An enormous multi-billion-dollar industry exists with the intention of treating your acne and competing for your money. Just look at all the items that pack the shelves of drugstores, supermarkets, and chain stores.

They come in fancy, eye-catching packages, as soaps, cleansers, lotions, pads, creams, gels, ointments, wipes, foams, and masks, and offer a treasure trove of preparations: oil-free, hypoallergenic, organic, noncomedogenic, herbal, radiant, protein rich, dermatologist-tested, and so on.

No wonder people who treat their acne themselves are so often and so easily overwhelmed and confused about what product is right for them. But I’m here to clear things up. (In more ways than one!) I talk about ways that you can go it alone — especially if your acne is mild.

In the process, I list and describe the over-the-counter, or OTC, medications (no prescription necessary) that may help you along the way, and I help you figure out which ones work and which ones don’t. But self-treatment isn’t the right solution for everyone. So, you may want to determine whether self-treatment is a good idea for you or whether you should just head straight to the doctor’s office.

Taking Action Topically

A topical product is one that is applied on the skin, such as a cream, ointment, gel, foam, or lotion. Almost every OTC acne medication is topical rather than oral, taken by mouth. Topical therapy is generally safer than systemic (oral or injected) therapy.

Topical acne treatments (both the OTC and prescription varieties) are made up of two general types of ingredients that you find on all labels:

• Active ingredient: This part of the medication does the real grunt work. I recommend you start your search for an OTC treatment by looking at the active ingredient because it’s the most important component of a product. Most commonly found are benzoyl peroxide, salicylic acid, sulfur, and resorcinol.

• Inactive ingredient(s): This part of the medicine is the stuff that holds onto the medicine and preserves it, keeps the product moving easily through the container, and makes the medicine easier to apply. Inactive ingredients are sometimes referred to as the inert ingredient or the vehicle because they deliver the medicine.

In choosing the right topical treatment, you need to consider both active and inactive ingredients. Just as some active ingredients may be more beneficial for your particular acne, certain vehicles may be more conducive to your skin type. The rest of this article explains what the various active ingredients do and how you use them.

I also explain what type of delivery vehicle is best for your particular skin type. Don’t buy brand-name products when you can spend less on generic. That way, you don’t have to pay for the fancy packaging and marketing that the name brands put into their products!

After you start to treat your acne, don’t get into the routine of checking your face every day and looking for improvement. The treatments take time to start working — sometimes up to six to eight weeks, so be patient!

Inactive Ingredients

Skin looks and feels better when it’s not too oily or too dry. If your skin tends to be dry, a moisturizing base (vehicle) is best; if it’s very oily, select a product that has a drying base. Of course, if you have neither dry nor oily skin, choose a neutral product that’s neither moisturizing nor drying.

Most topical treatments fall into one of a few different categories, based on their delivery vehicles. Table 1 lists the most commonly used vehicles for delivering effective topical acne treatments. Look for your skin type there.

Vehicle (Base)	Best for This Skin	Description
Alcohol solutions	Oily	Evaporate quickly. The most drying of all these treatments and can be very irritating. Cover large areas easily.
Aqueous solutions	Normal to dry	These are water based and alcohol-free. They’re less drying and irritating than alcohol solutions. Cover large areas easily.
Creams	Normal to oily	Generally more popular than ointments because they’re less greasy. Often preferred by patients because they absorb into the skin quickly. Their water content makes them more drying than ointments.
Foams	Normal to oily	May be somewhat drying, but they’re easy to spread, particularly on hairy areas such as chests and backs of males. Very expensive.
Gels	Normal to oily	Essentially oil-free and have a mildly drying effect. Some of the newer gel preparations contain emollients such as glycerin and dimethicone, which help diminish the drying effects.
Lotions	Any	May be somewhat moisturizing; however, those that contain propylene glycol may have drying effects. Easy to apply.
Ointment	Normal to dry	Greasy. More lubricating and tend to be less irritating than creams and gels.

