Over-The-Counter Acne Treatment 101: Esthetician's Guide

Sep. 23
Many of us have found ourselves in the same position: It’s time to revamp your skincare routine or simply replace one of your holy grails. You watch a couple of youtube videos, read some product reviews, and you feel ready to take on the drugstore. But as soon as you arrive, you find yourself overwhelmed by all of the choices in the skincare aisle. Suddenly, the acne cream you were set on is being overshadowed by the appeal of a similar product from a different brand. The only concern? They have two very different active ingredients. 
With the rise of skincare influencers, dermatologist YouTubers, and beauty bloggers, it’s easier than ever to find accessible recommendations for treating acne. And even better: they are beginning to recommend more and more drugstore products and simplified routines. Yet, it can still be hard to differentiate what’s actually in those products that are helping your breakouts. We are going to get into some of the common ingredients offered OTC and online and which types of acne they treat. First, it's important to know which type or types of acne you're trying to treat.

Different kinds of mild acne.

*Note: Severe cystic and nodular acne should be treated by a dermatologist.*
Salicylic Acid
Salicylic acid is somewhat of a star in the skincare realm. You see it mostly in cleansers and toners, although it can be splashed into almost anything. Salicylic acid is in a group of acids called beta hydroxy acids or BHA’s. It is great at gently exfoliating the epidermal layer, effectively revealing the fresh skin cells underneath to give you a smoother texture. It has anti-microbial (fights bacteria) and antifungal properties and can penetrate through oil in the pore, making it ideal for treating whiteheads, blackheads, small bumps, closed comedones, and even light hyperpigmentation. It is typically less irritating compared to AHA’s or alpha hydroxy acids (glycolic acid, lactic acid, etc..) My personal favorite is Paula's Choice 2% BHA Liquid because it's extremely effective yet gentle.

Paula's Choice 2% BHA Liquid Exfoliant ~ $29.50 USD

*Pro Tip: Opt for a leave-on product with salicylic acid, and make sure to apply before serum or moisturizer. This will allow the product to come in direct contact with your skin. Moisturizing after will prevent you from getting dry!
Benzoyl Peroxide
Benzoyl peroxide is really great for some, and a no-go for others due to its irritating potential. It is anti-microbial and works especially well for inflamed acne that contains pus. Benzoyl peroxide works by exfoliating deep within the pore, allowing for skin turnover to happen unhindered, and preventing dead skin cells from clogging in the first place. But this deeper exfoliation means that it can be more prone to irritating skin. Benzoyl peroxide works best for cystic acne, whiteheads, pustules, and papules. This cleanser from CeraVe is a great way to introduce benzoyl peroxide into your routine. Because benzoyl peroxide is very strong, a cleanser is short enough contact that it can do its job without staying on your skin for too long. https://www.target.com/p/cerave-acne-foaming-cream-cleanser-with-benzoyl-peroxide-5-fl-oz/-/A-76545850
*Pro Tip: Studies have shown that benzoyl peroxide at 5% is just as effective as at 10%. To avoid flaky skin and irritation, stick to 5% or lower concentrations.
*Pro Tip: Benzoyl peroxide is notorious for bleaching clothes, towels, and pillowcases. Try to use only white face cloths when using benzoyl peroxide or designate a few cloths that you don’t mind getting bleached. Sleep with a towel or old t-shirt on your pillow at night to keep your pillowcases bright!
Glycolic Acid
Glycolic acid is an alpha hydroxy acid or AHA. Glycolic acid is also an exfoliant, one that may be better suited for people who have moderate acne that is too sensitive for benzoyl peroxide. Glycolic acid is great for closed comedones or bumpy skin, whiteheads, pustules, papules, reducing pore size, and even fine lines and wrinkles. It is also great for treating acne scarring and hyperpigmentation to reveal more even-toned skin. Like all acne treatments, glycolic acid can be irritating if used in high doses or too frequently. The Ordinary has a cost-effective glycolic acid toner, with other skin-loving ingredients in it.  https://www.ulta.com/glycolic-acid-7-toning-solution?productId=pimprod2007097&AID=165150&PID=10078&CID=af_165150_10078_&clickId=SjuSpcSMwxyOTt8wUx0Mo3bwUkiX9QQUVVIj0U0&SubID=byrdie.com&irgwc=1
*Pro Tip: Like salicylic acid, you’ll want to find a leave-on product containing glycolic acid (like a toner or serum), as a cleanser doesn’t stay on long enough to absorb into your skin. 
*Pro Tip: A glycolic acid mask can be ideal if you are too sensitive for a leave-on product. Just make sure to use glycolic acid in whichever form at night!
Retinol or retinoids are commonly found in over-the-counter products geared for anti-aging. But people sometimes don’t know that it can be fantastic for acne as well! With Differin being sold at drugstores now, it’s never been easier to get your hands on a high concentration, proven acne treatment; one that you used to need a prescription for. Most anti-aging products don't have enough retinol in them to make much of a difference. But I highly recommend giving Differin a try if you are experiencing difficult-to-treat acne or have inflamed acne, pustules, papules, closed comedones or rough texture, and/or fine lines and wrinkles. https://www.walgreens.com/store/c/differin-adapalene-gel-0.1-acne-treatment/ID=prod6388971-product
*Pro Tip: Start SLOW. Retinol is notorious for giving dry, flaky, irritated skin. It’s tempting to use it every day, but 1x per week to start out with is more than enough. Make sure to moisturize generously. You’ll thank yourself later!
Azelaic Acid
Azelaic acid is another exfoliant. In a clinical trial, it proved effective against mild inflammatory acne, closed comedones, whiteheads, hyperpigmentation, and hormone-induced melasma. Positively, it’s very effective for redness caused by rosacea! Azelaic acid is considered a better option for very sensitive skin. This acid would be ideal for someone who has inflamed and red breakouts, and who is prone to acne scarring.
Sulfur works similarly to benzoyl peroxide in the way it prevents excess oil. Sulfur is really great for oily or combination skin and is an awesome option for light breakouts or breakouts from your period. Sulfur works best for whiteheads, closed comedones or small bumps, and texture. A sulfur mask can be a very effective spot treatment overnight as well. Sunday Riley has a sulfur mask that also has niacinamide, tea tree oil, and bentonite clay to help reduce oil production and pore size. This particular mask works well for me as a spot treatment or in-shower mask.

