Over The Counter (OTC) acne treatments are generally the first medications used by acne sufferers. OTC products are easily accessible and range in cost from very inexpensive to outrageously expensive.
There are thousands of acne products available in supermarkets, drugstores and pharmacies across the world. The vast majority of these products contain different blends of the same active ingredients. Over the counter products are generally most effective for the treatment of mild to moderate acne (Acne Types: 1-2). OTC products tend to be largely ineffective for the treatment of moderate to severe acne (Acne Types: 3-4).
Common “Active Ingredients” in OTC Acne Treatments
Benzoyl Peroxide
Benzoyl Peroxide is a Popular OTC Acne Treatment
Research has demonstrated that benzoyl peroxide is an effective treatment for non-inflammatory acne. Benzoyl peroxide functions as a keratolytic agent and increases shedding of the outer layer of the epidermis.
When benzoyl peroxide comes into contact with the skin it breaks down into benzoic acid and oxygen, molecules which are toxic to bacteria. Because of its limited penetration into the skin, benzoyl peroxide is not very effective for treating cystic and nodular acne.
Most people tolerate benzoyl peroxide treatment fairly well, with frequency of side effects increasing at higher dosages. Common side effects of benzoyl peroxide treatment include dry skin, flaking, redness and sensitivity to sunlight.
Benzoyl peroxide is commonly combined with antibiotics, such as clinadmycin and erythromycin in prescription topical medications. Benzoyl peroxide is a potent bleaching agent, and contact with clothes or furniture can cause permanent damage.
Salicylic Acid
Salicylic acid, a molecular cousin of aspirin, is widely used in over-the-counter acne products. At low concentrations, salicylic acid functions as a mild keratolytic and comedolytic agent.
Salicylic acid weakens the bonds between the keratinized cells on the outer surface of the epidermis, causing them to shed more rapidly and encouraging new cell growth. At higher concentrations, salicylic acid is used in chemical peels and wart removal.
Research indicates that salicylic acid is moderately effective in the treatment of acne, with efficacy rates similar to benzoyl peroxide. Because topical salicylic acid treatments do not penetrate deeply into the skin they are poor options for people suffering from nodular and cystic acne.
Overuse of salicylic acid treatments can cause dry skin, sensitivity and redness. People that are sensitive to aspirin are often allergic to salicylic acid.
Triclosan
Triclosan is a common active ingredient in a range of antibacterial mouthwashes, toothpastes and soaps, including many over-the-counter acne washes.
Triclosan inhibits bacterial fatty acid synthesis, which bacteria needs to build and maintain their cellular membrane. There is some concern that triclosan can degrade into toxic substances such as chlorophenol, dioxin and formaldehyde, however there does not appear to be any specific health risk from the exposure associated with normal use.
Use of face washes containing triclosan typically have minimal side effects. Research and anecdotal evidence indicate that triclosan based washes are, at best, mildly helpful in reducing the number and severity of acne lesions. Like salicylic acid and benzoyl peroxide, triclosan does not penetrate deeply into the skin and is a poor option for inflammatory acne.
Astringents
Witch Hazel Extract is a Common Astringent
Astringents tighten skin, diminish redness, and decrease the “oiliness” of the skin. Astringents work by denaturing and/or precipitating proteins.
Astringents include tannins, gallic acid, witch hazel and alum. Astringents, particularly tannins, are what give unripened fruit and banana peels that puckering, sand-papery feel in your mouth.
The most common over-the-counter astringent is witch hazel, primarily useful for cleansing and the immediate short-term decrease in redness and inflammation.
There is very little scientific research on the efficacy of astringents in acne treatment, and are unlikely to have a significant effect on the fundamental causes of acne. Astringents should be considered short-acting treatments that primarily address the symptoms of acne (instead of the causes).
Applications
Cleansers
Most acne cleansers contain triclosan and/or salycilic acid. In general, washing your face with a gentle cleaner once or twice a day is a good idea. Washing more than this is not helpful and can often cause irritation and dryness.
Acne cleansers are minimally effective against acne, because acne is not typically caused by dirt or bacteria on the surface of the skin. Cleansers do not penetrate deeply enough into the hair follicle to greatly effect the cause of most acne, and are not effective treatments for inflammatory acne.
Pads
There are Several Brands of Cleanser Pads
Most pads contain alcohol and salicylic acid, both of which are antibacterial and keratolytic.
As is the case with many topical treatments, the active ingredients are unlikely to penetrate deeply enough to have an impact on the bacteria growing within the follicle.
While some people observe an improvement in their acne with this type of product, most experience little or no improvement. Overuse of these products can cause irritation and dryness.
Creams & Gels
Most creams and gels contain benzoyl peroxide or salicylic acid. A few contain other ingredients such as sulfur, tea tree oil or glycolic acid.
Pore Strips
Pore strips only work for pores that are clogged, but open (blackheads). For this purpose pore strips have been demonstrated to be nearly as effective as standard dermatological extraction.
Closed comedos (whiteheads) are not accessible to the sticky polymer on the pore strip. Pore strips do not help treat inflammatory acne.
Exfoliants
Most over-the-counter exfoliants are simply a cleanser with some sort of abrasive ingredient. A gentle exfoliation every once in a while can even skin tone and improve areas of rough skin.
It is important to be aware that many other topical acne treatments are keratolytic agents, which are essentially chemical exfoliants. Combining these treatments can often exacerbate skin irritation.
For dry skin, a non-comedogenic moisturizer such as Cetaphil is often a more effective treatment than exfoliation. Over-the-counter exfoliants are not likely to significantly improve acne symptoms.
Masks
Green Clay Facial Treatment
The inexpensive masks available in drugstores and supermarkets contain a liquid polymer that dries into a thin clear-ish sheet that you then pull off.
There is no evidence to suggest that these masks will yield results of any kind. More expensive products often contain active ingredients with plausible potential such as various types of clay and essential oils, colloidal metals, etcetera.
No published research has surfaced to support the efficectiveness of facial/spa masks for the treatment of acne vulgaris.
Discussion