The inactive ingredients don’t do anything to fight acne, but some may be better for you than others based on your skin type. One delivery agent doesn’t fit all. If you have oily skin or if you have dry or sensitive skin, you may have to experiment with different preparations.

If you have combination skin that has an oily T-zone and a dry lower face, you might have to use different vehicles for different parts of your face. As for cleansers, washes, and scrubs, I think they’re somewhat overrated, because most of them hardly have enough time to do anything.

They get rinsed off before they can really penetrate and do the job! How much cream, ointment, or lotion should you apply? For those of us old enough to remember the old hair cream commercial: A little dab will do you.

Think thin, not thick; a little works as well as a lot. Don’t be inclined to have a “more is better” tendency. Only the thin layer that is actually in contact with the skin gets absorbed; the remainder is either rubbed off or unnecessary. Gobbing it on is wasteful, and besides, it takes longer to rub it in and make it vanish!

Getting In on the Active Ingredients

If you spend a little time comparing the labels on the products you find at the drugstore, you discover how incredibly similar they all are — just about all of them contain one of the following active ingredients plus other inactive ingredients:

• Benzoyl peroxide
• Salicylic acid
• Sulfur
• Resorcinol

Finding topical products that work is easier than you may suppose. The active ingredient you choose depends on what kind of acne you have:

• If your acne consists mostly of blackheads and whiteheads, get a product that contains benzoyl peroxide and then, if necessary, add one that has salicylic acid in it.

• If you’re just starting to get a few zits (inflammatory papules), try benzoyl peroxide alone.

In the following sections, I tell you about benzoyl peroxide and salicylic acid, as well other less active active ingredients that don’t work so well.

The benefits of benzoyl peroxide

Benzoyl peroxide, a potent antibacterial agent that kills P. acnes, the bacteria that are involved in producing acne, is the most commonly used OTC acne medication, and for good reason — it works! Benzoyl peroxide dries and peels the skin and removes dead cells, helps to clear blocked follicles, the non-inflammatory comedones (blackheads and whiteheads), and it works on the papules and pustules.

A triple threat! Unlike antibiotics and other prescription medications, you can use benzoyl peroxide for months, even years at a time, and there are really no long-term side effects including tolerance (bacterial resistance) associated with it. You can find benzoyl peroxide in many brand-name OTC products, such as Clearasil, Oxy, Clean and Clear, PanOxyl, and Neutrogena, as well as less-expensive generic or store brand products.

You can also find it in creams, gels, lotions, foams, soaps, washes, masks, and scrubs and in combination with other topical products. Here are a couple of little tidbits to keep in mind:

• Of all the benzoyl-peroxide options, creams, lotions, and pads are more effective than washes, soaps, and scrubs.

• Benzoyl peroxide is available as a prescription, but prescription benzoyl peroxide formulations are no more effective than OTC products, they just cost more.

Using benzoyl peroxide

Benzoyl peroxide is designed to treat existing acne and prevent future breakouts. If you have acne vulgaris, you should use it even when your face is clear. Women can use it regularly to prevent or minimize hormone-related acne breakouts. The strength of benzoyl peroxide varies in the different products, ranging from 2.5 to 10.0 percent.

Lower strength benzoyl peroxide preparations, such as 2.5 percent, are less irritating than the higher strength 5 percent and 10 percent concentrations and are just as effective for most people, plus they’re cheaper! Start out using the lowest dose possible, and then move up in strength if you need to.

You minimize the chances of irritation and hopefully save some money. In general, you begin using benzoyl peroxide products sparingly and then work toward more frequent application (follow the instructions that accompany the package — if you don’t understand them, ask your pharmacist, nurse, or doctor to explain them to you).

Here are some general guidelines:

1. Start out doing this every other night. After you wash your face, sparingly apply a very thin layer to areas of your skin that have acne or are acne-prone. Avoid your eyes, lips, and the corners of your mouth, which are often very sensitive.

