Everything you should know before choosing an over-the-counter (OTC) medication for acne.
Acne: a cosmetic blemish
Acne is an inflammatory or non-inflammatory condition of the skin. It occurs due to the clogging of hair follicles with dead cells and oils. The germs invade these cells leading to infection. According to the NHS, most teenagers and 95% of those aged 11-30 experience acne.
It commonly occurs with several clinical signs, e.g., blackheads, pimples, and whiteheads. These signs disappear very slowly and become a source of nuisance. Originally it was thought to be a problem associated with youths, but recent data shows that it can occur in all ages. A 2008 study involving 1013 men and women found that 73.3% of men and women above 20 have experienced mild to moderate acne. It could be;
It is a non-inflammatory skin condition manifested by non-painful blackheads and whiteheads.
It is an inflammatory condition and causes painful papules and pustules to be formed on the skin.
s and painful nodules characterise this inflammatory acne.
What types of OTC products are available to treat mild to severe acne?
The cosmetic market is flooded with creams, lotions, and various cleansers claiming to treat skin conditions. The demand for these over-the-counter (sold without a prescription) medicated products is increasing due to multiple benefits, e.g.,
- Ease of availability and sold without a prescription from a dermatologist
As these products are increasingly available in the market, you must know their types, their active ingredients and some essential products available in the market. So let's have a deep dive into these topics.
You can now buy OTC medications to treat acne in two simple steps. Click here to purchase.
How do the OTC acne products work?
These products have a variety of active ingredients that control acne by removing dead skin cells and excess oil from the skin. It would be best to wash your face regularly while using such products. Some of the ingredients available in these products are;
Hydroxy acids (HAs)
Hydroxy acids are often used in beauty products and acne medications. Hydroxy acids are of the following types;
- Alpha-hydroxy acids (AHA)
- Beta hydroxy acids (BHA)
- Polyhydroxy acids (PHA)
They have different chemical properties and structures.
Alpha Hydroxy Acids (AHAs)
Alpha Hydroxy Acids are derived from citric acid, glycolic acid and lactic acid. They have the following effects on your skin;
- Disperse the melanin present in the basal layer (the innermost layer) of the skin
- Cause the thinning of stratum carenum. It is the outermost layer of skin and consists of dead cells.
- Increase collagen synthesis in the skin. It improves the tone of the skin.
- A study conducted in recent times found that the six-month use of 25% alpha hydroxy acids resulted in a 25% increased dermal thickness of the skin. It also improves the density of collagen and the quality of elastic fibres in the skin.
- The AHAs also improve the skin texture and lower the visible flaking and scaling of the skin.
Beta Hydroxy Acids (BHAs)
Salicylic acid is the only compound in this category used in dermatological products. It is lipophilic which means it dissolves oils on the skin and is present in various cleansers, lotions, and face scrubs. It is also an excellent exfoliator and removes dead skin flakes and dead skin cells.
The OTC medications available in the market contain a 0.05-5% concentration of salicylic acid, and higher concentrations are usually available in the prescribed medications. Therefore, if you have problematic skin, it is recommended to use a scrubbing face wash, while for sensitive skin, a gentle cleanser or foaming face wash should be used.
Various studies have proven that prolonged use of low-dose salicylic acid products improved skin inflammations, e.g., acne.
Polyhydroxy acids (PHAs)
The PHAs are also a type of AHA. But they have the added advantage of avoiding side effects, e.g., stinging and irritation. These are usually available as multi-strand molecules that result in a gentler and slower absorption. Thus, the side effects of traditional AHAs are avoided. Therefore, these products containing the PHAs are helpful for sensitive skin also.
Lactobionic Acid, a PHA, inhibits the matrix metalloproteinase enzyme (MMPs), the leading cause of light-induced ageing. It also has antioxidant properties and prevents the skin from oxidative damage. The PHAs are also perfect moisturisers. The OTCs containing a combination of tretinoin and PHAs are used to cure acne and skin irritation.
Triocarban and Triclosan
These are antibacterial agents and are used frequently in various anti-acne OTC face washes, soaps and cleansers. It is also effective against gram-negative and positive bacteria and is used in surgical soaps, scrubs and deodorants. However, their use alone is not recommended, so combine it with other agents, e.g., benzoyl peroxide.
It is usually present in lotions and gels. It has an antibacterial effect and dries out pimples, and opens the skin's pores. It is proven to prevent the formation of new acne. It is also included in a variety of combination treatments for acne. Besides the OTC products, it is also an FDA-approved medication for acne.
Tea tree oil
Australian tea oil has been used for almost 70 years due to its antifungal and antimicrobial properties. The active ingredients present in the tea oil are Terpinen-4-ol, alpha-pinene and alpha-terpineol. A study conducted to compare the efficacy of tea tree oil with benzoyl peroxide for the treatment of acne found that both are equally effective. But, the action was slower in the case of tea tree oil.
A clinical trial was designed to check the efficacy of a 5% solution of tea tree oil for acne treatment and found that the oil was 3.5 times more effective than the placebo in reducing acne lesions.
Tea tree oil also possesses anti-inflammatory properties. For example, an early study by Hart and his colleagues in 2000 found that the terpinene-4-ol present in this oil helps control the inflammation associated with severe acne by blocking the production of inflammatory mediators.
