Millions of Dollars have gone in to the development of skin care products to treat acne. We discuss the effectiveness of most in this list.

OVER-THE–COUNTER SKIN-CARE PRODUCTS

Soap and water. Gentle cleansing of the skin with soap and water, no more than two or three times a day, removes excess oils (sebum) and may alleviate the "oily skin" appearance often associated with acne. There is no evidence that cleansing with soap and water prevents or clears up acne. Hard scrubbing, excessive cleansing (more than three times a day), or the use of harsh soaps or detergents may injure the skin and cause other skin problems in addition to acne.

Benzoyl peroxide. A mainstay of over-the-counter acne treatment, and a medication commonly prescribed by physicians to treat mild forms of acne. Benzoyl peroxide has been used in acne treatment for several decades; it was the first agent to be proven effective in the treatment of mild acne. The anti-acne effects of benzoyl peroxide are believed to be anti-bacterial with an accompanying decrease in some constituents of sebum. Benzoyl peroxide is available over-the-counter in a lotion or a gel. Its principal side effect is to cause excessive dryness of the skin. Benzoyl peroxide can bleach hair and fabric, including sheets, towels and clothing, so care should be taken when applying it. An old shirt should be worn when benzoyl peroxide is applied to the back or chest overnight.

Salicylic acid.On the skin, salicylic acid helps to correct the abnormal shedding of cells. For milder acne, salicylic acid helps unclog pores to resolve and prevent lesions. It does not have any effect on sebum production or P. acnes, It must be used continuously, just like benzoyl peroxide, since its effects stop when you stop using it–pores clog up again and the acne returns. Salicylic acid is available in many acne products, including lotions, creams and pads.

Sulfur An acne treatment in use for 50 years or longer. In combination with other agents—e.g., alcohol, salicylic acid, and resorcinol—sulfur is still a constituent of some of the most heavily marketed over-the-counter medications. Sulfur is less frequently used by itself as an acne treatment due to its unpleasant odor. Although long used in treatment of acne, it is not known how sulfur acts on the skin to influence the development of acne.

Sulfurated lime An older medication for treatment of various skin diseases and scabies. Sulfurated lime probably characterizes the medications that were the best available in past decades.

Resorcinol Together with sulfur, a constituent of popular over-the-counter acne medications. Resorcinol is less frequently used alone in treatment of acne.

Alcohol and acetone Acetone is a "degreasing" agent, and alcohol has a mild anti-bacterial activity. The two agents have been sometimes combined in over-the-counter medication. However, when acetone is used alone, it may have no effect in the treatment of acne.

Herbal, organic and "natural" medications Over-the-counter products called "herbal," "organic" or "natural" are marketed as acne treatments but their effectiveness has rarely been tested in clinical trials. The value of such treatments is generally unknown.

PHYSICAL THERAPIES

Comedo extraction Extraction of comedones should be performed only by a dermatologist, under sterile conditions, and usually only when comedones have not responded to other treatment. Acne patients should not attempt to extract comedones by squeezing or picking.

Ultraviolet light therapy Ultraviolet light has not been proven effective as an acne treatment. At most, skin tanning may mask acne. However, skin tanning increases risk for other, more serious skin conditions such as melanoma and other skin cancers.

Light Chemical Peels. Glycolic acid and other chemical agents are applied by a dermatologist to loosen blackheads and decrease acne papules.

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