34. Maxing Out - Maximal over-the-counter treatment regimens

Doctor Jacob here today, and we're talking about maxing out with maximal over-the-counter treatment regimens.

If you're looking to do things yourself and you're trying to avoid going to see the doctor, the dermatologist, this is a good place to start to get your idea of maximal what you can do.

Let's first talk about step one, which is avoid the acne exacerbators, and we have dozens of episodes of this show dedicated to telling you exactly what can exacerbate acne, and if you listen to those episodes you'll do a great job of avoiding the acne exacerbators.

Moving on, let's talk about what makes up the over-the-counter maximal treatment regimen. Benzoyl peroxide wash is a great component of any over-the-counter acne treatment regimen. I usually recommend to use it in the morning, and then combine it with an anti-acne sulfur soap mixed with salicylic acid in the evening. So twice a day cleansing for maximal strength.

If you're getting too dry, you may have to cut out the cleansing in the evening with sulfur soap and salicylic acid. As an optional step, you can add on a benzoyl peroxide leave-on product 2.5% strength in the morning. This leave-on product stays on all day. Be careful because it can bleach your clothes like any peroxide. So that's an optional step. If you're too sensitive, if you have eczema-prone skin or sensitive skin you'll probably want to skip the benzoyl peroxide leave-on gel.

Skipping back to night time, adding in a glycolic based toner at night, usually only on oily areas, is definitely a good component of any maximal strength over-the-counter therapy regimen. If you have acne on the chest or back, you can alternate using one day or one shower with a sulfur soap with salicylic acid like KAVI Coral on the chest, back and shoulders, and on the next day or the next shower you can use a benzoyl peroxide product. Of course, benzoyl peroxide can bleach your towel, so watch out if you choose to do that.

So that's cleansers, along with toner, and that can take you pretty far. For any maximal over-the-counter treatment regimen a retinol is a must. 1% retinol - and we have a link on our website - is maximal, but work up to it. Start at half a percent or even a quarter of a percent of the retinol and you can slowly by slowly, like we talked about in the topical retinoid episodes, work up to a higher strength to avoid irritant dermatitis, and that's especially true in patients with a darker skin type. You do not want to start at a maximal strength retinol, because you could hurt yourself.

***update: as of Jan 2017,
Differin (adapalene) 0.1% gel is the OTC retinoid of choice.

Finally there's adding on zinc or fish oils, especially for inflamed types of acne. Acne with deeper seated pimples, like zits or cysts. And then any acne regimen which is maximal might include a series of chemical peels. A series of peels every couple weeks done by a good aesthetician can really be a great addition for both inflamed, as well as non-inflamed, clogged pore acne, and it works pretty good. I wouldn't really suggest for very deep seated cystic acne because the peels won't get there, but for the face or even for the chest and back chemical peels, typically glycolic peels but sometimes others can do very well for yourself.

I don't recommend you do these at home. Don't try ordering any chemical peel supplies off of the internet and trying to do these, you can hurt yourself. You need to have a good aesthetician do the peels for you, and that way you can get the benefit but also be very safe.

So that's the over-the-counter maximal treatment regimen: cleansers in the morning, cleansers in the evening, potentially a leave-on benzoyl peroxide product all day long, and then retinol at bed time, maybe some zinc and fish oils for inflamed acne, and possibly, unless you have deep cystic acne, adding in some chemical peels done by a good aesthetician. If that is not doing it for you, you're going to need some prescription therapy.

I'm Doctor Jacob, we'll see you next time.