the formula’s pH is a critical factor, with a pH of 3 to 4 being optimal. [70] Surprisingly to us, many salicylic acid products for acne don’t meet these requirements, so they don’t work well, if at all, on acne and clogged pores.
In addition, the product must not contain any irritating ingredients because such ingredients cause inflammation as we’ve stated so many times (because it’s so important), potentially delaying healing and increasing oil production deep within the pore, keeping you on an endless cycle of clear skin–more acne, clear skin–more acne…Fortunately, well-formulated salicylic acid products do exist, and you’ll find them from Paula’s Choice and from other brands recommended at the end of this chapter.
Benzoyl peroxide is considered the most effective over-the-counter choice for a topical antibacterial agent in the treatment of acne. It penetrates into the pore and kills acne-causing bacteria, thus reducing inflammation. It does present a risk of irritation, but the risk is low compared with the benefits, and unlike antibiotics used to treat acne, it doesn’t have the potential to create bacterial resistance. [33]
The concentration of benzoyl peroxide in products usually ranges from 2.5% to 10%. A 2.5% benzoyl peroxide concentration is far less irritating than a 10% concentration (not irritating skin is always the goal), and it can be just as effective. If your skin doesn’t respond to the 2.5% concentration within a week or so of daily use, try a 5% concentration. [33]
Generally speaking, if your acne doesn’t respond to a 5% concentration of benzoyl peroxide, then the next step is to consider topical prescription options (such as a topical antibiotic mixed with smaller concentrations of benzoyl peroxide) before trying a product with 10% benzoyl peroxide. Concentrations of benzoyl peroxide over 5% have been shown to tip the scale in favor of irritation, causing dry, flaky, and inflamed skin. Not surprisingly, this causes more problems than it helps. [71]
Note: Research shows that combining benzoyl peroxide with topical antibiotics reduces the risk of the bacteria developing resistance to the antibiotic, which means the antibiotic will be effective over a longer period of time. [72] This combination also has been shown to reduce inflammation, making it a good ingredient in some prescription options for stubborn breakouts that aren’t responding to over-the-counter treatments such as benzoyl peroxide and salicylic acid. There are numerous topical prescription products that contain benzoyl peroxide + an antibiotic. Your dermatologist can help you determine which one is best for you.
Important note: When you’re struggling with acne, you must be consistent with your anti-acne treatments. For many, breakouts are an ongoing problem, not a “one and done”–type deal. Ongoing, consistent use of anti-acne treatments is required to maintain the results and to keep new breakouts from forming. Daily adherence to a treatment routine is essential for success!
When OTC Acne Treatments Aren’t Enough
Some cases of stubborn acne just won’t go away with over-the-counter medications alone, no matter how well-formulated they are. Instead of spending more money on product after product, if you notice your acne isn’t improving after several weeks of being consistent with your skincare routine, it’s time to see a dermatologist.
A dermatologist has numerous topical and oral prescription options to treat acne, from retinoids like tretinoin or Differin® to antibiotics and oral vitamin A (isotretinoin, formerly sold under the brand name Accutane). Each has its share of pros and cons, which you should discuss with your doctor. Following is an overview that will help you understand the options your doctor may suggest.
Important reminder: Using prescription-only products for your acne doesn’t change the basic skincare routine you need to follow. Bar soaps, harsh cleansers, abrasive scrubs, and products that contain irritating ingredients or overly waxy products will still harm your skin and increase the likelihood of your skin not being able to tolerate these prescription treatments.
Prescription topical antibiotics are an option if you haven’t gotten good results using over-the-counter treatments containing salicylic acid and benzoyl peroxide.
There are several topical antibiotics to consider; the main ones to discuss with your dermatologist are erythromycin, clindamycin, minocycline, and tetracycline. These can be used alone, but a good deal of research indicates that you can derive greater benefit without some of the side effects by combining one of these antibiotics in lower doses with benzoyl peroxide to create a far more potent and effective treatment.
Dapsone is a topical disinfectant gel available by prescription in 5% strength. The brand name for this anti-acne drug is Aczone. A recent study involving 347 adolescents and 434 adult women showed dapsone 5% gel used twice daily was effective in reducing inflammatory and noninflammatory acne lesions in both adolescent and adult women, but was even more effective for adult women. [73]
Retinoids, such as prescription tretinoin (Retin-A, Avita, Atralin, and generics) and other vitamin A derivatives, such as tazarotene (Tazorac®, Avage®) and adapalene (Differin®), can play a significant role in an anti-acne treatment routine. [74]
Retinoid is the name of the general category for any and all forms of vitamin A. Prescription retinoid options are viable treatments for breakouts because they change the way skin cells are formed in the layers of skin as well as in the pore, improving how skin cells shed while unclogging pores, thereby significantly reducing inflammatory lesions. Retinoids also have anti-inflammatory action, making them even more compelling.
Topical
