Manage acne effectively with expert-recommended over-the-counter treatments like benzoyl peroxide (2.5–10%) and adapalene (0.1–0.3%), both proven to reduce inflammation, unclog pores, and prevent new breakouts. Salicylic acid (0.5–2%) and azelaic acid (10–20%) are also effective, especially for sensitive or darker skin, targeting inflammation, blackheads, and discoloration. For best results, use consistently for 12 weeks and consult a doctor for prescription options like antibiotics or stronger retinoids if needed.
January 15, 2025

Acne: Best Dermatologist-Recommended Affordable Treatments

Evidence-Based Over-The-Counter Guide

William Shen

William Shen

Co-founder & CPO

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This guide is based on the 2024 evidence-based guidelines published by the American Academy of Dermatology. Recommendations are for the management of acne vulgaris in adults, adolescents, and preadolescents (≥9 years).

Topical treatments are used to treat all stages of acne. There are only 4 types of dermatologist-recommended over-the-counter products for acne, all listed below. These form the active agents in all “celebrity-endorsed” expensive non-prescription creams. Assess efficacy of treatment after consistent use for 12 weeks unless you experience worsened symptoms or intolerable skin side effects:

Dermatologist’s strongest recommendations:

  • Benzoyl peroxide: Among the most inexpensive and effective acne therapies. Has anti-inflammatory, antimicrobial, and comedolytic effects. Dose: 2.5-10% topically 1-2 times daily as needed on spots or as a facewash. You can use a spot treatment like Persa-Gel 10 Oil-Free Acne Spot Treatment (FDA M006) or a facewash like PanOxyl Hydrating Acne Creamy Wash (FDA M006).

  • Adapalene: Prevents clogged pores, reduces inflammation, and decreases the formation of pimples, whiteheads, and blackheads. Adapalene is a Vitamin A derivative with low systemic absorption and no evidence of teratogenic effects, hence is available OTC, but is not recommended for use while pregnant. Should be applied at night as it can cause photosensitivity. Dose: 0.1-0.3% once daily at bedtime. The FDA approved product is Differin Acne Treatment Gel (NDA 20380/S-010). 

Less certain recommendations:

  • Salicylic acid: 0.5-2% cream, gel, lotion, pad, or wash applied topically once daily. At least one randomized clinical trial (the gold standard for establishing clincial evidence) showed a 25% greater reduction in inflammatory lesions and 11% greater reduction in blackheads with use of a salicylic acid scrub at 12 weeks. We recommend Neutrogena Oil-Free Acne Wash Scrub (FDA M006).

  • Azelaic acid: 10-20% topical cream applied 1-2 times daily. May be particularly helpful for patients with sensitive skin or darker skin types due to its lightening effect on dyspigmentation. In 1 clinical study of 92 patients, 28% more patients receiving azelaic acid 20% cream twice daily achieved 50% to 100% reduction in total lesion count compared to vehicle at 3 months. The Ordinary Azelaic Acid Suspension 10%.

Prescription medications:

  • Vitamin A derivatives: prescription is needed as these medications can be highly teratogenic (harmful to fetuses) if ingested. No human studies have established causal relationships between the use of topical retinoids with birth defects. Adapalene is a Vitamin A derivative with low systemic absorption and no evidence of teratogenic effects, hence is available OTC.

  • Antibiotics (topical or oral): prescription is required as these medications can cause bacterial resistance if overused or misused. 

Citations:

Reynolds, R. V., Yeung, H., Cheng, C. E., Cook-Bolden, F., Desai, S. R., Druby, K. M., ... & Barbieri, J. S. (2024). Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology, 90(5), 1006-e1. doi: 10.1016/j.jaad.2023.12.017. Epub 2024 Jan 30. PMID: 38300170.

Eichenfield, D. Z., Sprague, J., & Eichenfield, L. F. (2021). Management of acne vulgaris: a review. Jama, 326(20), 2055-2067. doi: 10.1001/jama.2021.17633. PMID: 34812859.

Ogé, L. K., Broussard, A., & Marshall, M. D. (2019). Acne vulgaris: diagnosis and treatment. American family physician, 100(8), 475-484.

What OTC evidence is reviewed?

  • For each condition, we performed a literature review to find a recent widely cited expert group guideline published in the leading specialty-specific peer-reviewed journal or top general medical journal.

  • Based on the recommendations in the publication, we identify recommended active ingredients and devices that are available over-the-counter per FDA regulations.

What evidence is prioritized?

Levels of evidence considered:

  • Tier 1 (Safe and Definitely Effective): Professional field consensus or multiple randomized controlled clinical trials showing the same conclusion. Wherever possible, we use Tier 1 evidence for "first-line" recommendations.

  • Tier 2 (Safe and Probably Effective): Individual clinical trials which may be discordant or large-scale observational experience. Tier 2 evidence may inform "first-line", "second-line", or "supplement" recommendations.

  • Tier 3 (Safe and Maybe Effective): Mechanistic plausibility without high-quality clinical evidence of efficacy but high-quality evidence of safety. Tier 3 evidence may inform "second-line" or "supplement" recommendations.

How does MDandMe select recommended products?

  • Based on the top clinical recommendation, we evaluate products containing the recommended active agent with FDA-approved dosage based on price, average customer reviews, how often it is purchased, and how quickly it will ship to home. 

  • We provide public documentation of the active ingredients in our recommendations, using all 32 FDA monographs, Prescription-to-Nonprescription (Rx-to-OTC) Switches, as well as New Drug Application (NDA) approvals.

How does MDandMe select recommended devices?

  • Based on the top clinical recommendation, we evaluate devices that are FDA-cleared or comply with other medical guidelines (if not a FDA-regulated category) by reputability, price, and average customer reviews.

  • We provide public documentation of supporting evidence for each device.  

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