Acne is the most common skin disorder in the United States. Although it often plagues teenagers, acne can affect people of all ages, including young children and babies. According to Angela Palmer, About.com's guide to acne and acne treatments, "Acne occurs when oil and dead skin cells become trapped within the hair follicle, creating a plug within the pore."
Teenagers are prone to acne problems because of a change in hormone levels that contributes to more oil production in the pores. Most teenagers outgrow the problem as they enter adulthood. But for many, the problem continues well into their adult years. Experts say that 1 in 5 women between the ages of 25 and 40 suffer from some degree of adult acne. Paula Begoun, skin care expert and author of "Don't Go to the Cosmetics Counter Without Me," says, "Women in their 30s, 40s and 50s can have acne just like teenagers, and the treatment principles remain the same." Acne can also affect men, but it is more common among women due to hormone fluctuations.
Regardless of age, those who suffer from acne will benefit from a regular cleansing routine. This helps remove dirt and makeup buildup, both of which can clog pores. Experts recommend cleansing both night and morning with a gentle, water-soluble cleanser (see the ConsumerSearch report on facial cleansers) and following up with a leave-on acne product to treat and prevent blemishes.
According to experts, most cases of mild to moderate acne can be treated effectively with an over-the-counter topical medication or a combination of them. The ingredients of these topical treatments vary, but the most common are benzoyl peroxide, salicylic acid, sulfur and tea tree oil.
Both benzoyl peroxide and salicylic acid have oodles of research backing their effectiveness. Benzoyl peroxide is a topical disinfectant that kills acne-causing bacteria within the pores. Salicylic acid is an exfoliant that removes dead skin cells and penetrates through oil to clean out the pore. Both of these active ingredients can make a difference in clearing up acne, but experts suggest using them both for the best results.
One of the most heavily marketed acne treatments is the Proactiv Solution 3-Step System (*Est. $20), which includes Renewing Cleanser, Revitalizing Toner and Repairing Lotion. Some users complain that it works well in the beginning but that as their skin builds up a tolerance, it no longer works for them. Some experts and users say the microbeads in the cleanser are too harsh on the skin, and some object to buying from the Proactiv website, which automatically sends you more kits and charges your credit card every 60 days. Still, there are many who swear by the system as the only product that clears up their skin. Experts generally agree that Proactiv is a viable option for those who suffer from mild or moderate acne. Paula Begoun, who says most acne kits contain at least one problem product, gives each of the products in the Proactiv kit a reasonable review. Her main complaints are that the cleanser is not ideal for use around the eyes and that the toner is an alpha hydroxy (AHA) product rather than a beta hydroxy (BHA) product. "When it comes to most kinds of breakouts," she says, "research indicates that BHA (salicylic acid) rather than AHA (glycolic acid) is the best way to exfoliate for breakout prevention." Begoun particularly recommends the Proactiv Repairing Lotion, giving it her highest rating and praising it for its inclusion of anti-irritants. It contains 2.5 percent benzoyl peroxide.
Good Housekeeping chooses the Proactiv system as the best acne-control kit based on its ingredients and claims. Their dermatologists praise it for "providing the best antibacterial coverage, because its cleanser includes benzoyl peroxide." It should be noted that the Repairing Lotion is also a benzoyl peroxide product. Good Housekeeping likes that it uses a 2.5 percent solution rather than a higher concentration, "which could irritate the skin."
Experts say benzoyl peroxide is one of the most effective over-the-counter treatments for acne. It is a disinfectant that can penetrate into the hair follicle, killing the bacteria that cause blemishes. Benzoyl peroxide can, however, dry out the skin. Consumers should therefore start with the lowest dosage possible (2.5 percent) once a day and increase in frequency and concentration only as needed.
Another well-liked benzoyl peroxide product is Clinique Acne Solutions Emergency Gel Lotion (*Est. $14 for 0.5 oz.). It contains a 5 percent benzoyl peroxide solution that experts love because it also includes anti-inflammatory agents that reduce redness. Users also rave that it's extremely effective without being harsh on the skin. Clinique recommends daily use of a sunscreen with this product.
If you need something stronger, reviewers recommend Clean & Clear Persa-Gel 10 (*Est. $6 for 1 oz.). It contains 10 percent benzoyl peroxide, the strongest dosage available in an over-the-counter treatment. Experts warn, however, that this potent dosage can be especially drying and may cause mild irritation. That's why it's only recommended for spot treatment. User reviews at MakeupAlley.com and Acne.org also point this out, but most say that the dryness is a minor annoyance compared with the benefits Persa-Gel provides. Many say the gel clears up blemishes in as little as two to three days. Some even notice results overnight. Paula Begoun recommends Persa-Gel for the most stubborn cases of acne but suggests that users begin with a smaller dosage of benzoyl peroxide before moving up to something as strong as Persa-Gel 10. Some users say they experience less irritation when using the treatment every other night. Others say Persa-Gel 10 is a good spot treatment, best suited to those with occasional blemishes, rather than regular flare-ups that require consistent all-over treatment.
Salicylic acid is another proven acne treatment product that can penetrate the pores. It is a powerful exfoliant that can cut through the oil that is prevalent with many acne-prone individuals. It sloughs dead skin cells from the surface of the skin and from inside the pore walls. Because of its ability to clean out pores, many experts recommend salicylic acid for treating blackheads, but it is equally effective on all types of mild to moderate acne.
Marie Claire magazine recommends Patricia Wexler M.D Anti-Aging Acne Serum (*Est. $45 for 1 oz.) because it fights acne and fine lines at the same time. It contains 2 percent salicylic acid and several antioxidants. Paula Begoun, however, calls it "an expensive way to irritate skin." That's because the second ingredient in this serum is denatured alcohol, which is known to be drying and irritating. It also can strip the skin of essential oils, says Julyne Derrick, About.com's guide to beauty. Several users at MakeupAlley.com complain that the serum stung their skin and left it red and irritated.
For Paula Begoun, a major concern with salicylic acid treatments is that most of the products do not have the right concentration or pH balance for effectiveness. She says they should have a concentration of 1 to 2 percent and a pH between 3 and 4. We did not, however, find mention of this from any other expert. Nor is it easy to find products that meet this description because most companies do not list the pH balance of their products. As with any other acne product, it may take some trial and error to find the right match for your skin.
Neutrogena Oil-Free Acne Stress Control 3-in-1 Hydrating Acne Treatment (*Est. $7 for 2 oz.) is one product that meets Begoun's specifications for effectiveness. It has 2 percent salicylic acid with a pH of 3.4, according to Begoun. Many experts choose it as a favorite because it contains antioxidants as well as anti-irritants and is moisturizing as well. Experts at Shape magazine recommend it for normal skin types and say that it "sops up oil without overdrying." Users are also big fans of the 3-in-1 Hydrating Acne Treatment, with many of them raving that it is smooth and light and that it helps control redness. A handful of users complain that the treatment made breakouts worse, an effect that might be attributed to the silicone base used in the product. (Some people are allergic to silicone.)
Experts agree that the most effective regimen for mild to moderate acne is a combination of both benzoyl peroxide and salicylic acid products. Both products perform equally important functions in the fight against blemishes. As Stacy Colino of Real Simple magazine says, "A regimen that includes one product with salicylic acid and another with benzoyl peroxide offers a one-two punch against pimples."