Topical Acne Treatments – Are They Dangerous?
There is a topical acne treatment for every kind of acne, for every skin type, and for every budget. Not every treatment works for every kind of acne or for everyone who has the same kind of acne, however, and what helps one person fight acne can actually make acne worse for another. Here is what you need to know about the most common topical acne treatments.
- Even soap and water can be a useful acne treatment.
- People who have acne and do not have sensitive skin can use almost any kind of soap, but it is best not to rub the soap into the skin.
- People who have both acne and sensitive skin need to be careful to avoid soaps that contain botanicals or fragrances, since these can cause irritation, and irritation causes production of even more skin oil.
- The least expensive face masks usually get the best results.
- The least expensive non-prescription retinoid creams usually get the best results.
- Topic Retin-A opens cysts and nodules without lancing, but it can also cause new blemishes if careful cleansing is not part of the routine.
Soap and Water
No acne expert is ever going to tell you that soap and water is the best way to fight acne, but if soap and water is all you have, then soap and water is the topical acne treatment for you. But there is a right way to use soap and water for fighting acne, and a wrong way to use soap and water for fighting acne.
The right way to use soap and water to treat acne is to make a lather of soap with your hands and to apply the soap to your skin with your fingers. Let the soap do the work. Don’t rub, scrub, or work at making it work1. Rinse the lather off your skin with warm water and pat your face dry with a clean towel.
The wrong way to use soap and water is to rub it into your skin, either directly or with a washcloth. Not only can soap film clog pores, any irritant chemical in the soap can trigger a protective reaction2 in the skin: The skin protects itself by making even more sebum.
Some acne sufferers can wash their faces with any soap that’s handy. If you aren’t sensitive to perfumes, or laundry products, and you don’t have eczema or contact dermatitis, chances are any old soap as a topical acne treatment will do.
Other acne sufferers have sensitive skin and have to be careful about their choices of soaps. If perfumes make you sneeze, or laundry products make you break out, or you get pimples after you get too cold (rosacea) or too hot (heat rash), you probably need to be careful about your choice of soaps. Most Neutrogena and Cetaphil products, however, are fine for sensitive skin. Alpha Hydrox Foaming Face Wash and Eucerin Redness Relief Soothing Cleanser are good for all but the driest skin, and Body Shop Aloe Soothing Facial Cleanser works well for very dry skin.
Benzoyl peroxide creams, gels, and lotions are a good way to fight the bacteria that cause acne, but they don’t get rid of inflammation right away. They just stop the skin’s production of its own irritant chemicals by taking away the target of inflammation, the bacteria that cause acne. Still, most people see significant clearing of the skin in one to two weeks3, provided the benzoyl peroxide itself does not cause its own inflammation and irritation of the skin.
Benzoyl peroxide comes in different strengths. Over the counter products, in most countries, range from 2.5% to 10% benzoyl peroxide, while prescription products range from 5% to 20% benzoyl peroxide. Sometimes the 5% prescription strength product causes redness, inflammation, irritation, and peeling, while the 2.5% product, which the doctor would not prescribe, works just fine. Always start with the lowest concentration you can find, and only increase the strength of the product you put on your face when you are sure that you are not causing irritation.
Since the skin repairs itself by producing sebum4, using benzoyl peroxide that it is too strong may cure pimples but make whiteheads and blackheads pop out. You may be able to use a stronger spot treatment than all-over-the-face lotion or gel.
On the other hand, benzoyl peroxide face washes don’t do you any good because they only stay on your face a few seconds before you wash them down the drain. Benzoyl peroxide has to stay on your face several hours to work.
Good choices in benzoyl peroxide cleansers include Clean & Clear Persa-Gel 10, Clearasil StayClear Acne Tinted Cream, and Clinique Acne Solutions Emergency Gel Lotion.
Clay masks and, as strange as it sounds, Phillip’s Milk of Magnesia, are very useful for absorbing excess oil5 from the skin. You simply place the mask material on your skin, let it dry, and rinse it off 15 to 30 minutes later.
In choosing facial masks, the thing to remember is that the least expensive mask works best (but don’t dig around in your yard to get the clay, use a sterile commercial product). A mask that costs US $3 may be more beneficial for your skin than a mask that costs $30 if the more expensive product contains additional ingredients that irritate the skin. And they usually do.
Non-Prescription Retinoid Creams
Retinoids are nothing more than vitamin A for the skin applied directly to the skin. Vitamin A stimulates the growth of the skin, opening pores, and allowing them to drain.
Different non-prescription retinoids have different effects6 and side-effects:
- Retinol can be used directly by the skin but can cause peeling, dryness, redness, itching, irritation, and sensitivity to the sun.
- Retinyl propionate (used in Olay products) is a more stable form of retinol that has to be converted into retinol by enzymes in the skin, that will only work when the skin needs it. It causes less irritation but may not be as fast-acting.
- Retinyl palmitate is a form of retinol that also has to be processed by the skin itself, but which is easily absorbed into the skin. The retinyl palmitate in L’Oreal products is label as Pro-Retinol A, but most L’Oreal products contain only vanishingly small amounts of this active ingredient. Products that contain enough retinyl palmitate to make a difference include the Vit-A-Plus and A-Force XR acne products.
Prescription Retinoid Creams
The prescription retinoid creams use “turbocharged” forms of vitamin A, with the intention of causing the skin to grow7 so fast that it opens up over nodules and cysts so that they do not have to be lanced. In the United States, most retinoids are taken as a pill, but tretinoin topical, marketed under the trade names Retin-A Micro and Avita, is available as a cream.
The drawback to topical tretinoin8 is that it is comedogenic. That is, it cures nodules and cysts, but causes whiteheads and blackheads. Your physician will give you detailed instructions for the use of the drug, but you will also have to do a regular cleansing of the skin to prevent the formation of new blemishes.
- Skin care for acne-prone skin. Institute for Quality and Efficiency in Health Care (IQWiG). 2013.
- Sparavigna A., Tenconi B., De Ponti I., La Penna L. An innovative approach to the topical treatment of acne. Clinical, Cosmetic, and Investigational Dermatology. 2015;8:179–185.
- Bikowski J. A Review of the Safety and Efficacy of Benzoyl Peroxide (5.3%) Emollient Foam in the Management of Truncal Acne Vulgaris. The Journal of Clinical and Aesthetic Dermatology. 2010;3(11):26–29.
- Picardo M., Ottaviani M., Camera E., Mastrofrancesco A. Sebaceous gland lipids. Dermato-Endocrinology. 2009;1(2):68-71.
- Williams L.B., Haydel S.E. Evaluation of the medicinal use of clay minerals as antibacterial agents. International Geology Review. 2010;52(7/8):745–770.
- Leyden J., Stein-Gold L., Weiss J. Why Topical Retinoids Are Mainstay of Therapy for Acne. Dermatology and Therapy. 2017;7(3):293–304.
- Schmidt N., Gans, E.H. Tretinoin: A Review of Its Anti-inflammatory Properties in the Treatment of Acne. The Journal of Clinical and Aesthetic Dermatology. 2011;4(11):22–29.
- Veraldi S., Barbareschi M., Benardon S., Schianchi R. Short contact therapy of acne with tretinoin. The Journal of Dermatological Treatment. 2013;24(5):374-6.
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