Acne medication over the counter

Salicylic acid also has anti-inflammatory properties to help with inflamed cystic breakouts that can occur when blockages deep in the hair follicles rupture beneath the skin. Although it’s totally fine to use salicylic acid in a face wash, you may find that you have better results when using it as a toner, moisturizer, or leave-on spot treatment because these give it more time to do its work. And keep in mind, salicylic acid can dry out the skin if over-applied, so it may be wise to choose only one product with the ingredient to use every day.

2. Glycolic acid

Glycolic acid is an alpha-hydroxy acid (AHA) that gently exfoliates the skin, helping to get rid of the dead skin cells that can clog pores. Just like salicylic acid, you can find glycolic in washes, peels, moisturizers, and serums at your local beauty store or drugstore.

3. Benzoyl peroxide

Benzoyl peroxide is an antibacterial ingredient, and it’s very effective at killing the P. acnes bacteria that causes breakouts. But benzoyl isn’t without its downsides. The leave-on creams and cleansing treatments can dry out sensitive skin and bleach clothing if you aren’t careful. Board-certified dermatologist Eric Meinhardt, M.D., previously told SELF that it’s best to stick to formulations that have no more than 2 percent of benzoyl peroxide listed on the active ingredients chart; stronger concentrations are harder on your skin without being any tougher on bacteria.

4. Retinol

You’ve probably heard of the benefits of retinoid creams for anti-aging, but vitamin A is also efficient at clearing up acne. “ cause skin cells to turn over at a faster rate, decrease oil production, and help skin exfoliate,” board-certified dermatologist Rita Linkner, M.D., tells SELF. Another benefit: Acne is inflammation, and retinoids are anti-inflammatory.

Shah often recommends over-the-counter retinols or prescription retinoids to her acne-prone patients. “I find that, compared to other treatments, they are beneficial for not just treating acne but also preventing new acne from forming as they help prevent that initial stage of the follicle getting clogged,” she says. “They can also help with some of the post-acne , such as hyperpigmentation.”

But keep in mind that retinoids can also be irritating and if you have sensitive skin (or eczema or rosacea), a prescription retinoid might be too strong an option. However, your dermatologist can recommend an over-the-counter retinol with a low concentration (0.1 to 0.25 percent), which might be better tolerated.

Retinol also isn’t a quick fix. It takes time to see results (possibly a few months), and it’s something you’ll have to keep using to maintain its benefits.

5. Sulfur

Warning: Sulfur smells like rotten eggs. But it is an effective ingredient at drying up pus-filled pimples and whiteheads (you’ve gotta take the good with the bad). It works by sucking up the oil. Sulfur is typically mixed with other active ingredients to get the most efficacy and fragrances to mask the strong scent. You can often find it in masks and spot treatments.

And here are the best acne treatments for more severe acne. 6. Dapsone gel

Another prescription option your dermatologist might prescribe for acne is dapsone gel, like the brand name version Aczone. Dapsone is both antimicrobial and anti-inflammatory, and it’s proven to help with blackheads, whiteheads, and deeper painful pimples. Oftentimes, dapsone is used alongside other acne treatments. And, like many of those other remedies, this can cause skin to dry out.

7. A cortisone shot

Cortisone is a quick fix for acne emergencies. We mean got a big board meeting tomorrow kind of quick. Go into the dermatologist’s office for a shot of this corticosteroid, and acne will disappear in 24 to 48 hours. The treatment works to curb inflammation, which makes it best for cystic breakouts and can be really good at combating hormonal flare-ups. If done incorrectly, a cortisone shot can leave a small depression in the skin that lasts about eight weeks. “It’s a rare side effect that happens if dosage of cortisone is too high,” Dr. Linkner explains. “You want to go to someone who knows what they’re doing.”

8. Birth control pills

If you notice that you’re breaking out right around your period every month, your acne might be linked to hormones. “A sensitivity to the hormones called androgens manifests in the form of cystic acne,” Dr. Linkner says. Androgens, namely testosterone, cause the skin to produce more sebum. More sebum equals more acne. Birth control, which has estrogen and progestin, helps keep hormones balanced and skin clear. Ortho Tri-Cyclen, Estrostep, and YAZ are all FDA-approved as acne treatments.

9. Spironalactone

Sometimes birth control alone isn’t enough to really make a difference in hormonal acne. That’s when your doctor might recommend adding in an androgen blocker such as spironalactone. Spiro (as it’s often called) minimizes the amount of androgen hormones in circulation by blocking the receptors that bind with testosterone. When these pills are taken at the same time as an oral contraceptive, many women see an improvement in breakouts, according to Dr. Linkner. The drug is sometimes prescribed to women with PCOS (polycystic ovarian syndrome) to relieve androgen-related symptoms like excessive hair growth, hypertension, oily skin, and acne.

10. Isotretinoin

Isotretinoin is a particularly strong retinoid. It has a mixed reputation, but among dermatologists it’s the finisher for patients with severe acne. “If you have an acne patient that doesn’t respond to anything, can really be a game changer,” board-certified dermatologist Adam Friedman tells SELF. Commonly referred as Accutane even though that particular brand was discontinued, isotretinoin is an oral retinoid, and it has all the same benefits of a topical retinol but is even more effective.

Contents

Acne

Worried that oily skin and spots on your face, chest and back might be acne? Read on for a guide to acne, as well as advice and support on how to get treated.

What is acne?

Acne is a common condition that affects the skin, causing spots to develop on the face and body. It’s most common in teenagers, but it can affect people in adulthood as well.

It’s normal to get the odd pimple, but if you’re regularly experiencing outbreaks of spots, especially if they’re red, painful and widespread, this could be a sign of acne.

The good news is that most people who have acne as a teenager find it improves in early adulthood. Even for people with severe acne, there are many different treatment options available to help tackle it, so you shouldn’t be reluctant to seek help. Our pharmacists are always on hand to help discuss your skin concerns as well as offer advice and treatment options.

What are the symptoms of acne?

Broadly speaking, acne has two key symptoms:

  • Oily skin that might also be hot, red and tender
  • Multiple spots on the face, back, shoulders and/or chest

There are some specific types of acne spot, and identifying these can help you to work out how severe your acne is.

Types of acne spot

Blackheads and whiteheads are small bumps on the skin (blackheads usually have a black centre). Papules are small bumps on the skin that tend to be red, painful and tender. Pustules are similar to papules but have a white centre, caused by a build-up of pus.

