Efficacy and Consumer Perception of Topical Over-the-Counter Regimens Involving Beta-Hydroxy Acid for Acne Vulgaris

February 2025 | Volume 24 | Issue 2 | 162 | Copyright © February 2025


Published online January 27, 2025

doi:10.36849/JDD.8502T1

Neal Bhatia MDa, Angela Donald NDb, Kavita Mariwalla MDc

aDirector of Clinical Dermatology, Therapeutics Clinical Research, San Diego, CA
bDirector of Education, Phase 2 Phase Strategy, Halifax, Nova Scotia, Canada
cMariwalla Dermatology, West Islip, New York

Abstract
The use of alpha-hydroxy acids (AHAs) and beta-hydroxy acids (BHAs) for acne treatment and their integration into daily skincare routines for better cosmetic outcomes has increasingly become a norm, particularly in light of steep insurance deductibles and restricted access to prescription options. This article presents an analysis from a single-center, open-label study with 20 participants conducted to evaluate if an over-the-counter (OTC) barrier-restoring cream gel can alleviate the adverse skin reactions caused by a conventional dermatologist-recommended acne treatment plan in individuals with mild to moderate acne over 6 weeks. This evaluation encompassed both objective clinical assessments of facial skin health and subjective reports of product tolerability, complemented by before-and-after images and questionnaires to capture consumer feedback on the OTC moisturizer as well as an OTC salicylic acid-containing cleanser and spot treatment.

J Drugs Dermatol. 2025;24(2):162-166. doi:10.36849/JDD.8502T1

INTRODUCTION

Acne, a widespread chronic inflammatory condition targeting the pilosebaceous units, stands as the most common skin disorder in the United States, affecting around 50 million Americans.1 The management of acne involves a combination of over-the-counter (OTC) and prescription medications, advocating for a multi-pronged approach that targets various aspects of acne development. Such combination therapy is advised for most patients due to its effectiveness.2,3

Despite their effectiveness, these treatments come with drawbacks, such as the potential to cause dryness, irritation, burning, stinging, and erythema, all of which could considerably deter patients from adhering to their prescribed treatment plans.2,4 Indeed, studies show that only half of the patients stick to their acne therapy routines,5 and the rising issue of bacterial resistance further complicates the long-term success of traditional acne medications.6

This scenario underscores the urgent need for effective, adjunctive OTC products that complement standard acne treatments, especially as access to prescription options becomes more restricted due to high insurance co-pays and limited coverage. The importance of such products is magnified by traditional treatments' propensity to compromise the skin barrier, causing increased water loss and inflammation.7 Adopting a skincare routine that includes a gentle, effective moisturizer from the treatment's start is recommended to alleviate the drying and irritation often associated with acne treatments, thereby preserving the skin barrier and improving the treatment journey.8

Despite the crucial role of moisturizers, it's concerning that nearly 90% of the best-selling OTC moisturizers contain allergens,9 highlighting a significant concern for consumers. Moreover, the influx of new products, partly fueled by social media influencers10,11 and a shift towards non-physician clinics,12 has eroded trust in existing acne solutions. Many products feature ingredients with questionable efficacy,13 leaving consumers seeking dependable, tolerable, and effective treatments.

This situation, coupled with the growing preference for OTC acne solutions due to their convenience and cost-effectiveness,13 underscores the necessity for new products to establish a strong reputation grounded in clinical proof and patient feedback.

This study aimed to evaluate if the use of an OTC anti-inflammatory moisturizer (Skinfix Barrier+ Skin Barrier Restoring Gel Cream) could alleviate the adverse skin reactions from a standard dermatologist-recommended acne treatment over 6 weeks in individuals with mild to moderate acne. It also examined the role of a salicylic acid-containing cleansing wash (Skinfix 2% BHA Cleanser) and spot treatment (Skinfix