2. As you are able to tolerate it, build up to once or even twice daily if you’re not making too much progress.

When you choose a benzoyl peroxide treatment, keep these points in mind:

• Benzoyl peroxide can be irritating to your skin. For that reason, you should avoid abrasive, harsh, or drying soaps and cleansers while using it. After all, you don’t want to add to the irritation by physically scrubbing your skin.

• Benzoyl peroxide can bleach hair, sheets, towels, and clothing. (It contains peroxide, a powerful bleach.) To avoid the bleaching effect, an old T-shirt should be worn after applying benzoyl peroxide to acne on the back or chest. Also, make sure the benzoyl peroxide has completely dried before the treated skin touches towels, clothes, or bedding (towels, sheets, and pillowcases should be white).

• You can apply makeup or other skin-care products, such as moisturizer, over benzoyl peroxide.

• Be patient, acne responds very slowly to treatment. It may take several months before you notice significant improvement. To prevent new lesions from forming, continue using benzoyl peroxide even after your acne clears.

Side effects

Dryness of the treated area can be expected and is usually mild. If your skin is visibly scaly, apply a light, non-oily moisturizer, like Eucerin Daily Control & Care Moisturizer, Cetaphil Moisturizing Lotion, or Olay Oil-Free Active Hydrating Beauty Fluid.

You may experience a mild burning sensation or reddening of the skin when you first start to apply benzoyl peroxide. Irritation and burning are common, but usually disappear in two to three weeks.

If the preparation you’re applying causes too much redness, peeling, or dryness of your skin, reduce the number of times a day that you use it, or use a weaker strength.

If necessary, discontinue using it altogether. Use of benzoyl peroxide products may also cause contact dermatitis (red, dry, inflamed, itchy skin) due to irritation or allergy.

It can be treated with a topical steroid such as a 1 percent hydrocortisone cream, which is available without a prescription. Look for the brand names Cortaid or Cortizone 10, or store brand equivalents.

Trying salicylic acid

By itself, in the low concentrations that are available over the counter, salicylic acid isn’t very effective in treating acne. However, it’s believed to help the skin absorb benzoyl peroxide and other more effective prescription topical acne medications.

Salicylic acid is a beta-hydroxy acid (BHA). Beta-hydroxy acids are commonly called “fruit acids” because they’re natural substances derived from fruits, sugar, and plants. They’re found in many overthe- counter products. Salicylic acid works by exfoliating, which means it removes the top layers of dead skin cells.

Salicylic acid loosens the gluelike substances that hold the surface skin cells to each other, allowing the dead skin to peel off. It’s also oil soluble and can get into oil-clogged pores. These actions help the skin renew itself faster and reduce the chance for pore blockage and a subsequent acne breakout.

The OTC products that contain only salicylic acid are, at best, minimally effective in treating non-inflammatory acne lesions (like blackheads and whiteheads). Salicylic acid doesn’t have any effect on sebum production; it just removes the sebum that has reached the surface of the skin and makes your skin feel smoother.

That’s why salicylic acid is also found in some makeup removal products. Much more powerful salicylic acid preparations are sometimes used by dermatologists and plastic surgeons as acne treatments and for wrinkle removing and skin rejuvenation procedures.

The high concentrations are much more effective at clearing up blackheads and whiteheads than the OTC products. As with benzoyl peroxide, salicylic acid comes in a host of formulations and is an ingredient in Clearasil, Oxy, Clean and Clear, PanOxyl, and Neutrogena, as well as less expensive generic brands.

Salicylic acid is available in concentrations from 0.5 to 2.0 percent, mainly in creams, lotions, pads, washes, cleansers, and astringents (agents that dry oily skin). It’s available as a single agent or sometimes in combination with sulfur. Creams, lotions, and pads that contain salicylic acid are more effective than the other options.