Nodules are large hard lumps under the skin that are often painful. Cysts – the most severe type of acne spot – are large lumps filled with pus that look similar to boils. Nodules and cysts are prone to bursting, which can cause bleeding and scarring.

People with mild acne are mostly affected by blackheads and whiteheads, while people with moderate acne might have a lot of papules and pustules. In severe cases, the skin is affected by widespread papules and pustules, as well as nodules and cysts.

What causes acne?

The first thing to know is that acne is not caused by being unhygienic. Having the occasional spot can result from not cleaning your skin, but chronic acne results from biological reactions taking place beneath the skin.

In people with acne, the glands in the skin produce too much sebum, an oily substance that stops the skin drying out. When too much sebum is produced, it mixes with dead skin cells and blocks the hair follicles in your skin.

Blocked follicles create blackheads and whiteheads, which can later develop into papules, pustules, nodules and cysts if they become infected.

Changes in the skin that result in acne are often a result of hormones. For this reason, acne is most commonly associated with puberty, however it can also affect pregnant and menopausal women.

Teenagers and young adults are most likely to experience acne – 80% of people between 11 and 30 are affected (however only 5% of women and 1% of men have acne over the age of 25).*

How is acne diagnosed?

If you’re worried about your symptoms, you shouldn’t hesitate to speak to a medical professional, visit your local LloydsPharmacy and speak to one of our Pharmacists for advice and support.

With mild symptoms – i.e. blackheads, whiteheads, and only a few papules or pustules – you may want to start by talking to a pharmacist. This is because mild acne symptoms can often be treated with over-the-counter products, which can be purchased with the advice of a pharmacist.

For more severe symptoms you should book an appointment with your GP, or make use of the free LloydsPharmacy Online Doctor acne assessment. Moderate or severe acne will usually need to be examined by a doctor, and may require prescription treatment.

How is acne treated?

While there is no cure for acne, there are all kinds of treatment options available to improve the condition. Read our guide to acne treatment to find out more about the full range of medication and solutions available.

Treatment for mild acne

If your acne is mild you might find that using an over-the-counter treatment containing benzoyl peroxide helps your symptoms improve. These products normally come as creams or gels and must be applied to the skin once or twice a day.

If this non-prescription treatment doesn’t work you should speak to a doctor about your options.

Treatment for moderate or severe acne

For more severe acne, prescription treatment is often necessary. Common prescription treatments for acne include:

  • Topical retinoids and antibiotics
  • Azelaic acid
  • Antibiotic tablets
  • Combined contraceptive pills (for women only)
  • Isotretinoin tablets

Usually, treatment for severe acne begins with a combination of antibiotic tablets and topical treatments. You may be referred to a dermatologist if your symptoms are particularly bad.

You can also receive treatment for acne scarring, which occurs when large spots burst and damage the skin. Treatment for acne scarring includes dermabrasion and laser therapy.

Read our guide to acne treatment to find out more about the full range of medication and solutions available.

Living with acne

Acne can be a difficult condition to live with, as it can cause problems with self-esteem, anxiety and stress. In severe cases, acne can cause depression. If you’re struggling to cope with your acne, make sure you speak to your GP.

The best way to get to grips with your acne symptoms is to make sure you’re using the correct medication. Second to that, it can be a good idea to establish a skincare routine that includes any topical treatments recommended to you by a healthcare professional.

A skincare routine for acne should involve:

  • Gently cleaning your face twice a day with lukewarm water and a mild cleanser
  • Applying any topical treatments to the skin as directed
  • Keeping dry skin moisturised
  • Using makeup that is non-comedogenic (this means it won’t block the follicles)
  • Not squeezing or picking at spots as this can cause infection and scarring

Try to resist the urge to over-cleanse your face or scrub your skin too hard, as this can cause more damage and irritation. Remember that acne is not caused by being unclean. If you are still concerned about your acne, then visit your local LloydsPharmacy, our expert and friendly Pharmacists will be happy to talk you through possible treatments available to you.

*www.nhs.uk/conditions/acne

The best treatments for acne

If OTC medications are not effective, a healthcare professional may be able to assist with a prescription for stronger medication.

Topical prescription treatments

Examples of topical medications that are available on prescription include tazarotene, adapalene, and tretinoin. They are all derived from vitamin A.

Some topical antibiotics may help to rid the skin of excess bacteria.

It may take a while to find a suitable dosage and combination.

Some people find that a prescription containing benzoyl peroxide combined with an antibiotic can help.

Benzoyl peroxide should be used sparingly, as too much can harm the skin and bleach clothes.

Dapsone gel may help patients with inflammatory acne.

Side effects linked to topical prescription medications include burning, peeling, redness, and stinging. The patient should keep in touch with their doctor to minimize adverse effects.

Antibiotics

Share on PinterestAntibiotics are a potential treatment for severe acne.

Oral antibiotics, usually tetracycline, can be used together with a topical treatment for severe acne. Pregnant or breastfeeding mothers should take an erythromycin instead of tetracycline.

Most patients on oral antibiotics should notice improvements after about 6 weeks. A course may last from 4 to 6 months.

Tetracycline cannot be used with birth control pills, and too much direct sunlight exposure should also be avoided.

Antibiotic resistance is a growing problem among patients with pimples.

Doctors will advise tapering off antibiotics as soon as symptoms start to improve, or as soon as it becomes obvious that the drugs are losing their efficacy.

When topical benzoyl peroxide is prescribed together with an oral antibiotic, the risk of antibiotic resistance is lower.

Isotretinoin

For very severe symptoms, such as deep cysts, antibiotics may not be enough.

Isotretinoin, also known as Accutane or Roaccutane, may be prescribed.

This is a systemic oral treatment, which means it is taken as pills and affects the whole body.

A course lasts 15 to 20 weeks. During this time, the doctor must monitor the patient closely, because there is a risk of serious side effects.

Isotretinoin must not be prescribed to pregnant women or anyone who might become pregnant, due to the risk of fetal abnormalities.

Adverse effects include severely dry and cracking skin, nosebleeds, joint pain, and liver damage.

Depression and suicidal tendencies have been linked to isotretinoin, but a causal relationship has not been confirmed.

Two-thirds of users find that their symptoms disappear long term after treatment.

Birth control

Women with pimples may benefit if they take a combination of norgestimate and ethinyl estradiol.

