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Differin benzaclin together.Curing Your Acne With Over The Counter Products
Curing Your Acne With Over The Counter Products
If you walk through any drug store you will find a wide variety of topical acne medications available without a prescription. They all declare a similar message about clear skin. If you examine the ingredients closely you will find that they all contain varying degrees of different medications and this can be very confusing. In today’s post I’m going to cover the common acne medications that are available like Adapalene and Benzoyl Peroxide over the counter and provide some specific recommendations about what products work best for which types of acne.
Before we jump into this, I want to take a minute to refresh the topics that I have already covered in this blog series. We started with the most important step – making the diagnosis. There are four types of acne and knowing the type of acne that you have will be key in determining the best treatment options. Next up was the best face wash for acne prone skin. Keeping your skin clean is important and in this post we covered the types of cleansers available as well as how to properly clean your face. The third post was all about oily skin – the cause of oil and what you can do to help control it. If you are new here, enter your email address below and I’ll send the prior posts to you.
Knowing the type of acne you have will help determine what products will best treat that acne. A quick review of the four types of acne: 1) comedonal acne (non-inflammatory); 2) inflammatory acne (pustular and cystic); 3) combination acne (both comedonal and inflammatory); and 4) hormonal acne.
The two main ingredients in OTC acne medications are Salicylic Acid and Benzoyl Peroxide. This summer, the Federal Drug Administration approved adapalene (aka differin), which is a topical retinoid, for over the counter sales. This is huge in the acne world, because prior to this you usually needed a prescription to procure a retinoid. Update: In January, 2017 Adapalene became available over the counter. Read on below for how to purchase. If you remember back to the 2nd post in this series, we discussed these same ingredients in face washes. It’s important to find a balance of products that will treat your acne without causing irritation. Too much of any ingredient could leave you with dry, irritated skin.
The ingredients
First up, Salicylic Acid. This is probably the most common solution when it comes to treating acne. Salicylic acid is comedolytic meaning that it helps declog blackheads and whiteheads so it’s great when treating comedonal acne. Salicylic acid also works as a powerful exfoliator and will slough off dead skin. Products that contain 0.5 to 2 percent salicylic acid would be recommended – anything stronger will likely cause irritation. Salicylic acid is best used as a face wash. There are many OTC salicylic acid spot treatments, but I do not believe that spot treating acne works very well. Salicylic acid can also be used in much higher strengths in chemical peels. I use these often in my acne patients. However, these peels should be performed in a doctor’s office. Non-Surgical Nose Job
cSalicylic is an aspirin based product so if you are allergic to aspirin, products that contain salicylic acid should be avoided. If you are looking for a face wash that contains salicylic acid to help clear up comedonal acne, I recommend Neutrogena Acne Wash or Hydropeptide Purifying Cleanser (order from Hydropeptide with code Doctor-Ip for 15% discount!).
Next is Benzoyl Peroxide. If you have inflammatory acne, this is the product for you. Benzoyl Peroxide unclogs pores and stops bacteria (which is the cause of inflammatory acne). Typically available in strengths that range from 2.5% to 10%, starting with a low strength is recommended until you know how your skin will react to the product. People often report dry skin and some slight burning or tingling when starting to use this product. After applying the medication, I recommend using a thick cream to help retain moisture and prevent dryness. My personal favorite is OTC benzoyl peroxide is Obagi Clenziderm Therapeutic Lotion.
Finally, a new introduction to the OTC acne treatment options is Differin. In July, 2016 the FDA approved Differin for OTC use. Differin is a retinoid that treats mild to moderate acne. Topical retinoids are powerful comedolytics, which means that it can help knock blackheads out of the water. They help to encourage cell turnover and reduce inflammation. Differin is usually very effective on blackheads and whiteheads (comedonal acne) and tends to be less irritating than other prescription based retinoid treatments. Only a small amount is needed nightly, a pea-sized amount for the entire face.
In January, 2016 Differin was released for sale over the counter. I’ve seen it on shelves at Target, Walgreen’s, CVS and on Amazon.com.