As part of their skin-care lines, the same companies that offer benzoyl peroxide products often offer products containing salicylic acid. Sometimes they’re packaged together as a “total acne treatment system.”

When these “systems” contain salicylic acid as well as benzoyl peroxide as their active ingredients, they can work quite effectively to treat your acne. Those expensive mail-order OTC combination “systems” that you see on TV infomercials can’t always be trusted or tailored to match your skin.

But if you really want to use one, you can buy a much, much cheaper “knockoff” variety at your local drugstore or Wal- Mart. Read the labels!

Using salicylic acid products

Salicylic acid products are appropriate starter treatments for children who are just beginning to develop mild comedonal acne. When used alone for other types of acne or more advanced acne, don’t expect very much from them.

As with benzoyl peroxide, you apply a thin layer of salicylic acid to areas of skin affected by acne. If you discover that the salicylic acid isn’t working very well, substitute or add a benzoyl peroxide product to your regimen.

Side effects

Dryness of the treated area can be expected and is usually mild. If these products are used with benzoyl peroxide formulations, the dryness and irritation can be more severe, and if the skin is visibly scaly, apply a light non-oily moisturizer such as one described in the section “Using benzoyl peroxide.”

Other OTC medications

In this section, I briefly describe the medications that are of questionable value in treating your acne. Some can be quite expensive.

Retinols and alpha hydroxy acids

Retinol is a derivative of Vitamin A. You may have heard or read the term in advertising for products that claim to reduce fine lines and wrinkles by increasing cell turnover (sometimes called rejuvenation). Retinols are sometimes used alone, or in combination with alpha hydroxy acids (AHAs).

Glycolic acid is the AHA most frequently used for facial treatments, but lactic and citric acid are also used. (Most often AHAs are derived from fruits, which is why they’re sometimes called “fruit acids.” As you may expect, lactic acid doesn’t come from fruit, it comes from milk.)

OTC products contain very low concentrations of AHA, which acts as a mild exfoliant. Although retinols and AHAs were originally marketed to fight aging skin, they’re both currently being touted for use in treating acne; however, their effectiveness as an acne treatment hasn’t been scientifically tested.

Chemical peels have become popular as anti-aging, facial rejuvenation procedures; however, they’re sometimes used to treat acne and acne scars. This method involves the application of strong acid solutions such as AHAs or BHAs (beta-hydroxy acids), which cause the skin to peel off and encourage regeneration of new skin.

The treatment that is right for you depends on your skin type, and the activity of your acne. Such AHAs and BHAs that are applied and dispensed by physicians are much stronger than those that you can purchase over the counter. The over-the-counter products have been proven to be effective for the treatment of acne.

Resorcinol and sulfur

The following agents have been used to treat acne for many generations without great success, but they’re still available. Because they’ve been around for so long, I include them primarily for their historical interest and to tell you to save your money if you see these guys listed on a label:

• Resorcinol: This still-popular ingredient is frequently combined with sulfur in OTC products. Redness and peeling of your skin may occur after a few days.

• Sulfur: Sulfur has been used for more than 50 years in combination with other agents, such as alcohol, salicylic acid, and resorcinol. It is found in many OTC acne medications. Sulfur reacts with the skin in such a way that it makes it dry out, look red, and peel. Due to its unpleasant, “rotten egg” odor, sulfur isn’t frequently used alone as an acne treatment.

Multi-ingredient products

You can find numerous products that include various combinations of benzoyl peroxide, resorcinol, aloe, glycolic acid, sulfur, and salicylic acid. Also, herbal remedies are available that contain aloe, lemon oil, and various other fruit-derived items. Such products are difficult to evaluate scientifically.

You’re better off avoiding these products that contain such a hodgepodge of ingredients; besides, you only pay more for them. Avoid OTC products that fall under the heading “herbal,” “organic,” or “natural.” Their effectiveness has rarely been tested in clinical or scientific trials.

