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Choosing Acne Treatment: Prescription Medication vs. OTC

Choosing Acne Treatment: Prescription Medication vs. OTC

One thing everyone can agree on: acne is troublesome. Almost everyone has dealt with hormonal acne (also known as acne vulgaris): It affects 85% of teens and persists into the 20s more than half the time.

Whether breakouts affect your face, back, or other parts of your body, acne can cause anxiety, stress, low self-esteem, and sometimes pain.

Fortunately, there are many products available for treating acne. This article will discuss the differences between medications you can buy at common retail stores, also known as 'over-the-counter' (OTC), and prescription acne medications. It will cover specific products in each category.

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First things first: Two types of acne treatment

Over-the-counter (OTC) medications can help and may be enough to clear up your skin. However, if you're reading this, you've probably tried one or more OTC products and are possibly unsatisfied with the results. You're not alone. In a survey that included over 300 women dealing with acne, fewer than half were satisfied with OTC treatments.

Typically, we divide acne treatments into two broad groups:

  1. Over-the-counter (OTC) acne products

  2. Prescription acne products

You can buy OTC products at drugstores, grocery stores, or online. They don't require a prescription, so you don't have to see your doctor to get these products.

On the other hand, prescription medications need to be prescribed by a health care provider after an evaluation. Sometimes prescription products are stronger versions of OTC products.

Just as any other prescribed medication, when using prescription acne medication, you'd need to follow instructions from your doctor or pharmacist when taking them. It's generally best to try an OTC product first for your acne. These products are simpler to get and may save you some money and side effects. But if your breakouts are particularly stubborn, a prescription product is likely the best acne medication for you. Our expert dermatology team can recommend the best prescription acne cream or gel for you.

Popular 2 options for over-the-counter acne medication

Walking down any store's skincare aisles or browsing online for acne products can be extremely overwhelming. (Of course, you might buy a product from that one TV ad...the one with a perfectly zit-free girl dancing around holding the bottle...but does it work?)

The truth is that almost all OTC acne products boil down to two main ingredients:

  1. Benzoyl peroxide

  2. Salicylic acid

1. Main ingredient: Benzoyl peroxide

Benzoyl peroxide (BP) is an antiseptic substance. It works by slowing the growth of tiny living organisms on your skin that may contribute to acne.

When you look at the label, note how much benzoyl peroxide (BP) there is in the product. The higher the percentage of BP in the product, the more likely you are to experience some side effects, such as dry skin or flaky skin.

BP has the potential to bleach clothing or bedding. You can avoid fabric mishaps by using a thin layer of product and making sure the product is absorbed well before laying down on your favorite sheets and going to bed.

2. Main ingredient: Salicylic acid

Salicyclic acid (SA) is a substance that helps to easily remove the very top layer of your skin. This action can help prevent your pores from clogging and make room for new, healthy skin growth.

SA also has anti-inflammatory effects, meaning it helps your skin heal and fights redness. However, as SA works to clean out your pores, it also has the potential to make your skin uncomfortably dry. This side effect makes some people avoid salicylic acid as a treatment option.

In the previously mentioned survey that evaluated over 300 adult females with acne, 47% and 43% were satisfied with benzoyl peroxide and salicylic acid treatments, respectively. So while over half of these women still wanted better results after trying OTC products, they are worth a try before moving on to prescription products.

The top 3 options for prescription acne medication (topical)

If you've tried the OTC treatments and feel less-than-satisfied with your results, a prescription product may be what's needed to beat the breakouts. The following are some popular treatments that can be applied directly to your skin, also known as topical treatments.

acne-prescription-medication-1

1. Retinoids

Retinoids are a very effective acne treatment and are the go-to choice for most types of acne. They are a category of substances similar in their chemical structures to vitamin A.

How do retinoids work? These products work by increasing cell turnover, which means older layers of skin go away quickly to be replaced by younger, better-looking skin.

The most common retinoids are:

  • Tretinoin

  • Adapalene

  • Tazarotene

These are all ingredients commonly found in lotions and gels that you can use to fight acne.

Unfortunately, side effects are common with retinoids, especially if you are new to using them.

Retinoid side effects usually include:

  • Dryness

  • Irritation

  • Skin peeling.

