Advising patients on over-the-counter acne treatments

In this article:

• What is acne?
• Factors that can affect acne
• Recommending common OTC acne treatments
• Pregnancy and breastfeeding risks
• Prescription treatments for acne
• Tips for counseling patients on acne treatments
• The bottom line: OTC treatments can be effective

In this article

• What is acne?
• Factors that can affect acne
• Recommending common OTC acne treatments
• Pregnancy and breastfeeding risks
• Prescription treatments for acne
• Tips for counseling patients on acne treatments
• The bottom line: OTC treatments can be effective

Acne is a common problem that drives many people to seek solutions in the pharmacy aisle. For patients, knowing which over-the-counter (OTC) acne treatments work best can be difficult. Pharmacists may be helpful in guiding patients to effective treatments for their skincare needs. For example, you might recommend a product like adapalene, which is an OTC retinoid that can help treat and prevent breakouts by unclogging pores and reducing inflammation.

Patients often struggle with how to use products properly to avoid worsening their acne. You might advise patients to maintain gentle skin care habits to reduce irritation and potential breakouts. With your expertise, you can help patients explore a range of OTC options and find the most suitable options for their skin concerns.

What is acne?

Acne is a common skin condition that affects many people, especially adolescents. It occurs when hair follicles become clogged with oil and dead skin cells. This clogging can lead to various forms of pimples, including blackheads, whiteheads, and more severe lesions like cysts and nodules.

Acne mainly develops due to the overproduction of sebum, an oily substance produced by sebaceous glands. Sebum and dead skin cells can accumulate, blocking hair follicles. Bacteria, particularly Cutibacterium acnes (formerly known as Propionibacterium acnes), can then thrive in these clogged follicles, leading to inflammation and pimples.

Factors that can affect acne

Several factors can affect the development and severity of acne, including:

• Hormonal changes: During puberty, increased production of androgens can cause sebaceous glands to enlarge and produce more oil, which can clog pores and lead to acne. Women may also experience hormonal changes during menstruation, pregnancy, or when using birth control pills, which can worsen acne problems.
• Genetics: A person’s genetic makeup can influence acne. If parents had acne, their children may likely experience similar issues due to inherited traits affecting skin cell turnover and sebum production. Genetics can also determine how the skin responds to bacteria and hormonal changes.
• Stress: Stress can aggravate acne by increasing inflammation and sebum production in the skin. When stressed, the body releases cortisol, which can lead to more oil production and clogged pores. Stress management techniques, such as exercise, meditation, and adequate sleep, can help reduce the impact of stress on the skin. Patients should be encouraged to incorporate these practices into their daily routines.
• Humidity and sweating: High humidity and excessive sweating can contribute to acne. Sweat that mixes with oil, dirt, and dead skin cells can block pores and create an environment for bacteria to thrive. Therefore, it’s important to keep the skin clean and dry, especially after sweating.
• Friction or pressure on the skin: Repeated friction or pressure on the skin, such as from helmets, tight clothing, or backpacks, can cause a type of acne known as acne mechanica. It occurs when pressure and friction irritate the skin, leading to blocked pores and inflammation.
• Harsh cosmetic products: Using harsh or comedogenic cosmetic products can lead to acne. Ingredients like alcohol, fragrances, and heavy oils can irritate the skin and clog pores.
• Medication side effects: Certain medications can cause acne as a side effect. Drugs like corticosteroids, lithium, and some thyroid hormones are known to trigger acne. If a patient suspects their medication is causing acne, a healthcare provider can evaluate their treatment plan.

Recommending common OTC acne treatments

Many OTC treatments for acne are available. Each has unique properties and is suitable for different skin types and severities of acne. When recommending one of the following options, you can explain why it’s useful, its available strengths, and its common side effects.

Benzoyl peroxide

Benzoyl peroxide is an antimicrobial agent that reduces Cutibacterium acnes, the bacteria that cause acne. This ingredient also helps reduce inflammation.

Pharmacists may recommend it in concentrations ranging from 2.5% to 10%. Benzoyl peroxide may cause dryness and irritation, so applying a moisturizer afterward can help. Patients should start with a lower concentration and gradually increase it.

Commonly used in creams and gels, benzoyl peroxide can bleach hair and fabrics. Advising patients to wash their hands thoroughly after application can help prevent unwanted bleaching.

Retinoids

Retinoids, such as adapalene, increase skin cell turnover and unclog pores. They help treat both inflammatory and non-inflammatory acne and can reduce fine lines and wrinkles, boosting their appeal for adult acne patients.

Adapalene is available in 0.1% and 0.3% strengths. Starting with the lower strength may help minimize irritation. Patients should use retinoids in the evening because exposure to sunlight can degrade the product and cause photosensitivity. Common side effects include dryness, peeling, and redness, especially at the beginning.

Salicylic acid

Salicylic acid exfoliates the skin and clears pores by promoting the shedding of dead skin cells. As a result, it may be beneficial for treating blackheads and whiteheads. It is suitable for daily use and found in concentrations from 0.5% to 2% for home use.

Pharmacists should recommend starting with a lower concentration to minimize potential irritation. Lotions, creams, washes, and pads are common formulations. Patients with dry or sensitive skin should use salicylic acid sparingly. Regular use may help maintain clear skin and prevent future breakouts.