Birth control pills can slightly increase the risk of hypertension, blood clots, and heart disease.

Laser and light therapy

Laser and light therapy targets Propionibacterium acnes (p. acnes), the bacteria that cause acne inflammation.

This therapy reaches deep into the skin without affecting the surface. By damaging the sebaceous glands, it causes them to produce less sebum, or oil.

Use of this treatment is controversial and its safety and effectiveness have not been proven.

Chemical peels and microdermabrasion

Microdermabrasion is commonly used for skin rejuvenation and to improve the appearance of acne scars.

These cosmetic procedures may be more effective when used alongside other acne treatments.

Dermatologists use special chemical peels that are not available from pharmacies.

Drainage and extraction

Drainage and extraction is used to remove a large cyst, especially if the cyst has not responded to medication.

It reduces the pain and lowers risk of a scar. If the cyst has to be dealt with rapidly, the doctor may inject it with medication.

Anyone who is concerned about the severity of their acne should visit a doctor or dermatologist.

PMC

Cleansers and Leave-on Products

True soaps and synthetic detergents. Cleansing is a large part of personal health and hygiene, resulting in removal of unwanted dirt, bacteria, and dead skin cells, which theoretically should allow for better percutaneous penetration of topical drugs/medications.7 When soap was first developed many years ago, it was used mainly for cleansing purposes, but over the decades, the function of skin cleaners, which has progressed beyond true soaps, has morphed to encompass both health and cosmetic benefits. Over time, true soap has evolved into much more than a cleansing agent, with synthetic detergents (syndets) used in both bar and liquid cleansers demonstrating lessened skin irritation. As a result, non-soap-based skin cleansers are now marketed to decrease aged appearance of skin, soften skin, and improve overall skin health.

By definition, a true soap is a salt made of an alkali and a fatty acid; the alkali either consists of sodium or potassium hydroxide with pH ranging from 9 to 10, which is markedly more alkaline than the natural “acid mantle” of the epidermis.8 Daily use of a true soap compromises the permeability barrier of the stratum corneum (SC), resulting in damage to the intercellular lipid bilayer and SC proteins, both of which contribute to regulation of transepidermal water loss (TEWL) and SC hydration necessary for normal desquamation and prevention of xerosis.

Synthetic surfactants are the major ingredient in syndets; other ingredients include high-melting-point fatty acids, waxes, and esters. Due to the unique molecular properties of the surfactants, syndets are incorporated in the mildest bar and liquid cleaners available in the marketplace. Some incorporate lipid-based technologies, such as incorporation of free fatty acids for replenishment and optimal surfactant selection to reduce damage to integral SC proteins.

In a randomized, double-blind study by Subramanyan et al,7 patients undergoing topical acne treatment were randomly assigned to use either a soap or syndet bar (N=25). The syndet bar group demonstrated a greater reduction in signs and symptoms of cutaneous irritation and some decrease in AV lesions compared to the group using soap.7 In another study by Korting et al,9 adolescents and young adults were randomized to wash with either conventional true soap or a syndet bar for three months duration (N=120). Results of this study showed an increase in inflammatory AV lesions in the group using conventional soap and a decrease in inflammatory AV lesions in the group using the syndet bar (p<0.0001). The authors of this paper hypothesized that use of the true soap increased the pH of the skin leading to a more favorable environment for proliferation of P. acnes.9

Since the skin has an acidic pH of 5.3 to 5.9, washing the skin with true soap can increase the pH by 1.5 to 2.0 units for 4 to 8 hours. The increase in pH contributes to amplifying TEWL, thus leading to production of visible changes of dryness. In addition, the increase in pH may facilitate microbial growth potentially leading to increase in P. acnes and development of AV lesions.10,11 The pH of syndet cleansers hover around 5.5 and do not modify the pH of the skin.12

As an alkaline pH can also impair enzymes involved in normal SC functional integrity, true soaps contribute to xerotic changes within skin leading to fine fissuring, scaling, and sometimes low-grade inflammation, which produces erythema. With regard to AV, these adverse xerotic changes may potentiate cutaneous irritation associated with some topical acne medications, such as retinoids and/or benzoyl peroxide. On the other hand, use of a syndet-based skin cleanser can reduce the potential for cutaneous irritation that is sometimes associated with topical therapies for AV.

Benzoyl peroxide. Benzoyl peroxide (BP) is an organic acid in the peroxide family that has been a fundamental component of therapy for AV for more than six decades. In addition, BP is used for a variety of other purposes (i.e., hair/teeth bleaching, preparation of flour, polymerization reactions). Since the 1930s, BP has been a popular choice for the treatment of AV due to its keratolytic, moderate comedolytic, and antibacterial properties, which include the reduction of P. acnes and Staphylococcus aureus on skin.13,14 Cutaneous side effects of BP are most often irritant in nature, may be concentration and/or vehicle dependent, and are usually mild, including signs such as dryness, erythema, and fine scaling. A minority of the population treated with BP for AV will experience true allergic contact dermatitis (1:500). Although available OTC, BP is a pregnancy category C agent, suggesting that its use in pregnancy may not be prudent.

Common use worldwide of topical and oral antibiotics for treatment of AV over the past 3 to 4 decades has led to an increase in P. acnes strains that are less sensitive to antibiotics that are commonly used for treatment of AV, especially erythromycin and tetracycline. When the in-vitro mean inhibitory concentration of a specified antibiotic increases to predetermined breakpoints, the tested P. acnes strain is determined to be “resistant” to that antibiotic, with relative rates of high-level and low-level P. acnes resistance reported in some studies. Global rates for the presence of antibiotic-resistant P. acnes strains, most often highest to erythromycin followed by tetracycline, rose from 20 percent in 1978 to 62 percent in 1996. Resistance is most common with erythromycin, clindamycin, and tetracycline; however, reported rates with doxycycline, trimethoprim, and minocycline have increased in direct correlation with geographic usage patterns.15

When BP is combined with a topical antibiotic (i.e., erythromycin, clindamycin), there is an augment antibacterial effect based on log reductions of P. acnes in addition to a decrease in the emergence of both new and pre-existing antibiotic-resistant P. acnes strains.16 Combination gel formulations of BP with erythromycin or clindamycin are only available by prescription in the United States. BP is equally effective against erythromycin-sensitive and erythromycin-resistant P. acnes and coagulase-negative S. aureus in vitro.16 Clinical studies have shown that the combination gel formulations of BP and erythromycin or BP and clindamycin are more effective than either active agent used as monotherapy in decreasing acne lesions, especially inflammatory lesions (Figure 1).13,15,17 The effectiveness of the topical antibiotic and BP may be explained by their independent antibacterial effects, the moderate comedolytic effect of BP, and potentially anti-inflammatory properties associated with erythromycin or clindamycin, although the latter are not as well defined.13

Reduction of Propionibacterium acnes with topical therapies. Reprinted with permission from: Leyden JJ. Current issues in antimicrobial therapy for the treatment of acne.