To minimize these effects, you should start with a lower retinoid concentration and increase this only if needed and as tolerated. Consider using a gentle skin cleanser and a moisturizer with SPF because your skin may become dry and sensitive to the sun when using acne medicines.

Most retinoid products used to treat acne will require a prescription. However, in 2016, the FDA approved Differin gel (adapalene 0.1%) as the first topical retinoid available over-the-counter.

2. Antibiotics

The buildup of bacteria in your pores is one major contributor to acne. So it makes sense that an antibiotic would be used to kill this bacteria and help treat the condition.

Clindamycin is an especially common antibiotic, often used as a cream. The medication works against a specific acne-causing bacteria called Propionibacterium Acnes. This medication is usually quite well-tolerated, so you can expect minimal side effects apart from some possible skin dryness or irritation.

Doctors are not prescribing products as often with clindamycin as the sole ingredient. Why? Because bacteria can learn ways to resist antibiotics, and stay alive even when the medication is used. The risk of this resistance goes up the more we use antibiotics.

Editor's Note: To help fight this problem of antibiotic resistance, you should use antibiotics for acne for 12 weeks or less, and antibiotic products should be made with other ingredients included, such as benzoyl peroxide or retinoids.

3. Combination products

There are many products that combine antibiotic ingredients with retinoids or benzoyl peroxide. These combination products take advantage of the benefits of both types of ingredients. They also help prevent antibiotic resistance.

Popular 3 options for prescription acne medication (oral products)

Sometimes acne is severe enough that topical products are simply not strong enough to win the battle. Instead, you may need oral pills to control acne. This is most often true with cystic acne, which forms deeper breakouts under your skin and can be pretty painful.

1. Antibiotics

In addition to topical antibiotics, medical providers also prescribe oral antibiotics to treat acne. Clindamycin is common, and so are tetracycline antibiotics, such as doxycycline or minocycline.

Editor's Note: As previously mentioned, due to the risk of antibiotics not working against the smart bacteria, the scientific community advises most doctors to move away from prescribing antibiotics alone for acne. Instead, they should be used in combination with topical benzoyl peroxide or retinoids and should only be used for a short time.

2. Combined hormonal contraceptives

The FDA has approved multiple forms of birth control to treat acne. Why, you may ask, is birth control used for acne? Well, it's because hormone processes in your body are partially responsible for producing too much oil, leading to acne. Oral contraceptives can prevent too much oil from being made, leading to acne control.

However, as you may know, deciding to take birth control pills is a decision that extends beyond just treating your acne, and you'd need to consider other factors. See our birth control pill guide for more information.

3. Accutane (isotretinoin)

Accutane is the brand name for the drug isotretinoin. It is also a retinoid, but one you take as a pill rather than apply as a cream or gel. The FDA has approved Accutane for severe acne and moderate acne that leads to scarring or emotional stress.

Accutane is considered a safe drug, but it absolutely cannot be taken by pregnant women. It is known to cause or majorly raise the risk for birth defects in newborn babies. Therefore the use of Accutane is monitored by the FDA through a program called iPLEDGE. People who can get pregnant must use two accepted forms of birth control if they are sexually active.

What's the best acne medication for you?

The best acne medication for you is probably the one that does the following:

  • Controls your acne

  • Causes you minimal side effects

  • Improves your self-confidence or self-image

Despite acne being such a common problem, many factors contribute to it, and these are different for everyone.

That said, the American Academy of Dermatology recommends benzoyl peroxide products as a first-line topical treatment. When it comes to prescription acne treatment, they recommend retinoid products for most acne types.

How to get acne medication

As we discussed, OTC products are available at almost any drugstore or grocery store and online.

Traditionally for prescription products, you'd have to visit a medical provider in person to get a prescription. But now, thanks to the internet and technology, you have a few different options available for getting acne medication.

  • Virtual medical visits are becoming more and more common. These allow you to chat with a provider, and they can then make treatment decisions and prescribe your medication electronically.

  • You may still choose to see your primary care provider. Depending on how severe your acne is, they may write you a prescription or refer you to a dermatologist for specialist care

  • You may also choose to skip the primary care appointment and look for a dermatologist in your area right away. Some dermatologists are private pay, meaning they don't take insurance, and you simply pay for the appointment. You'll want to ask about insurance and pricing when you make your appointment.

