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Zoe Diana Draelos, M.D., is a consulting professor of dermatology, Duke University School of Medicine, Durham, N.C. She is investigator, Dermatology Consulting Services, High Point, N.C., and a Dermatology Times Editorial Advisor and co-medical editor.
An expert goes over the pros and cons of some of the available OTC acne products.
There are many excellent OTC acne products that can supplement prescription acne treatment or provide control during the maintenance phase of treatment. Many OTC 2.5% benzoyl peroxide products perform just as well as the older 5 and 10% benzoyl peroxide formulations that used to be prescription. Remember that all benzoyl peroxide prescription products became OTC drugs several years ago and concentrations of benzoyl peroxide higher than 10% are not routinely sold for medical purposes because of their explosive nature. The good 2.5% benzoyl peroxide OTC products use a micronized benzoyl peroxide that allows the 2.5% to form a thin layer over the skin surface delivering the same product coverage as the older larger particle size higher concentration formulations.
While the OTC benzoyl peroxide preparations are aimed at adolescent acne, salicylic acid is used as the active agent in products for more mature acne. Mature acne tends to be more inflammatory with larger, deeper papules. Salicylic acid has some minor anti-inflammatory properties, but is not very effective in adult acne because it is not antibacterial and has poor keratolytic activities. For this reason, OTC preparations for mature acne are less effective than hoped.
One of the most effective ways to combine a prescription product with an OTC product is the use of a benzoyl peroxide wash or cream with clindamycin gel or solution. With the newly restricted acne formularies, many insurance companies are decreasing access to the prescription benzoyl peroxide/clindamycin products. This is an effective way to use OTC benzoyl peroxide to minimize bacterial resistance to topical clindamycin.