Over-the-counter acne products: What works and why

Many over-the-counter (OTC) acne products are available to treat mild to moderate acne or periodic breakouts. They include cleansing lotions, gels, foams and towelettes, leave-on products, and treatments or kits. How do you know which one is best for you?

Before you decide, learn how OTC acne products work and what ingredients to look for. Then develop a gentle skin care regimen to treat and prevent acne.

The Food and Drug Administration warns that some popular OTC acne products can cause a serious reaction, including throat tightness and swelling of the face, lips or tongue. This type of reaction is quite rare, so don't confuse it with the redness, irritation or itchiness that may occur where you've applied such products.

Acne products work in different ways, depending on their active ingredients. Some OTC acne products work by killing the bacteria that cause acne inflammation. Others remove excess oil from the skin or speed up the growth of new skin cells and the removal of dead skin cells. Some acne products do a combination of these things.

Here are common active ingredients found in OTC acne products and how they work to treat acne.

• Benzoyl peroxide. This ingredient kills the bacteria that cause acne, helps remove excess oil from the skin and removes dead skin cells, which can clog pores. OTC benzoyl peroxide products are available in strengths from 2.5 to 10 percent. Possible side effects include dry skin, scaling, redness, burning and stinging, especially if you have sensitive skin. Be careful when applying benzoyl peroxide, as it can bleach hair and clothing.
• Salicylic acid. This ingredient helps prevent pores from becoming plugged. OTC salicylic acid products are available in strengths from 0.5 to 5 percent. Possible side effects include mild stinging and skin irritation.
• Alpha hydroxy acids. Two types of alpha hydroxy acids that are used in nonprescription acne products are glycolic acid and lactic acid. Alpha hydroxy acids are synthetic versions of acids derived from sugar-containing fruits. They treat acne by helping to remove dead skin cells and reduce inflammation. Alpha hydroxy acids also stimulate the growth of new, smoother skin. This helps improve the appearance of acne scars and gives the impression of smaller pores.
• Sulfur. Sulfur removes dead skin cells that clog pores and helps remove excess oil. It's often combined with other ingredients, such as salicylic acid, benzoyl peroxide or resorcinol. Products containing sulfur may cause dry skin. And some products have an unpleasant odor.

The acne product that's best for you depends on many factors, including your skin type, the type and severity of your acne, and your skin care preferences. Here are some general guidelines for choosing and using acne products:

• Begin with benzoyl peroxide. If you're not sure which acne product to buy, start with one that contains benzoyl peroxide. It's effective and well-tolerated by most people. Give it a few days before expecting to see results. Check product labels for the type and amount of its active ingredient. Stronger isn't always better with benzoyl peroxide. In some cases, a 2.5 percent product works as well as those with stronger concentrations — and with fewer side effects.
• Start with lower strength acne products. This can help minimize redness, dry skin and other skin problems. If needed, slowly — over several weeks — increase the strength of the product you use and how often you use it. This helps your skin adjust to the treatment gradually.
• Use products with different active ingredients to treat stubborn acne. Acne ingredients work in different ways, so you may find it helpful to use varying products and ingredients to treat stubborn acne. Apply one product in the morning and a different one at night to prevent skin irritation.
• Be patient. Treating acne with acne products takes time and patience. It may take two or three months of daily use of an acne product to see results. And acne may look worse before it gets better.
• Experiment with what works. You may need to try different products with varying active ingredients before you find what works for you.

Acne products are just one step in your skin care routine. When using acne products:

• Wash problem areas twice daily. Use a gentle nonsoap cleanser and don't overdo it. Excessive washing and scrubbing can worsen acne. Scrubs that dissolve during washing are the least abrasive. Scrubs with ground fruit pits and aluminum oxide tend to be more abrasive.
• Try cleansing cloths or towelettes. These are gentle alternatives to cleansers and washes. Cloths with an open weave are good for dry, sensitive skin. Cloths with a tighter weave are better at removing dead skin cells.
• Consider pore-clearing adhesive pads. These products (Biore Deep Cleansing Pore Strips, others) are intended to remove dirt, oil and plugs from pores. You apply the strip to wet skin, let it dry and then peel it off. Further study is needed to prove their use in treating and preventing acne. Don't use them more than once every three days.
• Don't use too much. Apply just enough acne product to cover the problem areas and apply it just after cleansing the skin. Some cloths and towelettes come with benzoyl peroxide and other active ingredients in them, so you don't need to apply more product with these active ingredients after cleansing.
• Use an oil-free, water-based moisturizer. This helps alleviate dry, peeling skin.
• Avoid oily cosmetics, sunscreens and hair products. Use products labeled water-based or noncomedogenic.
• Don't pick or squeeze blemishes. Infection or scarring may result.
• Watch what touches your face. Keep your hair clean and off your face. Also avoid resting your hand or phone against the side of your face.

If your acne doesn't improve after two or three months of home treatment, consider seeing your doctor or a skin specialist (dermatologist) for a prescription lotion or medication.