Despite all of its benefits, the use of tea tree oil in acne treatments is risky because it has the risk of causing contact dermatitis. However, a 2003 study found that the risk of such reactions is minimal.
It is a third-generation derivative of vitamin A. It also opens clogged pores and influences the growth of skin cells. However, using it as an over-the-counter medication should be avoided.
Vitamin and minerals
Some vitamins and minerals are also added to the cosmetics with a claim to treat acne and acne scars. They are also added to a variety of oral medications. The most common ones are;
It is a non-metallic element and is found abundantly. It is used in medicinal products due to its antibacterial properties. It is also added to the products sold for acne. Its use for treating acne is mainly ascribed to its keratolytic properties. Keratin is the protein present in the skin. Its excess production causes the skin to lose its elasticity.
The sulphur is rarely used alone and is combined with the other components, e.g., benzoyl peroxide, resorcinol and salicylic acid. In most of the OTC medications used for moderate acne, the sulphur is combined with the resorcinol as it has keratolytic, antifungal and antibacterial properties.
However, using a combination of resorcinol and sulphur may cause sensitization and mild irritation. Additionally, sulphur products are not very popular due to their unpleasant odour.
It is a very important metallic element and is required for the function of more than 100 enzymes. The use of zinc salts in the products used to treat moderate to severe acne dates back to the 1970s. It inhibits inflammation in acne patients by suppressing the release of inflammatory mediators.
A clinical trial was conducted in 2001 to compare zinc gluconate with minocycline for acne treatment. Both were effective, but the minocycline was more effective. However, zinc gluconate was not associated with any side effects (of minocycline), and it is safe for pregnant women, too. The minocycline is not safe in the second to the third trimester of pregnancy and may cause severe congenital disabilities. The zinc products also do not pose the danger of inducing bacterial resistance.
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Retinol (Vitamin A)
Vitamin A and its synthetic derivatives (retinoids) have essential biological functions in growth, blood synthesis, tissue repair, maintenance, and vision. Its dermatological effects are;
- They decrease the cohesion of keratinocytes and reduce the formation of microcomedones (comedones are flesh-coloured, small, dark or white bumps on the skin).
- It helps in the inflammatory process and regulates sebum production.
However, it should be kept in mind that not all retinoid products are safe for you as they have a dose-dependent effect. You should consult the dermatologist if possible.
It is the water-soluble derivative of vitamin B3 (Niacin). It is used in both oral and topical OTC medications to treat acne and various other inflammatory skin conditions. Earlier research in 1995 found that 4% topical gel has the same effect as 1% clindamycin gel without the danger of causing antibacterial resistance.
However, more thorough investigations are needed to check the effectiveness of different concentrations of nicotinamide on the severity of acne.
Vitamin E is a powerful antioxidant and also has anti-inflammatory properties. It is included various OTC acne products with the claim to treat the acne. It improves your immunity and increases the regeneration of cells. It has beneficial effects on acne scars, pustules, cysts, nodules and papules.
Although it has shown some effects, research is needed to compare its effectiveness to other standard acne treatments currently available. Moreover, the study is also required to assess whether it is safe in topical medications or should be taken in oral supplements.
What are OTC products available for acne?
The following is a list of products which are sold to treat acne. They have medicinal ingredients, as mentioned above. These products can be purchased from the local market, or (if not available), you can order them from online sellers.
Neutrogena acne wash
This product contains salicylic acid and can clean out clogged skin pores, which are the sites of acne development. It also effectively removes dead skin cells.
-CeraVe acne foaming cleanser
This product contains a milder (4%) concentration of benzoyl peroxide and is effective in acne.
La Roche Gel Face wash
This product has 2% salicylic acid as an effective ingredient and has various other components to have gentler effects on the skin. It also contains zinc.
Paula's choice of liquid exfoliant
This product also contains 2% salicylic acid and effectively removes the dead skin cells and opens the skin pores. It also removes excess oil from your skin.
INNbeauty Pimple paste
This product has sulfur as an effective ingredient and is available over the counter for acne treatment.
This product contains 0.1% adapalene as an effective ingredient. It was available on prescription only but is now available OTC. It can cause some degree of redness in the application area.
If you wish to learn more about Differin, click here.
These drugs are available over the counter for pregnancy control and acne treatment. The progesterone-only pills are perfect for acne.
Ordinary (10% suspension of azelaic acid)
This product is effective against non-inflammatory and moderate inflammatory acne and is sold OTC. However, it can cause peeling or sting at the application site.
Mario Badescu lotion
This product has a drying formula and prevents the conditions required for the development of acne. However, it is not suitable for you if you have dry skin.
SkinCeuticals cleanser gel
This product is effective for inflammatory as well as non-inflammatory acne. It has glycolic acid that works as an exfoliant to remove dead skin cells and clogs the skin pores.
This mask contains moisture-absorbing hydrocolloid gel that promotes healing by absorbing excessive moisture. However, you will need to wear it for 6-8 hours.
Acne is a blemish for your cosmetic beauty. First, identify which type of acne you have and then plan to get rid of it. However, the choice of an effective ingredient is crucial. You can take the help of your dermatologist to decide which active ingredient is best for your skin. Only experience will tell you what OTC product is best for your skin.
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