Nonprescription acne treatment: Which products work best?

You can buy many acne medications at the store to treat mild to moderate acne and prevent breakouts. They include cleansing lotions, gels, foams and towelettes, leave-on products, and kits. How do you know which products are best for you?

Before you decide, learn how acne medications work and what ingredients to look for. Then develop gentle skin care habits to help treat and prevent acne.

The Food and Drug Administration warns that some popular nonprescription acne products applied to the skin (topicals) can cause a serious reaction. This type of reaction is quite rare. It is common to have some irritation or itchiness when you try new acne products. If such side effects don't go away, stop using the product and seek medical care.

Acne products work in different ways, depending on their active ingredients. Some work by killing acne-causing bacteria. Others remove excess oil from the skin or speed the growth of new skin cells and the removal of dead skin cells. Some acne products try to do all these things.

Here are common active ingredients found in acne products used on the skin and how they work.

• Benzoyl peroxide. This ingredient kills bacteria that cause acne, helps remove excess oil from the skin and removes dead skin cells, which can clog pores. Benzoyl peroxide products that you can buy without a prescription are available in strengths from 2.5% to 10%. Studies show that lower strength products are as effective as higher strength preparations. Consider starting with a lower strength (2.5%) water-based product to lower the risk of side effects.

  Possible side effects include dry skin, scaling, irritation, burning and stinging, especially if you have sensitive skin. Be careful when applying benzoyl peroxide, as it can bleach hair and clothing. It has no bleaching effect on the dark patches that can linger after acne clears (postinflammatory hyperpigmentation).

• Adapalene. This ingredient is a retinoid that helps unclog pores and prevent new breakouts. Adapalene gel (Differin) is available without a prescription at a strength of 0.1%. Don't apply this product to skin that has a cut, sunburn or eczema rash. You might feel a slight stinging when the gel is applied, but it soon goes away. Other possible side effects include dry skin, scaling and inflamed skin. Use a nonoily (noncomedogenic) moisturizer to ease these symptoms.

• Salicylic acid. This ingredient may help unclog pores and prevent new breakouts.

  Salicylic acid products that you can buy without a prescription are available in strengths from 0.5% to 2% as both leave-on and wash-off products. Possible side effects include mild stinging, skin discoloration and minor skin irritation.

• Azelaic acid. This ingredient helps prevent pores from becoming plugged and is mildly antibacterial. Nonprescription azelaic acid products are available in 10% strength. Azelaic acid also helps correct dark spots that can linger after acne clears (postinflammatory hyperpigmentation).
• Alpha hydroxy acids. Alpha hydroxy acids are synthetic versions of acids derived from sugar-containing fruits, sugar cane or milk. Two types of alpha hydroxy acids that are used in nonprescription acne products are glycolic acid and lactic acid. They treat acne by removing dead skin cells and calming inflamed skin. Alpha hydroxy acids also spur the growth of new, smoother skin. This helps improve the look of acne scars and pores.

The acne products that are best for you depends on your skin type, acne type and skin care preferences. Here are some general guidelines for choosing and using topical nonprescription acne products:

• Begin with benzoyl peroxide and adapalene. If you're not sure which acne product to buy, start with one that contains benzoyl peroxide, adapalene or both. Either one is effective and usually well tolerated. Some studies show that they are more effective when combined. Give it a few days before expecting to see results.
• Start with lower strength acne products. This can help minimize inflamed, dry skin and other problems. If needed, slowly increase the strength of the product you use and how often you use it. Do this over several weeks. This helps your skin adjust to the treatment.
• Use more than one product. To treat stubborn acne, you might find it helpful to use more than one product, each with a different active ingredient or combination of ingredients. You might apply one product in the morning and a different one at night to help prevent skin irritation.
• Choose the form that works for you. The product you need might come in more than one formulation, such as a soap, cream, gel or ointment. In general, creams are less irritating than gels or ointments. But gels and ointments soak into the skin better. Gels can cause your skin to sting and feel dry. Ointments might feel too greasy for you. You may need to try different products before you find what works for you.
• Be patient. Treating acne with topical products that are available without a prescription takes time and patience. It may take 2 to 3 months of daily use before you see results. And acne may worsen before it gets better.

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

• Wash acne-prone skin twice daily. Twice a day, use your hands to wash your face with a mild cleanser (Cetaphil, Vanicream, others) and warm water. Be gentle. Too much washing and scrubbing can worsen acne. Avoid facial scrubs, astringents and masks. They tend to irritate the skin, which can worsen acne and the side effects of your medicated acne product.
• 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. If you wear makeup, remove it at the end of the day.
• Use just the right amount. Use a thin layer of the product — just enough to cover the face. 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 nonoily, water-based facial products. Choose nonoily (noncomedogenic) products for your facial moisturizers, acne concealers and cosmetics. They help avoid clogged pores and ease dry, peeling skin.
• Avoid irritants. Oily or greasy skin care products, sunscreen and hair products can worsen acne. Choose products labeled water-based or noncomedogenic, which means they are less likely to clog pores and cause acne. Silicone- or glycerin-based hair products formulated as moisturizing liquids might be a good replacement for heavy, oil-based ones. If you don't want to give up a favorite hair oil, try applying it to just the middle of your scalp and hair ends. This helps avoid acne on your forehead and temples.
• Don't pick or squeeze blemishes. Doing so increases your risk of infection or scarring.
• Watch what touches your face. Keep your hair clean and off your face. Protect your acne-prone skin from contact with phones, helmets, caps, tight collars, straps, backpacks and other items that might transfer sweat or oil to your skin.
• Protect your skin from the sun. The sun worsens dark spots (postinflammatory hyperpigmentation) that can linger after acne has cleared. And some acne medications make you more likely to sunburn. Check with your health care provider to see if your medication is one of these. If it is, stay out of the sun as much as possible. Regularly use a nonoily moisturizer that includes sunscreen.
• Shower after strenuous activities. Oil and sweat on your skin can lead to breakouts.

If your acne doesn't improve after 2 to 3 months of trying a skin care routine with your chosen acne products, consider seeing your health care provider or a skin specialist (dermatologist) for a prescription lotion or medication.