J Eur Acad Dermatol Venereol. 2001;15(Suppl 3):51–55.

Available OTC, BP-based products for AV range in concentration from 2.5 to 10% and encompass a wide variety of vehicle formulations. In three double-blind studies of patients with mild-to-moderately severe acne vulgaris, 2.5% BP gel was compared to its vehicle and also to 5 and 10% BP gel preparations (N=153).18 The results showed the 2.5% BP was more effective than its vehicle and equivalent to the 5 and 10% BP preparations. Cutaneous side effects, such as desquamation, erythema, and burning, were increased with the higher concentration formulas.18 Therefore, BP concentrations greater than 2.5% do not necessarily increase the efficacy of treatment in patients with facial AV. However, higher concentrations may be associated with increased risk and severity of signs and symptoms of application-site irritation. In addition, efficacy, tolerability, safety, and microbiological data on OTC formulations of BP have not always been completed and/or are not often published. As a result, it is difficult for the practicing clinician to make specific BP product recommendations to patients based on clinical and scientific evidence. This latter issue is confounded by the recent mandate from the United States Food and Drug Administration (FDA) directing that all BP formulations be available OTC, including those currently available by prescription only. All such formulations are given a basic designated BP monograph that is ascribed to the product (“class labeling”), although each specific product has not been studied individually in support of all of the information included in the designated monograph.

BP is also available by prescription. To the authors’ knowledge, there are no published direct-comparison (“head-to-head”) trials comparing OTC BP formulations to prescription BP formulations. However, some prescription formulations contain additional ingredients, which may decrease irritation and enhance delivery, and many are supported by published clinical trials evaluating clinical efficacy, primarily for facial AV, and/or microbiological data evaluating P. acnes reduction.

A six-week clinical study by Sawleshwarkar et al19 examined the efficacy and tolerability associated with a 4% BP cream in a hydrophase base (Brevoxyl®, Steifel Labs, Research Triangle Park, North Carolina) that was until recently available only by prescription.19 Results showed that the BP 4% cream was efficacious and well tolerated.19 The hydrophase vehicle, which contains dimethyl isosorbide (DMI), produces dissolution of BP which is believed to reduce irritation that can occur with BP. Many formulations incorporate BP crystals that vary in size and do not necessarily fully dissolve completely or at the same rate. Larger crystals that are not capable of settling into the follicular ostia due to their size may randomly rest on the skin surface for more prolonged periods of time, thus producing scattered foci of “hot spots” that may present as patches of cutaneous irritation.

Hydroxy acids. Hydroxy acids can be divided into two major categories:α-hydroxy acids (AHA) and β-hydroxy acids (Table 1). Both AHA and β-hydroxy acids are used for cosmetic applications in dermatology but differ in their structures and chemical properties. AHAs are a group of chemical compounds that have a carboxylic acid moiety that is substituted with a hydroxyl group at theα position of the acid, which confers water solubility to the compound. Whereas, lipid-solubleβ-hydroxyl acids are a group of chemicals containing a carboxyl and hydroxyl group separated by two carbons atoms, making the compound lipid soluble.

TABLE 1

Characteristics of alpha-hydroxy acids and beta-hydroxy acids

HYDROXY ACID SOLUBILITY SOURCE PENETRATION ACTION
Alpha-hydroxy acid Water soluble Dermis (at high concentrations) Exfoliative
 Glycolic acid Sugar cane
 Lactic acid Sour milk
Beta-hydroxy acid Lipid soluble Epidermis and pilosebaceous unit Exfoliative, comedolytic, anti-inflammatory
 Salicylic Willow bark, wintergreen, sweet birch

α-hydroxy acids (AHA). AHA’s are a group of hydroxy acids including glycolic, lactic, and citric acid. The exact mechanism of action of AHAs is not completely understood. They exert some effect by thinning the stratum corneum, promoting epidermolysis, dispersing basal layer melanin, and increasing collagen synthesis within the dermis.20 A study conducted by Ditre et al21 showed patients that applied 25% glycolic, lactic, or citric acid for six months had an approximately 25-percent increase in both epidermal and dermal thickness. Histological staining demonstrated increased mucopoly-saccharides, improved quality of elastic fibers, and increased density of collagen.21

Hyperkeratinization (hyperkeratosis), subclinical, clinical, or both, often results secondary to abnormal SC desquamation and epidermal thicken-ing, both often responses to impairment of the SC permeability barrier. With loss of cutaneous hydration, the decrease in mechanical resiliency of the epidermis leads to microfissuring and often to visible skin splits (macrofissures), the latter being fine and superficial (eczema craquele) or discrete and deep (canyon-like fissures of hyperkeratotic hand-foot eczema or keratoderma). Hyper-keratinization may be acquired or may be inherent to the progression of a variety of underlying skin disorders that are focally or diffusely involved in the progression of many common skin diseases including AV, eczematous dermatoses, severe xerosis, plaque psoriasis, and verrucae. Histologically, hyperkeratinization presents as a thickened SC and is sometimes associated with epidermal thickening. At lower concentrations, AHA functions as an exfoliant, interrupting corneocyte adhesion in the upper SC by interfering with formation of ionic bonds. As a result, AHAs promote individual corneocyte desquamation and decrease corneocyte clumping, both of which lead to smoother skin texture and decreased visible scaling and flaking; a decrease in follicular hyperkeratois promotes resolution and prevents formation of AV lesions, especially comedones.22,23 Higher concentrations of AHAs (8–10%) can lead to both epidermolysis and thickening of the dermis.

