Acne is caused by multiple factors resulting in bacterial growth and inflammation of the pilosebaceous duct. This duct contains of a hair follicle and surrounding sebaceous glands. These glands can be found all over the skin except the palms and soles, with the highest concentration being on the face, upper back, and chest area.
There are many treatment options for acne but this article will focus on over-the-counter (OTC) medications. These will include topicals, essential oils, and non pharmacotherapy.
How it works: inhibits bacterial growth by oxidation
The drug is available in the United States in both prescription and nonprescription products as 2.5 to 10% gels, lotions, creams, pads, masks, and cleansers. It can be used as leave on or wash off agents, however leave on agents have more reductions in bacterial growth. Concentrations of benzoyl peroxide that are higher than 2.5% may not contribute to increased benefit. In one study, 2.5% benzoyl peroxide was as effective as 10% benzoyl peroxide in reducing the number of inflammatory acne lesions. Increased concentrations of benzoyl peroxide can lead to increased skin irritation. The time required for onset of action for varying concentrations of benzoyl peroxide appears to be similar. Visible improvement typically occurs within three weeks, with maximum results evident after 8 to 12 weeks.
Patients should also be advised that benzoyl peroxide can cause bleaching of the hair and clothing, in addition to drying of the skin. Avoid excess sun exposure and use sunscreen and protective clothing. If you have sensitive skin, consider a lower concentration, water based, wash off agent. New products are combined with a moisturizer to decrease skin redness and irritation.
How it works: It is a desquamating agent, meaning it helps to shed dead skin cells on the top layer. Its lipophilic properties enable it to penetrate the pilosebaceous follicle, producing a comedolytic effect, meaning it break up clogged pores.
Salicylic acid (0.5 to 2%) is a beta hydroxy acid available in a number of nonprescription gels, lotions, solutions, cleansers, pads (40% strength), and masks.
It is a treatment option for patients who cannot tolerate topical retinoids or benzoyl peroxide. Salicylic acid can also be used in combination with benzoyl peroxide, as the mechanisms of action of these drugs complement each other in the treatment of acne.
Skin dryness, irritation, and peeling can occur, if this happens reduce frequency or discontinue. Topical salicylic acid should be avoided in patients with diabetes or poor blood circulation.
Differin (Adapalene) 0.1% gel
Approved in 2016 is for those people 12 years and older.
How it works: is a type of retinoid, so it modifies the production of enzymes needed for creation of new skin cells. This makes it harder for dead skin cells to accumulate inside pores. Some studies have shown regression of acne as early as 1 week.
Differin increases photosensitivity; patients may get sunburned more easily, so sunlamps and tanning beds should be avoided. The most common side effects were dry skin, itching, and skin discomfort.
Sulfur has anti fungal, bacteriostatic, and mild keratolytic properties. Not as effective when used by itself and is usually combined with other products, for example benzoyl peroxide and salicylic acid. Side effects are rare but include mild irritation and sensitization.
How it works: dissolves the top layer of the skin to prevent clogging.
Alpha Hydroxy Acids
How it works- Alpha hydroxy acids are weak organic acids that cause desquamation and diminish corneocyte cohesion, thereby normalizing follicular keratinization. they are available as over the counter washes, lotions, creams, and at-home peel systems.
(Desquamation, commonly called skin peeling, is the shedding of the outermost membrane or layer of a tissue, such as the skin)
The ones most commonly used are glycolic acid and lactic acid.
Tea Tree oil
How it works: One study has shown that is has anti-microbial and anti-inflammatory properties.
In one study they found 5% tea tree oil gel vs 5% benzoyl peroxide has significant effects in reducing the number of comedones. The onset was slower for Tea Tree Oil but had fewer side effects.
Shower or bath with warm (not hot) water.
Hydrate! Drink water, you skin is made up of 64% water as this can flush your system of waste and promote growth.
Patients should not aggressively scrub the skin; gentle massage with the fingertips is sufficient for cleansing
Water-based lotions, cosmetics, and hair products are less comedogenic than oil-based products. Patients should be encouraged to seek out non comedogenic skin care and cosmetic products.
Do not pick at the acne lesions as this can exacerbate the lesions.