The over-the-counter (OTC) acne treatment landscape is increasing exponentially, and many novel treatments such as topical probiotics, blue light masks, and concentrated oxygen therapies are gaining attention and traction among patients.
Do these therapies really work?
Can they cause harm?
To find out, researchers culled the medical literature to evaluate the efficacy and safety profiles of 27 established and emerging OTC acne treatments. Their findings appear in the Journal of Integrative Dermatology.
The gist? A few ingredients used in OTC acne treatments have either received U.S. Food and Drug Administration (FDA) approval or are recognized under the FDA’s monograph system, but the majority have limited or no high-quality clinical evidence supporting their use.
Here’s a snapshot of some of the findings:
Probiotics
Topical probiotics may help restore skin microbiome balance, suppress C. acnes overgrowth, and reduce inflammation. There are many of these available OTC, but none are FDA-approved for acne.
Potential risks may include allergic reactions, antibiotic resistance gene transfer, and—though rare—bacteremia, particularly in immunocompromised individuals.
Apple Cider Vinegar
Apple cider vinegar (ACV) is a popular home remedy for acne, but it lacks clinical trials supporting its efficacy in acne. In addition, its acidic nature poses risk for chemical burns, and ACV can also enhance the leaching of nickel from metal containers, potentially leading to contact dermatitis in nickel-sensitive individuals.
Cannabidiol
Cannabidiol (CBD) modulates the activity of sebaceous glands, decreasing sebum production and limiting the proliferation of C. acnes. Standardized concentrations are lacking across OTC products. Despite increasing commercial availability in OTC skincare, topical CBD is not FDA-approved for acne treatment.
Kaolin and Bentonite Clay Facial Masks and Cleansers
Kaolin and bentonite clay facial masks and cleansers are generally well-tolerated and can be helpful adjuncts for acne therapy, the study found. Clinical studies have demonstrated that masks containing these clays can significantly reduce sebum production, decrease the number of open and closed comedones, and improve overall skin texture, the study authors report. Potential adverse effects may include skin dryness and irritation.
Blue Light Therapy
Blue light therapy targets C. acnes. The FDA has approved light-emitting diode (LED) devices (blue, red, and combination light devices) for at-home use. Potential side effects include skin irritation, redness, dryness, and possibly hyperpigmentation.
Hydrocolloid Patches
These patches are widely available and are generally recognized as safe, but they are not specifically approved by the FDA for acne treatment.
Oxygen Therapy
Oxygen therapy for acne may be administered in medical spas. While adverse effects are rare and generally unreported, its clinical efficacy remains under investigation, and it has not received FDA approval specifically for acne treatment.
“The sheer number of potential treatments is remarkable, and somewhat overwhelming. One of the most important things to consider, however, is that just because there may be evidence that an ingredient can be helpful for acne, doesn’t mean that a particular preparation or product will actually work,” says Peter A. Lio, MD, a Clinical Assistant Professor of Dermatology and Pediatrics at Northwestern University Feinberg School of Medicine and a partner at Medical Dermatology Associates of Chicago in Chicago, IL. “The concentration, stability, and overall formulation all play a critical role in determining success or failure. Lacking trial data, we often fall upon experience and patient reports about individual products.”