Brief exposure to glycolic acid at concentrations of 30 to 70 percent is frequently used in superficial peeling, which may serve as an effective adjunct in patients with multiple and/or persistent closed comedones.23

β-hydroxy acids. Salicylic acid, the onlyβ-hydroxy acid that is used in dermatological practice, is lipophilic, and is a very common active ingredient in a plethora of OTC acne cleansers, astringents, and lotions. Due to its desmolytic properties, salicylic acid promotes individual corneocyte desquamation, thus simulating natural exfoliation, and exerts moderate comedolytic activity. The desmolytic and comedolytic properties of salicylic acid are concentration-dependent. In fact, salicylic acid is not keratolytic. Rather, it exerts its effect on SC desquamation by breaking the bonds created by corneodesmosomes, also called the “rivets” or “staples” of the SC, which sustain the adherence between contiguous corneocytes.23 As a result, mild visible peeling may be noted, and some salicylic acid-containing vehicles may promote cutaneous irritation, while others (i.e., multivesicular emulsion, emollient foam) are associated with little-to-no skin tolerability reactions.

OTC salicylic acid acne treatments include con-centrations of 0.05% to 5%. Higher concentrations are reserved for salicylic acid prescription medications and chemical peels. The “physiological” desquamation provided by salicylic acid provides smoother texture and appearance to the skin and can give the illusion of decreased pore sizes. Unfortunately, lower concentrations of salicylic acid may provide only a modest desmolytic activity, thus producing minimal therapeutic effects.

A 12-week, double-blind, randomized study by Shalita et al24 evaluated the response of mild-to-moderate AV with use of Stridex® pads (0.5% salicylic acid, Blistex, Oak Brook, Illinois) twice daily as compared to patients using vehicle pads twice daily, both applied twice a day for 12 weeks. The actively treated group demonstrated greater reduction of both inflammatory lesions and open comedones.24

Kessler et al25 compared the efficacy ofα- andβ-hydroxy peels in the treatment of mild-to-moderately severe facial AV in a split-face, double-blind, randomized, controlled study. Twenty patients were recruited to the study; aα-hydroxy (30% glycolic acid) was applied to one half of the face and aβ-hydroxy (30% salicylic acid) to the contralateral side every two weeks for a total of six treatments. There was no significant difference in efficacy between the two peels; however, salicylic acid had fewer initial side effects and sustained effectiveness at two months after treatment.25

Hydroxy acids are categorized as pregnancy category C; animal studies demonstrate birth defects when given orally in doses six times the maximum topical dose. Salicylism, although rare, can occur, especially in patients with impaired stratum corneum permeability barrier function receiving treatment over a large body surface area.26

Polyhydroxy acids (lactobionic acid and gluconolactone). Polyhydroxy acids (PHA), the new generation of AHAs, provide similar effects of traditional AHAs without the associated sensory side effects of irritation and stinging.27 PHAs are formulated as multiple strand molecules allowing for slower and gentler absorption rate, reducing aforementioned side effects, making them compatible for use on clinically sensitive skin.28

One PHA, lactobionic acid, has been suggested to be an inhibitor of the breakdown of matrix metalloproteinase enzymes (MMPs), possibly due to metal chelation. Breakdown of these MMPs due to sun exposure contribute to the appearance of photoaging. Lactobionic acid is a strong metal chelator conferring antioxidant properties; it is currently used as an antioxidant in organ transplantation. Additionally, PHAs have strong moisturizing and humectant properties.28 The combination of PHAs and tretinoin has been shown to decrease the total number of acne lesions and both subjective and objective measures of irritation.28

Triclosan/triclocarban. Triclosan/triclocarban are bacteriostatic agents that can be found in a variety of household items and are often the key ingredient in OTC acne cleansers and washes. Triclosan is a bisphenol disinfectant, with action against gram-positive and most gram-negative organisms and is used in surgical scrubs/soaps and deodorants.29 However, topical antibiotics should never be used as monotherapy and are preferably combined with other topical nonantibiotic antimicrobials such as benzoyl peroxide.30

Back acne: How to see clearer skin

Dermatologists recommend wearing sweat-wicking clothes when working out. If you have acne on your back—or “bacne” as some people call it—you don’t have to wait for it to clear on its own. Treatment and the right skin care can help you see clearer skin more quickly.

You may even be able to clear your back on your own.

Who can treat back acne at home?

You may see clearer skin from treating it yourself if you:

  • Have a few blemishes on your back (mild acne)

  • Developed back acne recently

  • Have a mix of whiteheads, blackheads, and pimples on your back, but nothing that’s painful or goes deep into the skin (moderate acne)

Anyone who has deep, painful acne on their back (or anywhere else) will need a dermatologist’s help.

OTC treatment for back acne that works

OTC stands for over-the-counter. It’s medical jargon that means any treatment that you can buy without a prescription.

Studies show that the following OTC acne products can help clear mild (or moderate) back acne when used along with acne-friendly skin care:

Benzoyl peroxide (emollient foam wash): This helps to kill the bacteria that cause acne. Used daily, it can help control back acne and reduce flares.

Benzoyl peroxide needs time to work

Studies show that benzoyl peroxide works best if left on the back for two to five minutes.

Letting the benzoyl peroxide sit on your skin for a few minutes has two advantages.

  1. This approach helps the medicine penetrate your skin. Skin is thicker on the back than on the face.

  2. Rinsing it off prevents bleached clothes, sheets, and towels. Benzoyl peroxide is known to bleach fabrics.

You’ll find OTC benzoyl peroxide foaming washes in different strengths. Using a product that contains 5.3% benzoyl peroxide is less likely to cause irritated skin, dryness, or peeling.

If you feel that you need stronger medicine, you can start with a foaming wash that contains 10% benzoyl peroxide. That’s the strongest concentration of benzoyl peroxide that you can buy without a prescription.

Retinoid (adapalene 0.1% gel): Using this along with benzoyl peroxide can improve your results. This OTC retinoid can help unclog pores, which will help the benzoyl peroxide work better.

Dermatologists recommend applying adapalene after you shower or before going to bed. Again, you want to apply it daily.

How to apply medicine to your back

For treatment to work, you must get it on your back. Investing in a lotion applicator for the back can help you apply the medicine where you want it.

If you’re not sure where to find one of these, just search online for a “lotion applicator for the back.”

Acne friendly skin care essential

To get the results you expect from treatment, you’ll also need acne-friendly skin care. Without it, your acne can flare, even when you’re treating it.

To help their patients with back acne get the best results, dermatologists recommend the following:

1. Develop these habits when working out or getting sweaty.

  • Wear loose-fitting workout clothes made of cotton or sweat-wicking fabric.

  • Wash workout clothes after each use.

