Figuring out which acne product to buy can be as confusing as shopping for a new cell phone. There may be an overwhelming number of options, but for both phones and breakout remedies, you have to understand a product’s features before you buy.
To select an acne medication, you should first familiarize yourself with the four basic methods of combating acne. Neal Schultz, MD, clinical professor of dermatology at Mount Sinai School of Medicine, and author of It’s Not Just About Wrinkles, explains that blemish-fighting agents work by killing acne-causing bacteria, exfoliating dead skin cells that clog pores, removing excess oil, or decreasing inflammation.
Over-the-Counter Acne Treatments
Alpha-hydroxy acids (AHAs). AHAs slough off dead skin cells that cause pimple-producing clogged pores and leave you with smoother, softer skin. They can be applied all over the face. Types of AHAs include glycolic and lactic acid. “All of my acne patients are on alpha-hydroxy acids,” says Dr. Schultz.
Benzoyl peroxide. “It’s the most effective over-the-counter ingredient for actually treating acne as opposed to only preventing it,” says Dr. Schultz. “It kills bacteria, removes excess oil, and exfoliates dead skin cells.” You’ll find it in strengths ranging from 2.5 percent up to 10 percent in pimple-fighting facial cleansers, lotions, creams, gels, and spot treatments.
Clay. It’s not just for making pottery – clay is a calming ingredient in acne treatments (usually masks) thanks to its anti-inflammatory properties. “Clay helps to soothe the skin and temporarily reduce oil production,” explains Elizabeth Tanzi, MD, a dermatologist at the Washington Institute of Dermatologic Laser Surgery in Washington, DC.
Salicylic acid. This beta-hydroxy acid is an effective and powerful exfoliant that helps keep pores clear by exfoliating inside the hair follicle, says Diane Berson, MD, an assistant professor of dermatology at Weill Medical College of Cornell University and a dermatologist in New York City. “Salicylic acid is related to aspirin, which has anti-inflammatory properties, so it’s usually better tolerated than glycolic acid,” she explains. Dr. Berson suggests looking for 2 percent salicylic acid in your OTC acne treatment.
Sulfur. The mineral decreases excess oil and inflammation and helps to exfoliate dead skin cells. “Sulfur is particularly helpful for people with both acne and rosacea,” states Dr. Tanzi. Unfortunately, the rotten-egg smell of sulfur isn’t as appealing as the results it gets, but products usually pair sulfur with other ingredients to help combat the odor.
Tea-tree oil. The natural blemish-fighter has antibacterial and anti-inflammatory properties to help calm acne. “Tea-tree oil is one of my favorites,” says Dr. Schultz. Research has shown that 5 percent tea-tree oil has results comparable to 5 percent benzoyl peroxide. But this natural remedy can be too harsh for some; people with sensitive skin or eczema should be careful about using tea-tree oil.
Prescription Acne Treatments
Antibiotics. Prescription antibiotics kill the P. acnes bacteria that bring on breakouts. They come in oral (tetracycline, doxycycline, minocycline, erythromycin) and topical form (erythromycin, clindamycin). Antibiotics are often used in tandem with other acne medications such as sulfur and tea-tree oil, notes Dr. Schultz.
Azelaic acid. This type of acne treatment kills bacteria and exfoliates the dead skin cells that can plug up pores. “It works to reduce P. acnes, so it’s like an antibiotic,” explains Dr. Tanzi. Azelaic acid (Azelex, Finacea), which comes in cream and gel form, is best for mild to moderate acne.
Birth-control pills. Combination birth-control pills, which contain the hormones estrogen and progestin, help regulate hormone swings that cause cyclical acne and reduce excess oil, explains Dr. Tanzi. Oral contraceptives are usually coupled with other pimple-fighting medications, such as benzoyl peroxide or salicylic acid.
Oral retinoids. Isotretinoin (Amnesteem, Claravis, Sotret, and the no-longer-available Accutane) is a pill form of a retinoid designed to treat severe acne after all other treatments have failed. About 85 percent of patients see permanent clearing after one treatment, according to the American Academy of Dermatology. The powerful, stand-alone medication works by halting the production of oil. “The root cause of acne is oil,” explains Dr. Schultz. “It doesn’t matter how much bacteria you have or how much clogging you have – if you can shut down oil production, you shut down acne at the source. It’s able to cure acne permanently.”
But the drug isn’t without serious side effects, including birth defects and possibly depression. Before taking the medication, patients are required to get a complete medical workup, including pregnancy tests (you cannot be pregnant or become pregnant while on the medication). Monthly checkups with a dermatologist are also required.
Topical retinoids. The vitamin-A-derived topical retinoids, including tretinoin (Retin-A, Renova), adapalene (Differin), and tazarotene (Tazorac, Avage) not only smooth fine lines and wrinkles, but they also exfoliate the dead skin cells that cause clogs and lead to acne. As with any exfoliating acne treatment, retinoids can cause skin irritation, dryness, and redness, especially if you have sensitive skin, use too high of a concentration, or use too much product. You should add a non-comedogenic moisturizer (one that doesn’t clog pores) and sunscreen to help combat the side effects of peeling and sun sensitivity, suggests Dr. Tanzi.