Not all acne products need a doctor’s prescription. Over-the-counter (OTC) formulations are widely available to make treating pimples convenient and inexpensive.
However, not all OTC acne therapies are strongly backed by science or recommended by expert groups. So, choosing among the vast number of skincare products claiming to be pimple busters can be confusing if you’re not armed with the right information.
What are the best OTC treatments for acne? Is it safe to try all of them? How do you know which acne products are suitable for your skin? How do you incorporate these treatments into your skincare routine? Read on to learn how you can maximize the benefits of OTC acne treatments.
How Do OTC Anti-Acne Products Work?
Acne treatments usually target at least one of the four stages of acne formation:
- Abnormal growth and shedding of skin cells in pores and hair follicles
- Overproduction of abnormal sebum (natural skin oil)
- Excessive growth of the bacterial species Cutibacterium acnes (previously known as Propionibacterium acnes) in hair follicles
- Inflammation
OTC acne products are typically applied to the skin and not taken by mouth or injected. They contain ingredients that, while effective, do not have effects requiring a doctor’s prescription, unlike antibiotics and anti-hormonal drugs. When used as instructed, these formulations do not damage crucial organs, such as the kidneys and heart.
OTC acne preparations may be taken as standalone treatments in mild cases or added to prescription medications in moderate-to-severe disease. According to the 2024 guidelines published by the American Academy of Dermatology (AAD), acne care should address multiple steps in pimple formation, which may be accomplished by using one or multiple active ingredients.
What OTC Active Ingredients Help Acne?
OTC acne drugs with strong recommendations from the AAD include some retinoids, as well as benzoyl peroxide. Salicylic acid and azelaic acid have conditional recommendations. The effects of these substances are explained below.
Retinoids
Retinoids are drugs that mimic vitamin A’s structure and function. These substances act on all stages of pimple formation, making them highly effective against this skin problem.
Topical retinoids help clear pores, prolong remissions, and improve dark spots left by pimples. Importantly, these drugs can kill off acne-causing bacteria without producing bacterial resistance—a problem that can render antibiotics like clindamycin ineffective when used over long periods.
The FDA has approved four topical retinoids for acne treatment: adapalene, tazarotene, tretinoin, and trifarotene. Research shows that none of these agents stands out as more effective or tolerable than others of the same drug class. However, only adapalene is sold in OTC formulations, available as 0.1% lotion or cream and 0.1-0.3% gel.
Potential side effects of skin-applied retinoids include a burning sensation on the treated area, as well as skin dryness, redness, and scaliness. The skin may become quite sensitive to UV rays, making sun protection necessary during treatment.
Except for tazarotene, topical retinoids are not known to cause developmental problems in humans when used during pregnancy. Nevertheless, other drugs are preferred over this class of medications when treating acne in pregnant women.
Benzoyl Peroxide
Benzoyl peroxide clears pores and has antimicrobial and anti-inflammatory effects. Like retinoids, this OTC active ingredient fights pimple-causing bacteria without bringing about bacterial resistance. Benzoyl peroxide can be found in leave-on and cleanser products at concentrations of 2.5-10%.
Potential side effects include skin irritation, scaling, dryness, redness, and stinging. This drug may stain or bleach fabrics and hair and cause contact allergy. However, benzoyl peroxide is deemed safe for use during pregnancy. Using the cleanser form and lower-strength leave-on formulations can help further diminish the risks associated with this medication.
Salicylic Acid
Salicylic acid is an exfoliating agent that remedies acne by unclogging pores. OTC products containing this substance include leave-on and cleanser formulations at concentrations of 0.5-6%.
The most common side effect of topical salicylic acid is mild irritation of the treated site. However, when applied to large skin areas, this substance may cause salicylate toxicity, with symptoms that include nausea, vomiting, confusion, and breathing problems. Products containing this medication may be used during pregnancy unless breakouts involve vast portions of skin.See AlsoOver-the-counter procured emergency contraception among undergraduate students in a public University in GhanaChoosing a combined oral contraceptive pillContraceptives available at Arizona pharmacies without prescription likely by end of fallGuidance for OTC Human Chorionic Gonadotropin (hCG) 510(k)s
Azelaic Acid
Azelaic acid has antibacterial and anti-inflammatory properties. This drug also unblocks pores and lightens dark spots. OTC formulations include 20% acne creams and 15% rosacea gel treatments.
Azelaic acid does not cause bacterial resistance, although it may produce a sensation of burning or stinging and an uneven skin tone in individuals of color. This OTC acne agent is safe for pregnant women.
OTC Acne Solutions Lacking AAD Support
Many OTC actives marketed as pimple fighters are not backed by the AAD despite their wide availability. That’s because there’s not enough scientific evidence to prove their effectiveness in combating the stages of acne formation. These active ingredients include sulfur, resorcinol, tea tree oil, and the vitamins zinc and niacinamide.
Sulfur is an old acne soap ingredient thought to have antimicrobial and exfoliating effects. Resorcinol is supposed to work the same way, but these actives are ineffective on their own. Additionally, many patients cannot tolerate sulfur’s odor. The combination of sulfur and resorcinol can irritate the skin.