Woman touching her face
If you remember back to Step 2 of the Cure Your Acne blog (The Best Face Wash For Acne Prone Skin), there are many facial cleansers that contain Salicylic Acid and Benzoyl Peroxide (two of the ingredients that I’ve covered above). The key to clearing your skin is finding the correct balance of ingredients for your skin type. Below I’ve summarized my suggested routine for each type of acne. Often, I find that the best combination is a gentle cleanser with treatments applied after washing. Too much of any one ingredient could cause excessive dryness and further irritate the skin.
- Comedonal acne – Wash with a gentle cleanser twice a day, followed by a moisturizer. In the evening, use a pea-sized amount of a topical retinoid (Differin) before applying moisturizer.
- Inflammatory acne – Wash with a gentle cleaner and use a mild OTC benzoyl peroxide cream twice a day, followed by a moisturizer
- Combination acne – Wash with a gentle cleanser twice a day. A mild OTC benzoyl peroxide cream can be used during the day and a topical retinoid like Differin can be used at night. After medication is applied a moisturizer should always be applied.
- Hormonal acne – A combination of products may be effective but you will likely need a hormonal remedy.
Product Recommendations
Gentle Cleanser: Hydropeptide Cleansing Gel or Vanicream Facial Cleanser
OTC Retinoid: Differin
OTC Benzoyl Peroxide: Obagi Clenziderm Therapeutic Lotion or La Roche-Posay Effaclar Duo Dual Action Acne Treatment
Moisturizer: CerAve AM and Cerave PM add Vanicream if you experience excessive dryness
As with most products that are applied topically, a small amount of the drug can enter your bloodstream. If you are pregnant or breastfeeding these products are not safe to use and should be avoided. When starting a new treatment for acne it is important to ease into the new routine. Start off by applying any new medications every other evening as part of your skincare routine and only increase to daily if you find that you need it. Also, these treatments tend to be very drying so you will want to make sure you are moisturizing well when using. My preferred facial moisturizers are Cerave AM, Cerave PM and Vanicream.
Looking for more skin tips & advice like Adapalene and Benzoyl Peroxide over the counter? Take the Clear Skin Challenge. A free e-book filled with tips to set you on a path to clear skin. Click here to sign up with Vibrant Dermatolog!
Topical Acne Treatments
This sheet is about exposure to topical acne treatment in pregnancy and while breastfeeding. This information should not take the place of medical care and advice from your healthcare provider.
What are topical acne treatments?
Topical acne treatments are medications that are put directly on the skin in the form of a lotion, gel, cream, or ointment. There are many different topical acne treatments with different generic and brand names. Topical acne treatments can be over-the-counter or prescription. Common active ingredients in topical acne medications have been benzoyl peroxide, azelaic acid, glycolic acid, or salicylic acid. Prescription topical acne medications might include tretinoin, adapalene, dapsone, or antibiotics such as erythromycin or clindamycin. Products will vary in how strong the active ingredient is and how much of the medication is in the product. Prescription treatments usually have higher amounts of the active ingredients than over-the-counter products.
Are topical medications absorbed through the skin?
In general, the skin serves as a good barrier, so only a small amount of the acne medication is likely to be absorbed with topical exposure. The amount of the medication that can reach the developing baby by absorption through the skin is much lower than with medications taken by mouth. However, more of the active ingredients can be absorbed into the person’s blood stream if the skin is broken or irritated and when it is used over a large area of the skin. The more times the medication is applied on the skin, the more of it can be absorbed.
Are there topical acne medications that may be used during pregnancy?
The American College of Obstetricians and Gynecologists (ACOG) has recommendations, and you can discuss them with your healthcare providers. In general, they have suggested topical benzoyl peroxide, azelaic acid, topical salicylic acid, or glycolic acid for treatment of acne in pregnancy.
I use a topical acne treatment. Can it make it harder for me to get pregnant?
While not well studied, use of topical acne treatments is not expected to make it harder to get pregnant.
Does using topical acne treatments increase the chance for miscarriage?
Miscarriage can occur in any pregnancy. Based on the data available, the use of topical acne medications is not expected to increase the chance for miscarriage since only a small amount of the acne medication is expected to be absorbed with topical exposure.
