Acne Treatment

The importance of over-the-counter skin care in acne treatment has been recognised for some time A paper by Hilary Baldwin MD of Rutgers Robert Wood Johnson Medical Center, New Brunswick, NJ and others (1) introduces the term "Acneceuticals" to cover a wide range of non-prescription ingredients proven to alter the structure and function of acne-prone skin. The article is not open access so I am not allowed to reproduce any of the article here so you may like to follow the link to learn more about this interesting topic and to understand more about this issue.

All severity of acne has a significant burden on patients. Addressing environmental factors that are important for the individual with acne may help to educate, prevent, effectively manage, and maintain acne. The adult female acne population has unique needs because of their aging skin and social environment. Non-prescription acne treatment products may help to balance the efficacy and tolerability of prescription acne treatment. (2)

When managing acne, it is important to target the four main pathogenesis, such as follicular hyperkeratosis, inflammation, sebum production, and the skin microbiome, while maintaining an intact skin barrier.

Non-prescription acne treatment may play a role in acne prevention, treatment and maintenance regimens. Also, non-prescription acne treatment plays a significant role in the management of mild acne, as maintenance therapy, or in combination with acne prescription medications to enhance efficacy or to improve tolerability. Non-prescription acne treatment, cleansers, and moisturiser use may prevent the appearance of new lesions, reduce inflammation, and improve skin barrier function. The composition of moisturisers and cleansers should have a pH close to a physiological skin surface pH ranging from 4 to 6 to prevent an increase of moisture vapour water loss and a change of protease‐activated receptor affecting skin barrier integrity and elevating inflammation. (2)

Various gels, lotions and creams are used to treat acne. There are plenty of acne treatments to buy. Sometimes they work, sometimes they don't and it is quite easy to build up a large collection of creams that sit in your bathroom cabinet and have cost a lot of money, but don't seem to help your spots. It's often worth asking your doctor about your acne before buying things: getting the right treatment from the start can save a lot of time and money.

Benzoyl Peroxide is a common topical treatment. It has three actions - it kills germs (bacteria), reduces inflammation and helps to unplug blocked pores. Therefore, it often works well to clear inflamed spots and it helps to clear blackheads and whiteheads (comedones). You can buy benzoyl peroxide at pharmacies, without a prescription. There are lots of brand names for it and it comes in different strengths - there is a 2.5%, 4%, 5% and 10% strength.

Retinoids are categorised into four generations based on their molecular structures and specific receptor affinities, with the latest generation progressively reducing toxicity while enhancing efficacy. Additionally, topical retinoids are classified into six classes: tretinoin (all-trans retinoic acid), Adapalene, Tazarotene, Trifarotene, Alitretinoin, and Bexarotene. Topical retinoids are a cornerstone of acne therapy due to their comedolytic and anti-inflammatory effects. These vitamin A derivatives bind to Retinoic Acid receptors in skin cells, influencing gene transcription to increase skin cell turnover and reduce oil production. Topical therapies offer the advantage of direct application to the affected area, minimising potential systemic side effects and increasing exposure within the pilosebaceous follicular unit (4)

Azelaic Acid is an alternative to benzoyl peroxide that mainly works by unplugging blocked pores. So, like retinoids, it is good at clearing blackheads and whiteheads. It has some effect on reducing inflamed acne too but probably not as much as antibiotics or benzoyl peroxide. However, it may cause less skin irritation than benzoyl peroxide. (3)

Salicylic acid, a beta-hydroxy compound, combats mild acne by acting as a comedolytic, keratolytic, and mild anti-inflammatory, while also possessing fungistatic and bacteriostatic properties. Salicylic acid is widely available over the counter in concentrations ranging from 0.5% to 2% in both leave-on (gels, creams, lotions) and wash-off (cleansers) products

Gentle skin cleansers or specific oily/ acne skin type cleansers should be used instead of harsh soaps or scrubs. Soaps tend to have a higher pH level than the skin which can lead to skin irritation and dryness. Aggressive scrubbing and picking of the skin should be discouraged as it may promote the development of new acne lesions and scarring.

There are some new treatments that use light to treat acne. You can buy light therapy units to use at home. Although there are a lot of online articles about how good they are, the scientific research doesn't prove them to be that good at the moment (apart from 'blue light' for mild acne). These treatments are improving and look like a good treatment as they improve.

NOT MY OWN WORK. The above is taken from:

(1) The Use of Acneceuticals to Improve Acne Care: Introduction of a New Term and Review of the Literature March 2025 Volume 24, Issue 3 281 doi: 10.36849/JDD.8817

(2) Dréno B, Araviiskaia E, Kerob D, Andriessen A, Anfilova M, Arenbergerova M, Forero Barrios OL, Bukvić Mokos Z, Haedersdal M, Hofmann MA, Khamaysi Z, Kosmadaki M, Lesiak A, Roó E, Zbranca-Toporas A, Wiseman MC, Zimmo S, Guerin L, Fabbrocini G. Nonprescription acne vulgaris treatments: Their role in our treatment armamentarium-An international panel discussion. J Cosmet Dermatol. 2020 Sep;19(9):2201-2211. doi: 10.1111/jocd.13497. Epub 2020 Jun 17. PMID: 32426933; PMCID: PMC7496538.

(3) Acne review: https://patient.info/skin-conditions/acne-leaflet/acne-treatments

(4) Kim, H.J.; Kim, Y.H. Exploring Acne Treatments: From Pathophysiological Mechanisms to Emerging Therapies. Int. J. Mol. Sci. 2024, 25, 5302. https://doi.org/10.3390/ijms25105302