Over-the-Counter Treatments

Azelaic Acid

  • Anti-inflammatory: Azelaic acid has anti-inflammatory properties, which help to reduce redness, swelling, and inflammation associated with acne lesions. This makes it particularly effective for treating inflammatory acne, such as papules and pustules. Inflammation is associated with various scalp conditions that may affect hair follicle health and growth.
  • Antibacterial: Azelaic acid also has mild antibacterial properties, which can help to reduce the population of acne-causing bacteria (such as Propionibacterium acnes) on the skin. By targeting these bacteria, azelaic acid helps to prevent new acne lesions from forming.
  • Unclogging Pores: Azelaic acid has a comedolytic effect, meaning it helps to unclog pores and prevent the formation of comedones (whiteheads and blackheads). It achieves this by normalizing the shedding of skin cells and preventing the accumulation of keratin within hair follicles.
  • Hyperpigmentation: In addition to treating acne, azelaic acid is effective in reducing post-inflammatory hyperpigmentation (PIH) associated with acne scars. It helps to lighten dark spots and even out skin tone over time.
  • Well-Tolerated: Azelaic acid is generally well-tolerated by most skin types, including sensitive skin. It is less likely to cause irritation compared to other acne treatments like benzoyl peroxide or retinoids.
  • Maintenance Therapy: Azelaic acid can be used as a maintenance therapy to prevent acne flare-ups after the initial treatment phase. It helps to maintain clear skin and reduce the recurrence of acne lesions.
  • Even Skin Tone: Azelaic acid can fade hyperpigmentation and dark spots caused by aging, sun damage, or inflammation. By promoting a more even skin tone, it can give the appearance of smoother and younger-looking skin.
  • Improving Skin Texture: Regular use of azelaic acid can help refine skin texture, making it smoother and softer. This improvement in texture can reduce the visibility of fine lines and wrinkles.

 Benzoyl Peroxide 

  • Antibacterial Action: Benzoyl peroxide effectively kills acne-causing bacteria on the skin, primarily Propionibacterium acnes (P. acnes). These bacteria thrive in clogged pores and contribute to the formation of acne lesions. By reducing the population of P. acnes, benzoyl peroxide helps to decrease inflammation and prevent new acne lesions from forming.
  • Exfoliation: Benzoyl peroxide has keratolytic properties, meaning it helps to break down keratin (a protein found in the skin) and remove dead skin cells. This action helps to unclog pores, preventing the buildup of debris and reducing the formation of comedones (whiteheads and blackheads).
  • Reduction of Sebum Production: Benzoyl peroxide can also reduce the production of sebum (skin oil) by the sebaceous glands. Excess sebum contributes to the development of acne by clogging pores and providing an ideal environment for bacterial growth. By reducing sebum production, benzoyl peroxide helps to prevent the formation of acne lesions.
  • Anti-inflammatory Properties: In addition to its antibacterial effects, benzoyl peroxide has mild anti-inflammatory properties. It helps to reduce redness and swelling associated with inflammatory acne lesions, such as papules and pustules.
  • Prevention of Resistance: Unlike antibiotics, which can lead to bacterial resistance over time, benzoyl peroxide has not been associated with bacterial resistance. This makes it a valuable treatment option for long-term acne management.

Topical Antibiotics (Clindamycin and Dapsone)

Uses & Benefits

  • Acne Treatment: Topical antibiotics are effective in treating acne vulgaris, particularly inflammatory acne. It works by inhibiting the growth of acne-causing bacteria on the skin, such as Propionibacterium acnes.
  • Reduction of Inflammation: Antibiotics have anti-inflammatory properties that help reduce the redness, swelling, and tenderness associated with inflammatory acne lesions.
  • Complementary Therapy: It is often used in combination with other acne treatments, such as benzoyl peroxide or topical retinoids, to enhance effectiveness and reduce the development of antibiotic resistance.
  • Ease of Use: Topical antibiotics are generally well-tolerated and easy to apply directly to affected areas of the skin.
  • Minimal Systemic Absorption: Since it is applied topically, systemic absorption of antibiotics is minimal, which helps reduce the risk of systemic side effects often associated with oral antibiotics.
  • Prevention of Acne Flare-ups: Continuous use of topical antibiotics can help prevent new acne lesions from forming and keep existing acne under control.

Considerations 

Topical antibiotics should be used as directed by a healthcare provider, and it may take several weeks to see noticeable improvement in acne symptoms. It is typically recommended for mild to moderate acne, and severe cases may require additional or different treatments.

It's important to note that like any medication, topical antibiotics may cause side effects such as skin dryness, irritation, itching, or a mild burning sensation at the application site. These side effects are usually mild and temporary. Rarely, allergic reactions can occur, characterized by rash, itching, swelling, dizziness, or difficulty breathing, which require immediate medical attention

Spironolactone (a.k.a. Aldactone)

Uses & Benefits

  • Anti-Androgenic Effects: Spironolactone has anti-androgenic properties, meaning it can block the effects of androgens (male hormones) in the body. Androgens, such as testosterone, can stimulate the sebaceous glands in the skin to produce more oil (sebum). Excess sebum production can contribute to the development of acne by clogging pores and promoting bacterial growth. By reducing androgen activity, spironolactone helps to decrease sebum production and thus reduce acne lesions.
  • Hormonal Acne: Acne in women, especially adult women, is often influenced by hormonal factors. Conditions such as polycystic ovary syndrome (PCOS) can lead to hormonal imbalances that exacerbate acne. Spironolactone can be particularly effective in these cases by targeting the underlying hormonal cause of acne.
  • Reduction in Sebum Production: By lowering androgen levels and activity, spironolactone can lead to a decrease in sebum production. This helps to prevent clogged pores and reduces the occurrence of whiteheads and blackheads.
  • Complementary Therapy: Spironolactone is often used in combination with other acne treatments, such as topical retinoids or oral contraceptives, to achieve better control over acne symptoms.
  • Long-Term Management: Spironolactone can be used as a long-term maintenance therapy for acne, particularly for women who have not responded well to other treatments or who have hormonal acne that persists into adulthood.

It's important to note that spironolactone is typically prescribed off-label for acne treatment, meaning it is used for a purpose not specifically approved by regulatory authorities (like the FDA in the United States) but based on clinical evidence and physician experience. As with any medication, spironolactone may have potential side effects and considerations, so its use should be supervised and monitored by a healthcare provider, especially when used for acne.