The value of such treatments is generally unknown. And don’t bother experimenting with some old home remedies such as rubbing on papaya or a paste of roasted pomegranate skin, fresh cut cloves of garlic, and so on.

Fruits and vegetables don’t work. They taste good, but are better put to work in your stomach than on your face. On second thought, I’m not so sure about the taste of pomegranate skin.

Acne Soaps, Cleansing Strips, Et Al

Some products physically (rather than chemically) agitate your skin. In most cases, they remove dirt, sebum, and dead skin cells from the surface, but they don’t do much, if anything, to treat your acne. Having a clean face is great, but these rubby, scrubby products often only serve to irritate and redden an already inflamed complexion.

Here are some of the most common physical acne treatments:

• Pore cleansing strips: These sticky patches temporarily lift solidified sebum and dead cells out of your pores for a day or so. They may occasionally cause mild irritation. They aren’t very useful.

• Acne soaps: Antibacterial foaming washes, scrubs, and soap bars are available in many shapes and sizes. Some contain benzoyl peroxide, others have salicylic acid and some have triclosan, an antibacterial chemical cleanser that removes excess sebaceous secretions.

None of them hang around on your skin long enough to do much to help your acne. To make them more effective, leave them on for at least 5 to 10 minutes before rinsing them off.

• Exfoliants: These are products that physically scrub the skin cells off. They can be very harsh on your skin if you have inflammatory acne, and they can be especially irritating when they contain salicylic acid.

Exfoliants come in many forms: abrasive sponges, cosmetic scrubs, facial masks, toners, pads, and sponges. Avoid these products if you have sensitive skin.

• Masks: Masks to treat acne are essentially self-indulgent ways to spend more money and get a mild facial exfoliation. Masks contain various ingredients such as salicylic acid, benzoyl peroxide, vitamins, aloe, and lemon juice, to name a few.

• Loofah sponges: Almost as bad as using sandpaper on your skin if you have inflammatory acne. If you have non-inflammatory acne and tough skin, I guess they can’t hurt.

These treatments are most effective when used sparingly and in conjunction with other treatments that have antibacterial properties, like benzoyl peroxide. But my final word on all of these products: Save your money! Go with proven treatments like benzoyl peroxide and salicylic acid preparations, if you’re going to treat acne on your own.

Evaluating Advertisers’ Claims

There is some excellent, time-tested, helpful information about acne and acne-fighting products available, but sadly you need to take a lot of the stuff you find with a grain of salt. Be especially wary of the following as you walk through acne aisle at the drugstore, search the Internet, visit your local bookstore, or watch those infomercials:

• People who are selling products: Many supposed experts have a financial interest in pushing their own products; this often outweighs their interest in really educating and helping you.

So learn to read between the lines and to skip all of the hucksterism. Such keywords and phrases as magic, revolutionary, our laboratories, and overnight should have you raising a skeptical eyebrow.

• Claims that are too good to be true: Any product or book that has the word cure on the package or in its title, or 24 hours or even 5 weeks to clear skin, should make you very suspicious. I don’t know how to cure acne and I’m a dermatologist with many powerful drugs at my disposal.

There is no cure for acne, and in most instances, and even with the strongest of medications, it often takes months to get it under control and years of treatment to keep your skin clear.

• Unsubstantiated claims about scientific testing: When a product says it was dermatologist-tested, it wasn’t necessarily approved or recommended by dermatologists. It could be that just one dermatologist tested it; maybe the dermatologist tested it and didn’t like it!

But I guess the manufacturer can still say that it was dermatologist tested. And when a highly paid TV actor/doctor or your favorite movie star or pop star endorses a product, I realize that it’s not easy to separate the real claims from the phony. Perky ears, raised eyebrows, and this blog can be your best guides.

I’ve written this to provide you with the information you need to make educated decisions about your acne. If you elect to go it alone in your acne treatment, your pharmacist is an excellent source of additional information to help you find your way through all the hype.