Once you have your prescription, you can take it to the pharmacy of your choice.

The Pill Club virtual visit

Using The Pill Club's virtual visit option means you never have to leave your home to get your acne medication. Our medical team can prescribe you acne medication online, and we ship it right to your door for free. Note that you have to be a member of The Pill Club first before you can add acne medication to your birth control.

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What else can you do to prevent acne?

Some people are more or less likely to get acne due to genetics. Despite this likelihood, there are things you can do in your everyday life that will minimize your risk and help keep the pimples at bay.

  1. Whenever you wear makeup, completely remove it before bed. Look for a non-comedogenic makeup that will not clog your pores.

  2. Shower (or at least wash your face) as soon as possible after you exercise.

Sports bras are great for keeping everything secure while working out, but acne loves to form underneath those straps where sweat gets trapped.

  1. Drink plenty of water.

You've heard it a thousand times. On top of the hundreds of functions it performs for us already, it can also help clean stuff out of our bodies that contribute to acne forming.

Whether or not diet and acne are linked is a complicated topic and is up for debate in the dermatology field. However, some evidence seems to at least weakly support that high glycemic index foods such as sweets, fries, or chips, dairy products like sugary yogurt, and other processed foods may worsen acne.

Takeaways

Suppose your acne is too stubborn to go away with OTC products like benzoyl peroxide or salicylic acid. Then, you can talk to your healthcare provider who can recommend a specific prescription product for you, such as retinoids or antibiotics, or a combination of all of these products.

Acne can be a big source of stress for many. Luckily, you have options to help treat acne. The best product for you is the one that helps clear up your skin while also causing the fewest side effects.

Already get your birth control from The Pill Club? Check out our acne treatment program for prescription creams and gels, handpicked by our expert dermatology team for your unique skin goals.

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Sources

  • Kaiane A. Habeshian, Bernard A. Cohen. Current Issues in the Treatment of Acne Vulgaris. Pediatrics May 2020, 145 (Supplement 2) S225-S230; DOI: 10.1542/peds.2019-2056L

  • Bhate K, Williams HC. Epidemiology of acne vulgaris. Br J Dermatol. 2013;168(3):474-485. doi:10.1111/bjd.12149

  • Rendon MI, Rodriguez D, Kawata A, Degboe A, Wilcox T, Burk CT, Daniels S, Roberts, MD WE, Borchert M, Powell K. Acne treatment patterns, expectations, and satisfaction among adult females of different races/ethnicities. Clin Cosmet Investig Dermatol. 2015;8:231-238. https://doi.org/10.2147/CCID.S80467

  • Wishart DS, Knox C, Guo AC, Shrivastava S, Hassanali M, Stothard P, Chang Z, Woolsey J. Drugbank: a comprehensive resource for in silico drug discovery and exploration. Nucleic Acids Res. 2006 Jan 1;34 (Database issue):DB09096. https://go.drugbank.com/drugs/DB09096

  • Fox L, Csongradi C, Aucamp M, Du Plessis J, Gerber M. Treatment Modalities for Acne. Molecules. 2016; 21(8):1063. https://doi.org/10.3390/molecules21081063

  • "Topical Retinoid Acne Treatment Approved for OTC Use." AAP News, 16 Dec. 2016, www.aappublications.org/news/2016/12/16/FDAUpdate121616.

  • Draelos ZD. Cosmetics in acne and rosacea. Semin Cutan Med Surg. 2001;20(3):209-214. doi:10.1053/sder.2001.27556

  • "Is Your Workout Causing Your Acne?" American Academy of Dermatology, www.aad.org/public/diseases/acne/causes/workouts.

  • Kucharska, Alicja et al. "Significance of diet in treated and untreated acne vulgaris." Postepy dermatologii i alergologii vol. 33,2 (2016): 81-6. doi:10.5114/ada.2016.59146

  • Baldwin, Hilary, and Jerry Tan. "Effects of Diet on Acne and Its Response to Treatment." American journal of clinical dermatology vol. 22,1 (2021): 55-65. doi:10.1007/s40257-020-00542-y

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