Sunday Riley Sulfur Acne Treatment Mask ~ $20 USD for travel size.

*Pro Tip: Use as an in-shower mask, apply before you hop in, and rinse off at the end of your shower. The steam will help it penetrate better, and it’s super relaxing!
Pimple Patches
Acne pimple patches have gained a lot of popularity over the past few years, and with good reason! Most pimple patches are actually small hydrocolloid bandages. Many people think that acne needs to be dried out, which is not the case for some types of acne. Hydrocolloid patches work because they keep wounds (or in this case, your pimple) moist, which allows for it to heal quicker and without interference from outside elements. They can actually suck the pus and fluid out of your pimple without you having to squeeze (which is a big no-no in itself), and do so without drying the skin around the pimple. By using pimple patches, you’re less likely to pick at your face and less likely to end up with an acne scar. Hydrocolloid patches are best for whiteheads, or pimples that have visible pus in them. They can also help a pimple that you’ve picked at heal quicker. They will not work for cystic acne, blackheads, or inflamed pimples that don't have any visible pus. Another form of pimple patches is treatment patches. These usually have salicylic acid or another active ingredient in them and work similarly. These ones are better for inflamed acne, and will still work on whiteheads. Treatment patches are great for overnight, as they prevent the active ingredient from wiping off and allow it to penetrate deeper into the skin. Treatment patches shouldn’t be used on cystic acne, blackheads, or pimples without pus either. COSRX is my personal favorite, as they are comfortable to wear, clear, and come in mulitple sizes for differently sized pimples. https://www.amazon.com/Cosrx-Pimple-Master-Patch-24patches4sheet/dp/B014SAB948
*Pro Tip: Most pimple patches are small and clear, meaning you can wear them all day while quarantined, if you work from home, or overnight. They work best when worn for many hours (think 8-12) but you will be able to wash your face and moisturize over them because they stick to your face!
*Pro Tip: Apply the patch of your choosing directly on top of your whitehead, and make sure your skin is freshly washed before you apply. Moisturize after it’s already on!
Final Thoughts
Over the counter acne treatments have never been more plentiful. Remember to patch test your products (apply a small amount on your inner wrist and wait 24 hours to see if you react poorly) before you apply to your whole face. This can save your skin from a negative reaction! Start slowly with your treatments, 1x per week to begin should be enough until your skin acclimates. After that, you should be able to incorporate it more consistently throughout the week. If you see any type of irritation, cut back on use. It’s extremely important to note: If you are introducing any type of acne treatment or active into your routine, try to apply them at night, and make sure to wear a broad-spectrum SPF every day!! Even if you aren’t treating acne, wear sunscreen every day! You’ll thank yourself in 30 years.
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