Is Your Over-the-Counter Treatment for Acne Really Safe?

Is Your Over-the-Counter Treatment for Acne Really Safe?

In part I of a discussion on safety of acne treatments, we discussed how when we find ourselves suddenly experiencing acne breakouts, or when we suffer a long battle with acne and nothing seems to help, we may be willing to take any prescription acne treatment our doctor prescribes.

We may also reach for the first over-the-counter treatment we lay our eyes on or just look for what seems "the strongest." Again, what we often forget about is to consider both short-term and long-term health  consequences. Whatever the choice is, it will affect not only our skin but our entire system. So become an educated consumer!

Read on to learn more about your over-the-counter acne treatment and whether or not it's safe for you to keep using. And if you're using prescription acne treatments, don't forget to check out part 1 of this discussion.


Why We Use Them: Phytoestrogens are nature-made chemicals that can mimic the action of a woman's sex hormone, estrogen. It is important to note that there are 3 sex hormones produced in the human body by both women and men: estrogen, testosterone (androgens) and progesterone. Obviously they are produced in different amounts, with higher levels of androgens circulating in men. Phytoestrogens can be friends to our skin and body or, if inappropriately used, may be a foe.

Common Products: 

Phytoestrogens can be found in food, herbs, and in pills or capsules. The following foods are rich in phytoestrogens:

  • Whole grains (rye, oats, barley, millet, rice, wheat, corn), edible seeds (buckwheat, sesame, sunflower, pumpkin, amaranth, quinoa), beans (yellow split peas, black turtle beans, baby limas, Anasazi beans, red kidney beans, red lentils, soy beans), leafy greens and seaweed (parsley, nettle, kelp, cabbage, broccoli, kale, collards, lamb's quarter).
  • Fruits (olives, cherries, grapes, apples, pears, peaches, plums, strawberries, blackberries, raspberries, salmon berries, apricots, crab apples, quinces, rosehips, blueberries), olive oil and seed oils, garlic, onions and their relatives leeks, chives, scallions, ramps and shallots.

You may rightfully assume that you may safely eat more phytoestrogens-containing foods and restrict your intake of phytoestrogens to dietary intake; however, caution needs to be taken to avoid consumption of phytoestrogens that are isolated and concentrated, sold in pills or as part of other products. Use of excessive amounts of phytoestrogens changes the equation from protection to potential side effects such as promoting cancer or other health problems.

For Women Only: Various analogs of estrogen are used in oral contraceptives (OCs) to prevent pregnancy and during menopause. OCs are also prescribed by doctors as an "off-label" acne treatment (not approved by the FDA for this indication). The potential benefits of estrogen needs to be balanced by the fact that higher exposure to estrogens over a prolonged period of time is linked to increased breast cancer risk and other potential health concerns.

Be Aware:

  • For Women Only: Isolated, concentrated phytoestrogens and enriched forms of phytoestrogens in pills or capsules may carry the same dangers as regular estrogens and are not helpful in treating acne.
  • It is important to note that phytoestrogenic food-like herbs and concentrated phytoestrogens may have different effects on women who do not have ovaries.
  • Concentrated phytoestrogens may affect men similarly to estrogens and may carry, in addition to cancer, the danger of erectile dysfunction, low sperm count and low libido.
  • For more information to help you decide whether using phytoestrogen-containing foods or other products containing concentrated or extracted phytoestrogens is right for you, check out our article on phytoestrogens.

Over-The-Counter Topicals

Why We Use Them: Prescription and over-the-counter topicals do not treat acne, but rather try to address the outward manifestation of acne (the pimples themselves). Most topicals are relatively inexpensive and easy to find at the local drug store. They are also heavily advertised, which makes them more widely used without actual consideration of their efficacy and safety.

Many people mistakenly believe that they can treat their acne using only a topical cream, gel, cleanser, etc. Unfortunately it is a myth. Acne is an internal problem and therefore can only be treated from inside.   

Common Products:

  • Almost all over-the-counter acne products contain salicylic acid  and several often carry a "natural ingredients" claim. Salicylic acid is put in cleansers, tonics, pads and gels and included in  brands such as Aveeno, Neutrogena, or ProActiv. Its major role is to kill or limit the bacteria that cause inflammation in sebum-stuffed pores and it must be used several time daily.
  • Benzoyl peroxide, which is actually used as a first-aid product to disinfect (kill bacteria) that may infect minor wounds and scrapes, is also considered the most effective topical agent to kill acne bacteria and is available over-the-counter in preparations of 2.5% to 10% strengths. Common brand names include Clearasil Maximum Strength Cream, Clean and Clear, and Oxy-10 Balance Maximum Medicated Face Wash. These are available in lotion, gel, and cleanser forms, and must be used several times daily in order to be effective.

Be Aware:

  • Salicylic acid may dry the skin, causing irritation and redness. It may prematurely age the skin, and recently it was added to a warning list as possibly unsafe for pregnant or soon-to-be-pregnant women, as well as young teens. It also requires a strong sun protection to avoid burns and possibly skin cancer.
  • Benzoyl peroxide can cause premature skin aging, slow healing, and is associated with increased skin cancer risks. In 1995, the FDA issued warnings regarding the use of benzoyl peroxide and changed its status from "safe" to "uncertain."
  • Topical agents do NOT affect sebaceous glands but only target existing acne and do nothing to prevent acne from forming.

Many people end up coming to us after they've tried everything and want a safe and natural treatment that breaks the acne cycle.  We hope you're one of the many that do the same!

With a Promise of Clear Skin,
Dr. A 

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