  • Shower and change clothes ASAP after working out (or doing anything that causes you to sweat).

If you cannot shower immediately, use an oil-free cleansing wipe to gently wipe off your sweaty skin. You’ll also want to change out of sweaty clothes.

2. Cleanse your skin gently.

Scrubbing skin with acne may seem best, but this actually worsens acne. When washing your back and applying acne treatment, you want to be gentle.

3. Stop irritating your skin with harsh skin care products.

Antibacterial soaps, astringents, and abrasive scrubs can worsen acne. Ditto for loofahs, back brushes, and buff puffs. For best results, you’ll want to use gentle, fragrance-free skin-care products.

4. Use oil-free skin care products and cosmetics.

The packaging may read “non-comedogenic,” “non-acnegenic,” “won’t clog pores,” or “oil-free.”

5. Avoid using anything that rubs against your back, such as a backpack.

Anything that rubs against your back can irritate your skin, causing back acne to flare. Swap a backpack for a handheld bag. If you carry a purse on your shoulder, place the strap on your arm.

6. Resist the temptation to pick and pop acne, even on your back.

This will only worsen acne.

Choose the right sunscreen

Buy non-comedogenic, SPF 30, broad-spectrum, and water resistant sunscreen.

7. Protect your skin from the sun.

People often believe that the sun’s rays will help clear acne, but the sun can actually worsen acne. The sun’s rays tend to darken acne and cause it to last longer.

You can help clear acne by always wearing oil-free sunscreen when outdoors. You’ll want to apply sunscreen to all skin that clothes won’t cover.

8. Change your sheets and pillowcases weekly.

Clean sheets and pillowcases are essential for clearing back acne. You may want to change pillowcases twice a week. By the end of a week, sheets and pillowcases are swarming with dead skin cells and bacteria.

When washing sheets and pillowcases, be sure to use fragrance-free detergent. If you like fabric softener, it, too, should be fragrance-free.

When to see a dermatologist

It can take time to see results from treatment. If treatment works, you may start to see results in six to eight weeks. Complete clearing can take three or four months.

If you don’t see any difference in six to eight weeks, you may need a dermatologist’s help. With a dermatologist’s help, virtually every type of acne can be successfully treated.

Bikowski J. “A review of the safety and efficacy of benzoyl peroxide (5.3%) emollient foam in the management of truncal acne vulgaris.” J Clin Aesthet Dermatol. 2010;3(11):26-9.

Brand B, Gilbert R, et al. “Cumulative irritancy comparison of adapalene gel 0.1% versus other retinoid products when applied in combination with topical antimicrobial agents.” J Am Acad Dermatol. 2003;49(3 Suppl):S227-32.

Del Rosso JQ. “Management of truncal acne vulgaris: current perspectives on treatment.” Cutis. 2006 May;77(5):285-9.

Eichenfield LF, Andrew C. Krakowski AC, et al. “Evidence-Based Recommendations for the Diagnosis and Treatment of Pediatric Acne.” Pediatrics. 2013;131 Suppl 3:S163-86.

Leyden JJ, Del Rosso JQ. “The effect of benzoyl peroxide 9.8% emollient foam on reduction of Propionibacterium acnes on the back using a short contact therapy approach.” J Drugs Dermatol. 2012;11(7):830-3.

Drugstore Remedies for Acne

XYZPRAT A severe acne breakout that covers your face or body may require professional acne treatment from a dermatologist. But for most people, the occasional pimple or blemish can be handled at home with an over-the-counter acne treatment. There are many options to choose from and different ingredients to consider, so do your homework before putting anything on your face.

About Over-the-Counter Acne Treatments

Healthy habits — including a good skin care regimen, regularly washing your skin, and keeping your hands and oily products off of your face — are your first line of defense in preventing an acne breakout. But no matter how hard you try, you’re likely to get a pimple or two at some point.

If you have regular acne breakouts, take steps to improve your skin care regiment. When problem skin is left untreated, you may experience frustration, problems with self-esteem, and physical scars from your acne. You can treat your acne breakout — so don’t just live with it and hide your face until it goes away.

Which Over-the-Counter Acne Treatments Should You Try?

Over-the-counter acne medication comes in a variety of different forms and strengths. Topical over-the-counter acne medications are available as:

  • Medicated pads to clean the skin
  • Special soaps and cleansers
  • Gels
  • Creams
  • Lotions

These nonprescription acne medication options are a good choice for people who have only mild acne — the occasional acne breakout of small pimples, blackheads, or whiteheads.

You’ll have to decide what’s the best method of acne treatment for you and your skin — whether you need a gel or cream to spot-treat the occasional pimple, or if you need a medicated wash and lotion to keep your whole face or body blemish-free and clear.

Ingredients to Fight an Acne Breakout

Over-the-counter acne medications may contain a few different ingredients to help fight a simple pimple or a full-fledged acne breakout. Common ingredients are:

  • Benzoyl peroxide
  • Salicylic acid
  • Resorcinol
  • Sulfur

Some of these may also be found in prescription acne treatments, but you can get milder, lower-dose versions in over-the-counter products.

The most commonly found ingredients in over-the-counter acne medications are benzoyl peroxide and salicylic acid. They help to rid your skin of excess oil and destroy lingering bacteria to help fight acne. Once the oils have dried up, the skin layers making up the pimple will peel and flake off. Benzoyl peroxide can also help to shrink pimples by reducing swelling and inflammation. Sulfur, resorcinol, and salicylic acid actually help pimples disintegrate and clear up skin.

(Prescription-strength acne medication is stronger — and may offer the option of oral medications and other, more effective ingredients, like retinoids or injections of corticosteroids, that you can’t get over-the-counter.)

Possible Side Effects of Over-the-Counter Acne Treatments

There are some potential, although relatively minor, side effects to consider when using over-the-counter acne medication. Because these treatments help dry up excess oil, they can leave your skin too dry if used too frequently. Other common side effects include:

  • Reddened skin
  • A burning sensation
  • Irritated skin

Always follow the instructions provided on the packaging of any over-the-counter acne medication that you use to help minimize the risk of these side effects.

No acne medication works immediately, so it’s important to understand that it takes time to see results — and that you shouldn’t give up. Some over-the-counter acne medications can take as long as eight weeks to provide results.

If you can’t get relief from your acne using over-the-counter acne medication — or if you have painful side effects — it may be time to see a dermatologist about other methods of clearing up your skin.