Does using topical acne treatment increase the chance of birth defects?
Every pregnancy starts out with a 3-5% chance of having a birth defect. This is called the background risk. While not well studied, over-the-counter and prescription topical acne treatments have not been associated with an increased chance for birth defects. In many cases, only a small amount of the acne medication is likely to be absorbed with topical exposure, which means little medication gets into the blood stream so little could reach the developing baby. Because only small amounts applied on the skin are absorbed into the body, it is not likely to increase the change for birth defects or cause problems for the baby.
Salicylic acid is related to aspirin. When a person who is pregnant takes an adult dose (325 mg or higher) of aspirin (acetylsalicylic acid) by mouth, there may be risks to the pregnancy. Low dose aspirin (less than 81 mg/day) has been well studied in pregnancy and does not increase the chance of birth defects or other pregnancy complications. When applied on the skin, the amount of salicylic acid that enters the body would be much less than when a woman takes low dose aspirin. For this reason, it is unlikely that topical salicylic acid would pose any risk to a developing baby.
Are there any topical acne medications that should be avoided during pregnancy?
It has generally been recommended to avoid the use of topical retinoid medications, such as tretinoin (Retin A®) and adapalene. Retinoids, when taken by mouth, are known to cause birth defects. Studies have shown that only small amounts of tretinoin and adapalene are absorbed through the skin and that those who use topical tretinoin during pregnancy did not have an increased chance for birth defects. However, due to the theoretical concerns and the availability of other topical acne products, topical retinoid use is discouraged during pregnancy. Please refer to the MotherToBaby fact sheet on Tretinoin at https://mothertobaby.org/fact-sheets/tretinoin-retin-a-pregnancy/ and https://mothertobaby.org/fact-sheets/isotretinoin-accutane-pregnancy/.
Can I use topical antibacterial or antibiotic medications during pregnancy?
When used on the skin, only a small amount of erythromycin and clindamycin antibiotics are absorbed into the blood stream. This small amount is not thought to increase the chance for birth defects or other pregnancy problems. Studies have shown that only a small amount of antibacterial medication dapsone is absorbed through the skin. Studies looking at topical dapsone in pregnancy include only a very small number of exposed pregnancies; and better studied acne products might be preferred for use in a pregnancy.
What if my topical product contains a different active ingredient other than those discussed above?
There are many topical acne treatments available over-the-counter or by prescription, and some of them may contain other active ingredients that are not discussed in this fact sheet. If you have any questions about the active ingredients in your topical acne treatment, please contact MotherToBaby.
Does using topical acne medication during pregnancy cause other pregnancy complications?
When used as directed, topical acne medications are not likely to increase the chance for pregnancy complications, such as preterm delivery (birth before week 37) or low birth weight (weighing less than 5 pounds, 8 ounces (2500 grams) at birth)
Does using topical acne medications in pregnancy cause long-term problems in behavior or learning for the baby?
Studies have not been done to see if using topical acne medications can cause behavior or learning issues for the child.
Breastfeeding while using topical acne treatments?
Use of topical acne treatments have not been well studied in people who are breastfeeding. However, since most topical treatments are poorly absorbed by the skin, little, if any, of the medication is expected to pass into the breast milk. Make sure that the medication is not placed on the breast area or in any area that may come in contact with your baby’s skin before the medication has dried. Be sure to wash your hands well after applying the medication. Talk to your healthcare provider about all your breastfeeding questions.
If a male uses topical acne treatments, could it affect fertility (ability to get partner pregnant) or increase the chance of birth defects?
Studies have not been done to see if use of topical acne medication could affect male fertility or increase the chance of birth defects. In general, exposures that fathers or sperm donors have are unlikely to increase the risks to a pregnancy. For more information, please see the MotherToBaby fact sheet Paternal Exposures at https://mothertobaby.org/fact-sheets/paternal-exposures-pregnancy/.
Please click here for references.
OTIS/MotherToBaby encourages inclusive and person-centered language. While our name still contains a reference to mothers, we are updating our resources with more inclusive terms. Use of the term mother or maternal refers to a person who is pregnant. Use of the term father or paternal refers to a person who contributes sperm.
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