Madison, Wisconsin – From salicylic acid to tea tree oil, store shelves and online sellers offer a wide variety of over-the-counter treatments for acne. But what do these products really do for acne-prone skin?
UW Health integrative dermatologist Apple Bodemer offers some tips – but first, it’s helpful to understand what causes acne to form in the first place.
When the oil glands in your skin are working properly, they produce enough oil to form a protective layer for the skin. Acne happens when the oil glands become too active.
At the same time, the hair follicles that anchor each hair to your skin get plugged up from the skin cells that slough off into the follicles’ openings. The oil and dead skin cells feed the normal bacteria that live on our skin and the bacteria multiplies.
This debris results in the telltale visible inflammation of your skin that we see as acne.
“Acne starts under the skin,” Dr. Bodemer explains. “So anything we do to over-dry or irritate the skin can potentially make the problem worse, by signaling the oil gland to make more oil.”
Over-the-counter treatments can be helpful for acne when used appropriately, Bodemer says, cautioning that there’s no magic bullet quick fix.
When selecting over-the-counter products for acne, you may need to adjust your regimen to avoid dryness and irritation.
“Because acne starts underneath the skin, it does not go away quickly,” Bodemer said. “Improvement requires two to three months of regular use with any kind of treatment.”
Salicylic acid is derived from the bark of the willow tree and helps break up the plug of oil and dead skin cells that block the opening of the hair follicle. Salicylic acid also has mild anti-inflammatory properties.
Benzoyl peroxide helps decrease the number of bacteria in your skin which lead to acne formation. Benzoyl peroxide also helps break up the plug of dead skin cells that can clog your hair follicles and cause acne inflammation.
While benzoyl peroxide is available over the counter in formulations up to 10% concentration, Bodemer says 2.5% formulation appears to be as effective as higher concentrations and won’t irritate the skin as much.
“Benzoyl peroxide will bleach clothing, so make sure you dry off well after using it,” Bodemer advises.
Tea Tree Oil
Like benzoyl peroxide, tea tree oil helps decrease the number of bacteria in the skin, and also has some anti-inflammatory effects.
“Tea tree oil appears to work as well as benzoyl peroxide and it may be easier for skin to tolerate, but it takes longer to work,” Bodemer says.
When applied directly to the skin, tea tree oil can be irritating, so Bodemer suggests making a solution of tea tree oil and water – use 12 drops of tea tree oil for each tablespoon of water in your solution (or use aloe or raw honey in place of water).
“Honey itself has some anti-bacterial properties and is rich in antioxidants, which can help with the inflammation seen in acne,” Bodemer says.
Sulfur is an old treatment for acne that is available over the counter and may inhibit the growth of acne-causing bacteria. Bodemer recommends sulfur products with concentrations of 5-10%, and sulfur treatments in bar soap form are helpful for acne on the chest and back.
Nicotinamide (Vitamin B3)
Topical nicotinamide has anti-inflammatory activity and appears to decrease oil production, as well. Using 4% nicotinamide gel for 8 weeks was found to have similar effects as a common topical prescription antibiotic.
“Given concerns about antibiotic resistance, this is a great option to try,” Bodemer says. Nicotinamide may be little harder to find than other over-the-counter acne treatments, but it’s available through several online sellers.
No matter which treatment you use for acne, Bodemer stresses a key principle: “Be gentle with the skin. If the anti-acne products or medications you’re using are causing dryness or irritation, you may need to moisturize and adjust your regimen.”