Over-the-Counter Treatments

For mild acne, start with over-the-counter products, which don’t need a prescription. First, wash your face daily. “Studies have shown that regular washing of the face makes a huge difference,” Nagler says. Be gentle; overdoing it can make matters worse.

Acne face washes often contain salicylic acid, which removes oil and clears your pores. If you have sensitive skin, find a foaming face wash or other gentle cleanser labeled sensitive, says Allison Arthur, MD, a dermatologist at Sand Lake Dermatology Center in Orlando, FL.

Look for these other ingredients when you shop:

Adapalene (Differin). This medicine is a retinoid, a group of topical medicines derived from vitamin A. It affects the way skin cells grow and helps prevent clogged pores. It used to be only available by prescription.

Benzoyl peroxide. This treatment is usually sold in gels or lotions. It unclogs pores, dries out pimples, and kills bacteria. It prevents new acne.

Using benzoyl peroxide and adapalene together is a common starting point for acne treatment, Arthur says. Then give it a chance to work.

“Sometimes I see people try over-the-counter products just for a couple of weeks, they get frustrated, they say it’s not working, and they discontinue them,” Arthur says. “But it really does take a while to see the effectiveness. So unless you’re having a problem with the medication, like it’s causing severe irritation or dryness, it’s recommended to give it at least 2-3 months before switching to something else.”

If you are among the 50 million Americans with acne, you know that clearing it up can be expensive. In fact, patients who received medical care for acne in 2013 spent over $1.2 billion total on treatments and associated costs.

So why exactly are these skin-clearing medications so expensive? It’s a complicated answer, but one worth exploring. If you’re currently using acne medication or seeking treatment, here’s an overview of the high costs and how you can save.

Common acne medications and classes that treat acne

Acne medications come in many forms, from topical creams and tinctures to antibiotics to oral contraceptives. In many cases, healthcare providers suggest a combination approach.

  • Benzoyl peroxide: Benzoyl peroxide is a common ingredient found in many over-the-counter acne products. It is also available at a higher strength with a prescription. Benzoyl peroxide works as a topical antiseptic to treat mild to moderate acne. For more severe cases, it can be combined with prescription antibiotics like clindamycin or erythromycin.
  • Retinoids: Retinoids and retinoid-like drugs are derived from vitamin A and work by preventing dead skin cells from clogging pores. Popular prescription forms include tretinoin (Avita, Retin-A, Atralin), adapalene (Differin), and tretinoin micro (Retin-A Micro). Similar to retinoids in its effect, isotretinoin(Accutane) is an expensive drug used to treat severe acne that has not responded to other therapies.
  • Antibiotics: These drugs help fight the bacteria that sometimes cause acne, and help decrease inflammation. To prevent antibiotic resistance, experts recommend using antibiotics for as short a time as possible. Both oral and topical antibiotics are usually prescribed alongside an additional treatment, like benzoyl peroxide or a retinoid. Popular antibiotics to treat acne include:
    • clindamycin (Cleocin, Cleocin T, Evoclin)
    • doxycycline monohydrate (Vibramycin Monohydrate, Monodox)
    • doxycycline hyclate (Acticlate, Vibramycin Hyclate)
    • erythromycin (Ery-Tab, Eryc, Erygel)
    • minocycline (Dynacin, Minocin)
    • sulfacetamide (Klaron)
  • Contraceptives: Finally, birth control pills can also control acne by reducing hormones that can lead to excess sebum, which can clog pores. There are 4 combined contraceptives that are FDA-approved for acne therapy in women who also wish to use them for birth control. Leading brand names of estrogen-progestin contraceptives include gianvi, nikki, and loryna.

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Average pricing of popular acne medications

Clindamycin is the most commonly prescribed antibiotic for acne treatment. Its list price (the price that a pharmaceutical company assigns as the official price) is around $4 for a 30-day supply of 150 mg capsules, and around $13 for a 30-day supply of 300 mg capsules. Without insurance or other discounts, a 30-day supply will cost around $30 for the 150 mg capsule and $90 for the 300 mg capsule.

Sulfacetamide, another popular acne drug, has a cash price (the price without insurance) around $74 for a 3.5 g tube of ointment. Sulfacetamide/sulfur, which contains an antibiotic and is often dispensed as lotion, can exceed $400 without insurance for a 30-day supply.

Plain, topical benzoyl peroxide gel has a cash price of around $25 for a 30-day supply. But preparations that include an antibiotic like erythromycin or clindamycin can be up to 10 times more expensive. Benzoyl peroxide products are also available over-the-counter (OTC) at a lower dose and usually cost less than $10.

Combination contraceptives—birth control—can cost as little as $21 with insurance or as much as around $77 without insurance. Health clinics like Planned Parenthood also offer birth control at little to no cost.

The most expensive acne medications

The priciest acne medications tend to be the options that are a combination of two drugs. Examples of these expensive, one-two punch medications are benzoyl peroxide with an antibiotic or a combination of a retinoid with benzoyl peroxide. Brand-name Epiduo has an average cash price of $530 for a 45 g gel pump and is not usually covered by insurance.

Straight retinoids, which tend to have high manufacturing costs, aren’t much easier on the wallet. Even a 45 g tube of generic topical tretinoin carries an average cash price of $175 or more, while a 45 g tube of brand-name Retin-A goes for about $100 cash for most forms and concentrations. Meanwhile, the average cash price for generic adapalene is around $250. OTC Differin Gel is now available without a prescription for about $30.

Tips for how to save on popular acne medications

A 2018 study found that cost or insurance restrictions are the main factors preventing patients from filling their acne medication prescriptions. Effective treatment shouldn’t break the bank. Here are a few cost-saving tips to help you get the drugs you need.

  • Try over-the-counter products first. For mild to moderate acne, an array of OTC products containing benzoyl peroxide, salicylic acid, or retinol may do the trick. Ask your healthcare provider to recommend an OTC product to use in combination with prescription antibiotics rather than paying top dollar for combination drugs.
  • Opt for generic. If they’re available, try lower-cost generics instead of brand names. You can discuss this with your healthcare provider when they prescribe the medication, or with your pharmacist when you pick it up. Even if you’ve already been using a brand medication for a while, your pharmacist can easily help you switch to the less-expensive generic option.
  • Use insurance. Insurance coverage for acne medication can be tricky. Most prescription acne medications are covered under the average health insurance plan, but there may be some restrictions. If you’re enrolling in a new plan and you’re on an acne medication that you intend to continue taking, be sure to check your insurer’s formulary (list of covered medication). If necessary, your healthcare provider may have to call your insurance to get a pre-authorization for coverage of your medication.
  • Use GoodRx. Before filling a prescription, type the drug name into goodrx.com to find available discount coupons and savings. For example, the average GoodRx coupon price for clindamycin/benzoyl peroxide is around $95, about one-third of the average list price.
  • Use products as directed. Prescription acne medicines are powerful and potentially irritating, so a little goes a long way. Following package directions closely can reduce waste and save your skin.