Azelaic acid

Azelaic acid has antibacterial and anti-inflammatory properties. It reduces the growth of C. acnes and decreases the production of keratin, a natural substance that can lead to acne.

Pharmacists can recommend azelaic acid to patients with sensitive skin or those who experience post-inflammatory hyperpigmentation. It is typically available OTC in 10% to 12% concentrations.

Patients should apply azelaic acid twice daily, morning and night. While generally well-tolerated, some may experience mild burning, itching, or redness initially.

Alpha-hydroxy acids

Alpha-hydroxy acids (AHAs), such as glycolic acid and lactic acid, help exfoliate the skin’s surface. They are ideal for treating mild to moderate acne and improving skin texture and tone.

Pharmacists should suggest starting with lower concentrations (5% to 10%) to reduce irritation risk. AHAs increase skin sensitivity to the sun, so recommending daily sunscreen is key.

AHAs can be found in peels, cleansers, and serums. Consistent use can help reduce acne scars and spots over time.

Sulfur

Sulfur removes dead skin cells and excessive oil, helping prevent clogged pores. This ingredient may be suitable for patients with oily and combination skin types.

Pharmacists can propose products containing sulfur in concentrations between 3% and 10%. However, sulfur can cause dryness or an unpleasant odor for some patients. Patients should use sulfur-based treatments as spot treatments or masks.

Pregnancy and breastfeeding risks

Many OTC treatments, such as benzoyl peroxide, salicylic acid, and azelaic acid, can be considered safe when used in limited amounts. However, retinoids, like adapalene, are strictly contraindicated during pregnancy due to their potential to cause fetal harm. It is also recommended to avoid retinoids in breastfeeding mothers due to potential harm to the child. 

For those who are pregnant or nursing, it’s important to consult a healthcare provider before starting any acne treatment to ensure safety for both the mother and child. Non-retinoid options may provide effective acne management without significant risks.

Prescription treatments for acne

For some individuals, OTC treatments may not provide sufficient relief from acne. These cases often require prescription medications that target acne more aggressively.

Antibiotics like doxycycline and minocycline can help reduce inflammation and bacterial growth on the skin. Tretinoin, a topical retinoid, is highly effective in promoting skin cell turnover and preventing clogged pores. Spironolactone is another option, particularly for women. This oral medication reduces androgen levels, which can decrease oil production and improve acne.

Tips for counseling patients on acne treatments

When assisting patients with OTC acne treatments, you may want to consider different aspects of their health, lifestyle, and skincare habits.

Discuss the patient’s medical history

Ask about any allergies, past skin conditions, and current medications. Knowing if the patient has used any prescription treatments previously may help you find a suitable OTC option. This history also helps to avoid any potential interactions with current treatments or conditions. In many cases, you should refer them to a dermatologist, especially if their acne is severe.

Consider the patient’s lifestyle

A patient’s lifestyle may influence their skin health and response to acne treatments. Inquire about their diet, stress levels, and overall lifestyle. Factors such as poor diet and high stress levels may worsen acne.

Evaluate current skincare routines

Look at the patient’s existing skincare routine to identify products that may be aggravating their acne. Ask about the types of cleansers, moisturizers, and other products they use. Non-comedogenic and gentle formulas are recommended to avoid clogging pores and increasing irritation.

Set realistic expectations

Over-the-counter treatments often take time to show results, sometimes several weeks. Explain that acne treatment is a gradual process, and remind them that initial improvements might be subtle. Consistency and patience are key.

Reinforce consistent use of treatments

Patients may need reminders that skipping applications can delay progress. Consider suggesting a daily routine and possibly using reminders to maintain regular use. Compliance can affect the efficacy of acne treatments.

Monitor for allergic reactions

Tell patients about possible allergic reactions to new products. Advise them to perform a patch test before using any new treatment extensively. Redness, itching, or swelling may indicate an allergy, and if any of these occur, they should discontinue use immediately and consult a healthcare provider.

Stress the importance of sun protection

Stress the importance of sun protection, as many acne treatments can make skin more sensitive to UV rays. Recommend using a broad-spectrum sunscreen with at least SPF 30 daily. Protective measures like wearing hats and avoiding peak sun hours can further safeguard their skin.

Advise against picking or squeezing acne

Advise patients against picking or squeezing acne lesions. This habit can worsen inflammation, lead to scarring, and spread bacteria. Suggest alternative methods, such as using spot treatments, to handle pimples effectively and reduce the temptation to pick.

Discuss the potential initial worsening of acne

Explain to patients that acne may initially worsen before improving when starting new treatments. This can be due to purging, in which underlying acne comes to the surface. Clarifying this early can prevent discouragement and assure them that sticking with the regimen is important for long-term results.

The bottom line: OTC treatments can be effective

Over-the-counter acne treatments offer a variety of solutions to help patients manage their skin. These treatments include topical retinoids, benzoyl peroxide, and salicylic acid, which may be effective for various types of acne, including hormonal and cystic types.

Pharmacists can help patients choose the right product based on their skin type and the severity of their acne. By educating patients on the benefits and risks of these treatments, patients may experience better skin health and reduce the impact of acne on their daily lives.