Tea tree oil, zinc, and niacinamide are considered alternative medicine treatments. Tea tree oil has shown some antibacterial and anti-inflammatory effects. However, the byproducts of exposing tea tree oil to light can trigger allergic contact dermatitis. Zinc and niacinamide are touted as anti-inflammatory agents. However, research is unclear whether they work effectively when used on their own for clearing acne.
How Do You Find the Right OTC Acne Treatment for You?
Choosing an OTC acne medication is a complex process that is beyond the scope of this article. Various factors must be considered, and only a board-certified dermatologist is qualified to identify your skin’s needs, navigate your options, and help you make a decision. So, even though many acne products can be bought without a prescription, it’s still best to consult your dermatologist to find the most suitable therapy for you.
During the clinical evaluation, your skin doctor will ask you questions to help them figure out what triggers your acne flare-ups. Personal factors that must be considered include but are not limited to the following:
- Diet: High intake of sugars
- Hormonal conditions: Polycystic ovarian syndrome, premenstrual period, insulin issues
- Skin disorders besides acne: Atopic dermatitis, rosacea
- Current medications: Steroids, progestin-only contraceptives
- Skincare: Use of harsh or contaminated cosmetics
- Exposure to toxins: Pollutants and use of cigarettes and prohibited substances
- Climate: High heat, humidity, and UV exposure
- Lifestyle: Socioeconomic pressures
These issues increase your risk of triggering an acne breakout. Managing these concerns may reduce the frequency and severity of your flare-ups.
Your dermatologist will also examine your skin and determine its type. Knowing your skin type helps them recommend the appropriate acne products for you. For example, cleansers suitable for oily skin may be too harsh on dry skin. Sensitive skin types may get irritated with highly concentrated acne medications.
There are no shortcuts to finding the perfect acne solution because it differs for every patient. If you can’t visit a skincare professional in person, a virtual consultation is a convenient alternative that can get you expert skincare advice right where you are.
What OTC Skincare Product Is Best for Acne?
As mentioned, the best acne product varies for everyone. However, for individuals who are not pregnant, adapalene, benzoyl peroxide, and fixed-dose combinations of these two are the most recommended.
Adapalene combined with benzoyl peroxide works as effectively as when either agent is paired with topical antibiotics. Additionally, this combo is generally well tolerated and does not lead to bacterial resistance. Using adapalene or benzoyl peroxide alone or mixing either drug with other acne treatments may be recommended for individuals with contraindications to the combined formulation.
In pregnant women, topical azelaic acid is the most highly recommended by the American Board of Family Medicine for mild-to-moderate acne. Combinations of this drug with benzoyl peroxide or topical antibiotics may be considered for more severe cases. Adapalene and tetracycline antibiotics like minocycline and doxycycline, which increase the risk of fetal problems, are avoided in this patient group.
What Skincare Routine Do Dermatologists Recommend for Acne?
Skincare practices that can enhance the effectiveness of acne treatments include cleansing, moisturizing, and using sun protection. These measures prevent inflammation that can contribute to breakouts.
Cleansing removes excess sebum, dead skin cells, and other debris that can clog pores and irritate the skin. Cleansers recommended for people with acne-prone skin must be non-irritating, non-allergenic, fragrance-free, and alcohol-free. These products must not clog pores, raise the skin‘s pH, or impair the skin’s protective function. Some cleansers contain acne-combating actives, such as benzoyl peroxide and salicylic acid.
Experts recommend that cleansing frequency should be based on geographic location besides physical activity. Cleansing must be generally limited to twice a day but may be as frequent as thrice daily if the patient sweats a lot from living in a hot region or being highly active. Sweat can irritate the skin, but so can excessive cleansing.See AlsoA company is seeking FDA approval for the 1st nonprescription birth control
Moisturizing hydrates the skin and restores its protective lipids after cleansing. Patients must choose a moisturizer that reduces skin dryness and irritation caused by topical acne medications without affecting the latter’s absorption or efficacy. Patients must also ensure they pick a moisturizer that is hypoallergenic, fragrance- and alcohol-free, non-greasy, water-based, and safe for acne-prone skin.
Hyaluronic acid, glycerin, and ceramides are some of the moisturizer ingredients recommended for individuals with highly sensitive skin. These actives are non-greasy and can soothe skin irritation. Hyaluronic acid is especially beneficial for individuals with adult acne.
Moisturizers must be liberally applied after bathing. Experts recommend that moisturizers must be used at least four to five times daily.
Sun protection is a crucial skincare component for people prone to acne formation. UV rays cause skin thickening, which blocks the pores. Sunlight also upsets the balance of natural skin bacteria. These tendencies worsen with the use of acne products containing tetracycline antibiotics, which increase the skin’s light sensitivity.
