How do I choose an over-the-counter product for my acne?

If you have mild acne that is not causing scarring it is reasonable to try an over-the-counter (OTC) product before seeking medical attention.  Most over-the-counter acne products contain either salicylic acid or benzoyl peroxide. Acne products are found in drugstores as washes, astringents/toners, medicated pads, lotions, gels and creams.  The product you choose should depend on the type of acne you have and how oily or sensitive your skin is.

Salicylic acid  is the active ingredient in most drugstore acne products. It is a good comedolytic. That means it unclogs blocked pores ("blackheads" and "whiteheads"). Tiny blocked pores are thought to be the first step in the development of acne and so treating them may prevent acne outbreaks. Salicylic acid also removes excess sebum from the face, making the skin less oily. Most OTC products that contain salicylic acid contain it in concentrations of 0.5-2%.  They can be found as washes, lotions, creams, astringents, medicated pads and bar soaps. Products containing salicylic acid are a good choice if you have a lot of blackheads and/or whiteheads and not as many red pimples.

Benzoyl peroxide is an antibacterial medication found in some OTC acne products. It works by killing the bacteria that contribute to acne.  It also decreases inflammation in active pimples and has some comedolytic activity (it opens up pores and treats blackheads and whiteheads). Generally speaking, benzoyl peroxide is more effective than salicylic acid at treating acne that is composed of both blocked pores and pimples. It is also more irritating and can cause dryness and redness, especially in people with sensitive skin. Benzoyl peroxide is available in over-the-counter products in concentrations ranging from 2.5-5%. It can be found as washes, lotions, creams and gels.

So....What do I do?

• If you have oily skin and blackheads/whiteheads consider starting with a salicylic acid product in a lotion, astringent or medicated pad.

• If you have oily skin and have both blocked pores and pimples, consider starting with a 5% benzoyl peroxide gel or cream. If your skin doesn’t become too dry, add in a salicylic acid cleanser or medicated pad 2-3 weeks later.

• If you have sensitive skin consider starting with a salicylic acid product that is a lotion or cream. Avoid astringents, gels or medicated pads. Products with benzoyl peroxide can be used but may cause dryness and irritation.

• Washes containing benzoyl peroxide often work well for acne on the chest, back and shoulders.  Use a brush with a long handle for hard-to-reach areas.

• Treat entire areas where you break out in acne lesions; spot-treating individual acne spots does not prevent new acne from developing

If your acne doesn't respond after 2-3 months of using over-the-counter treatments, consider seeing your family doctor or a dermatologist. If you are developing acne scarring, see a dermatologist right away. Acne that is causing scarring requires more aggressive treatment as scars can be permanent and difficult to treat.

Michelle Levy

Dr. Michelle Levy is a board-certified dermatologist specializing in medical and aesthetic dermatology. A graduate of the University of Toronto's Faculty of Medicine, Dr. Levy provides a full spectrum of dermatologic services in Toronto, Canada. Education: M.D., University of Toronto, 1999 Residency in Dermatology, University of Toronto, 1999-2004 Employment History: Self-employed, North York, Ontario, 2005-Present Medcan. Consultant Dermatologist. 2007-Present