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  • Your friends swear they can’t see that zit, but to you, it’s the size of a baseball. (I feel your pain, girl.)

    Fret no more: These dermatologist-backed OTC acne treatments work wonders against pimples, blackheads, and whiteheads so you can finally forego layers on layers of concealer.

    Ready to put your best face forward? Thought so.

    Best exfoliator: Cane + Austin Miracle Pad 20% Glycolic Facial Treatment

    Cand + Austin

    BUY IT $78, sephora.com

    “This is an all-in-one user-friendly pad that we recommend our patients use twice a day,” says Lily Talakoub, M.D., of McLean Dermatology and Skincare Center. First, the glycolic acid removes dead surface skin, and lifts away debris and oils carrying nasty bacteria. The pad also has antioxidants like green tea to smooth skin and witch hazel to tone. What you’re left with is balanced skin that can operate normally without bacterial intrusion, she says.

    Best natural acne product: Lush Grease Lightning Tea Tree Cleanser

    Lush

    BUY IT $16, lushusa.com

    For the ultimate all-natural acne-fighting potion that works double duty to spot-treat zits and combat oily skin, look no further. “This product contains multiple antioxidants like aloe vera, grape juice and witch hazel, and natural lavender oil,” says dermatologist Gary Goldenberg, M.D., of Goldenberg Dermatology in NYC. He says its tea tree and thyme component help fight signs of aging, too. (Just spot-test first, since tea tree oil can be irritating to some skin types.)

    Best drugstore acne treatment: Clearasil Daily Clear Vanishing Acne Treatment Cream

    Clearasil

    The best over-the-counter product for acne is benzoyl peroxide cream, says Marisa Potter, M.D., a dermatologist with Advanced Dermatology & Cosmetic Surgery in Aventura, Florida. The active ingredient (which fights the bacteria that can cause painful pimples) is more important than the brand, but Clearasil is a tried-and-true product. Potter recommends using a small amount once per day for acne (though, be warned: it can bleach your clothes and pillowcase).

    Best spot treatment: Mario Badescu Drying Lotion

    Mario Badescu

    BUY IT $17, amazon.com

    “This product has found a permanent home in my medicine cabinet,” says New York City dermatologist Lian Mack, M.D. “Containing sulfur, salicylic acid, and calamine, it easily eliminates my random breakouts,” she adds.

    Learn everything you could ever want to know about adult acne:

    Best acne treatment tool: Clarisonic Skin Care Brush

    Clarisonic

    BUY IT $129, amazon.com

    “This is a great tool for exfoliating the face to effectively remove pore-clogging dead skin cells,” says New York City-based cosmetic dermatologist Paul Jarrod Frank, M.D. You also get the bonus benefit of reducing the excess sweat and oil that may lead to acne. “Using the Clarisonic will also help increase the efficacy of the skincare products you apply,” he adds. Score.

    Best all-in-one kit: La Roche Posay Effaclar Dermatological Acne System

    La Roche-Posay

    BUY IT $30, laroche-posay.us

    With a medicated gel cleanser, clarifying solution, and acne treatment, this takes care of acne from all angles. “This is the best system,” says Elizabeth Tanzi, M.D., founder and director of Capital Laser & Skin Care and associate clinical professor at the George Washington University Medical Center. “Just like the other popular acne systems, it has salicylic acid and benzoyl peroxide, but the ‘secret’ ingredient that makes this a winner is the LHA micro-exfoliator. It helps to gently clean pores without irritation,” she says.

    Best prescription dupe: Differin Acne Treatment Gel

    Differin

    BUY IT $11, amazon.com

    This is a common derm favorite, and New Orleans dermatologist Deirdre Hooper, M.D., of Audubon Dermatology, is just one of the dermatologists who swears by it. “I love Differin for acne and off-label for brown spots and texture,” she says. Thanks to the retinoid adapalene, it unclogs pores and calms inflammation. Since it can be drying, she recommends using a pea-sized amount and blending it with a moisturizer before applying.

    Best acne face wash: SkinCeuticals LHA Cleansing Gel

    Skinceuticals

    BUY IT $40, skinceuticals.com

    This is one product derm Jennifer MacGregor, M.D. regularly uses in the morning. This gentle glycolic acid-based cleanser is ideal if you have oily skin and are susceptible to getting blocked pores, she says. Use it in the morning, and follow up with a light oil-free sunscreen moisturizer, she recommends.

    Best for aging skin: Hydropeptide Redefining Serum

    Hydropeptide

    BUY IT $132, dermstore.com

    Joyce Imahiyerobo-Ip, M.D., a board-certified dermatologist, resorts to this uber-gentle serum because acne-prone skin “doesn’t like to be overly scrubbed,” she says. Its salicylic and azeliac acid content treats blackheads and whiteheads by promoting healthy skin turnover and dissolving clogged pores. It also contains plumping moisturizer hyaluronic acid and anti-aging peptides, to attack signs of aging, too.

    Best serum: LaFlore Probiotic Serum Concentrate

    LaFlore

    BUY IT $140, amazon.com

    You know probiotics are great for your gut, but Whitney Bowe, M.D., celebrity dermatologist and author of The Beauty of Dirty Skin, makes a case for using probiotics for acne, too. She loves this serum because it combines skin-balancing probiotics with prebiotics (to feed the good bacteria and help them do their job) and postbiotics (byproducts of probiotics) “in order to help strengthen skin’s immune system and restore its healthy balance.”

    Jessica Migala Jessica Migala is a health writer specializing in general wellness, fitness, nutrition, and skincare, with work published in Women’s Health, Glamour, Health, Men’s Health, and more. Marissa Miller Marissa Miller has spent a decade editing and reporting on women’s health issues from an intersectional lens with a focus on peer-reviewed nutrition, fitness trends, mental health, skincare, reproductive rights and beyond.

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