Using sun protection reduces the risk of acne breakouts, as well as skin cancer, in patients who are pimple-prone. Experts recommend using physical sun shields, such as hats and clothing, when sun exposure is expected. For sunscreens, formulations must be broad-spectrum, protecting from both UVA and UVB light, and have a minimum of SPF 30.
Individuals with skin of color are at a higher risk of getting dark marks from acne, a manifestation of what is known as post-inflammatory hyperpigmentation. These patients may benefit from tinted sunscreen, which protects from both UV and visible light.
The AAD advises applying sunscreen 15 minutes before sun exposure and reapplying every two hours if staying outdoors for an extended period. Sunscreen formulations must be sensitive skin-friendly.
Cleansing, moisturizing, and sun protection are simple yet highly effective practices that can complement your acne treatment. These measures are usually sufficient unless patients have special concerns, in which case a dermatologist may recommend additional steps in their skincare routines.
When Should You Consult a Dermatologist for Your Acne?
The AAD advises visiting a board-certified dermatologist even if your acne seems mild. Still, if you’re unsure whether you need medical help for pimple control, take a look at these statements and see if any sound familiar:
- You’ve tried multiple treatments with little success.
- Your zits clear up but always come back.
- You’ve noticed pimples in unusual spots like your armpits, thighs, upper arms, or groin.
- Acne appeared when you were between 8 and 11 years old or younger.
- You’re dealing with painful, deep pimples.
- Acne has lasted for years, and you’re unsure why.
- Your acne is affecting your mood or social life.
- You’ve felt like hiding your face because of pimples.
- You had a breakout within 6 months of starting a new medication.
- You’re left with scars or dark spots after pimples heal.
- Acne persists on your back and chest even after it clears up on your face.
The AAD recommends consulting a dermatologist if at least 6 of these statements apply to you.
OTC Acne Products: Finding Convenient and Effective Pimple Solutions
Acne is a multifactorial skin condition requiring a multifaceted treatment approach. Some pimple therapies need a prescription, while others don’t. OTC acne product types are the kind that are applied to the skin and do not harm vital organs. These medications may be given as standalone treatments for mild acne or combined with other pimple-fighting actives for moderate-to-severe cases.
OTC acne products must have active ingredients that are both safe and effective. For non-pregnant individuals, adapalene, benzoyl peroxide, and fixed-dose combinations of these two drugs are highly recommended. For pregnant patients, topical azelaic acid is the first consideration for mild-to-moderate acne. This medication may be combined with other approved acne treatments for more severe cases.
However, choosing the right acne fix is never as clear-cut as it looks. A myriad of patient factors, including skin type, medical history, skin sensitivities, and social circumstances, must be assessed before making a decision. Guidance by a highly trained, board-certified dermatologist is paramount to ensure that your acne treatment is efficacious, safe, and truly cost-effective.
Frequently Asked Questions
In What Order Should You Use Acne Products?
The practice commonly recommended to patients is to cleanse first, followed by applying the acne treatment, moisturizer, and sunscreen in that order. Moisturizers were previously thought to reduce the efficacy of acne treatments if applied to the skin first because of their ability to boost the skin barrier.
However, research shows that moisturizers containing glycerin and ceramides, which improve hydration and skin barrier function, do not affect the absorption or effectiveness of topical acne actives regardless of the order they’re used. On the other hand, bigger factors that can reduce acne treatment efficacy are non-compliance with the treatment schedule and inappropriate use or combination of medications, leading to skin irritation and discontinuation of therapy.
Does Your Diet Affect Your Acne?
The role of food intake in acne development is still not fully understood. Edibles low in sugar and rich in omega-3 fatty acids, as well as probiotics, have been linked to acne blemish reduction, but such associations have not been consistently proven in large clinical trials.
Milk and chocolate have also been implicated as acne triggers due to their ability to raise blood sugar levels. However, these findings were based on poor-quality studies. Regardless, patients who have experienced skin eruptions of any kind after eating a particular type of food must avoid these triggers in the future.
Is Vitamin C Good for Acne?
Vitamin C is a natural substance in the human body that promotes wound healing and soothes inflammation. Topical vitamin C has been used as an anti-acne scarring agent but is currently not among the AAD’s recommended treatments for active acne. Research shows that Vitamin C derivatives can decrease dark spot formation, redness, and scarring after healing from acne.
Unsure Which Acne Hack to Choose? Ask LA’s Top Skin Experts
Acne vulgaris is a highly prevalent skin condition that may cause scars and a less-than-ideal skin texture. It’s never an easy problem to solve unless you have a bona fide acne specialist rooting for you.
At BHSkin Dermatology, our board-certified skin doctors are some of California’s leading acne experts. We’re proud to help our patients achieve clearer skin and a renewed sense of confidence. Visit us at our Glendale or Encino clinic or use our telederm platform for your initial consultation.
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Author: Don Mehrabi
Don Mehrabi, MD, FAAD, is LA’s leading board-certified dermatologist who treats patients, builds the BHSkin clinics, and raises three kids. This blog builds on medical studies combined with Dr. Mehrabi's first-hand experiences from practicing in Encino-Tarzana, Glendale, and online
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