During the past few years, the skincare industry has seen a massive boom. It’s become nearly impossible to go online without encountering a sponsored post or an ad for the newest skincare innovation, and beauty companies are constantly launching new campaigns to keep up with skincare trends. Whether it’s in the form of jade rollers or charcoal-infused face masks, consumers are overwhelmed by an array of products that promise to cleanse impurities, unclog pores and, ultimately, lead to blemish-free skin, glowing skin.
While over-the-counter (OTC) skincare can be beneficial for people looking to maintain their already clear skin or to treat some mild acne, the products don’t usually benefit more severe cases. Despite what listicles, product descriptions, and beauty influencers might lead consumers to believe, not all acne can be fixed by a good skincare regimen or with luxe products. These products appear to offer a solution to an issue that is often framed as superficial or cosmetic rather than medical. As the skincare industry grows, we need to be more careful about drawing a line between skincare and healthcare. Otherwise, we run the risk of swaying people who need medical help away from getting it.
The mentality that any and all acne can be ousted with OTC products is a dangerous one—it can push consumers to spend money on products when what they really is medical help from a doctor or dermatologist. In severe cases, this wasted time and money leaves consumers with permanent scarring. I know this because I’ve experienced it personally.
Acne—which can be brought on by hormonal changes—sprouts up for a lot of people during puberty and several years after. When I developed cystic acne in college, I tried countless OTC products before turning to a doctor for prescription medication. I spent three expensive years cycling through every mask, serum, and toner that my friends, the internet and influencers recommended. But these were not small, cover-up friendly pimples—cystic acne starts deep under the skin and the bumps it causes are usually inflamed, tender, and painful. In the end, I was out hundreds of dollars and left with deep-set scars.
During those three years, every time I thought about turning to a doctor I convinced myself that I just hadn’t found the right product yet. I felt ashamed that my issue must be the result of a faulty skincare regimen rather than genetics and hormones. I would see another cystic acne before-and-after online or read a sponsored article and feel emboldened to continue my search for the holy-grail product that would fix my skin. Despite the fact that my cysts lasted weeks and caused me an immense amount of anxiety and physical pain, I persevered with OTC products, clinging to the hope that one of them would work.
When I finally went to the doctor, he took one look at the scars and cysts that dotted my face and frowned. “What took you so long to come in?” he asked. I was promptly prescribed an oral antibiotic and a topical cream and within a few months, my skin was almost completely clear.
It’s evident from the aggressive push from skincare marketing (and subsequent audience engagement online) that putting off a doctor’s visit in favor of an over-the-counter product is trending. Steven Daveluy, a Michigan-based dermatologist and associate professor at Wayne State University, said that many of his patients try to treat cystic acne on their own before seeking medical help. He reasons that, though OTC don’t usually make cystic acne any worse, they don’t help it either. This becomes problematic when consumers put off getting effective treatment, prolonging their painful symptoms and leading to scarring.
“Over-the-counter treatments can be effective for milder acne, but not cystic acne,” Daveluy said. He stressed that while OTC treatments can be effective for milder acne, people should turn to a board-certified dermatologist if they experience painful and swollen red bumps instead of smaller whiteheads or the like.
Despite what social media, sites about natural skincare, and advertising lead us to believe, cystic acne can rarely be fully treated by OTC products. Acne products often claim to work by clearing out pores and cleansing the skin’s impurities, and cystic acne can lay too deep beneath the skin for these products to target.
Cystic acne has the same root cause as other forms of acne: It begins as a clogged pore and leads to an overgrowth of bacteria under the skin’s surface (bacteria that live on top of your skin can get in and cause the blocked pore to swell). However, cystic acne differs in that it leads to severe inflammation, resulting in the characteristic redness and pain of a cyst. Though there’s no specific cause it's linked to or demographic that this form of acne targets, it’s often associated with hormonal fluctuations in women, said Melanie Palm, a San Diego-based dermatologist and the director of Art of Skin MD.
Palm believes that, in some cases, OTC products can be effective for mild cystic acne but generally, the products that work best are those that mimic treatments a dermatologist can provide (but with much weaker dosage). “Theoretically, if you had mild cystic acne that wasn’t causing significant scarring and you wanted to try something at home, you could start by using a benzoyl peroxide product in the morning, a retinoid in the form of Differin Gel, and you might try something like a glycolic or a salicylic acid wash,” she said.
While she encourages consumers to try out these OTC products, especially if they’re just noticing what could be cystic acne, Palm maintained that dermatologists provide the gold-standard in acne treatment through oral antibiotics, stronger topical medications, and even specialized in-house treatments like phototherapy (UV light is believed to help clear up acne in this treatment). Given that the scarring and hyperpigmentation left behind by cysts are hard to treat, she echoes the importance of going to a doctor if OTC products aren’t helping.
The responsibility to inform consumers about what OTC products can and can’t do doesn’t solely fall on skincare brands—in fact, most reputable skincare brands will never explicitly claim that their products can treat cystic acne. These claims usually come from media outlets and influencers. Though brands might advertise “stubborn acne” or “pore cleansing” products, the idea that OTC products can help cystic acne tends to come—by design—by “experts” outside the brand (and without a medical degree).
Take Neutrogena as an example. The brand’s Rapid Clear line is frequently named in listicles and articles as suitable for cystic acne. Though some of the articles start with a short disclaimer about the importance of seeing a dermatologist, they go on to list at-home remedies and OTC products anyways. When I reached out to Neutrogena for comment, a brand representative said that their products are solely intended for mild acne: “Cystic acne sufferers should always consult a doctor first for personalized treatment options. Because of the depth and inflammation involved, these deep blemishes can cause scarring, so they should be treated promptly.” The brand representative emphasized that as soon as cysts appear, a dermatologist should be consulted in lieu of OTC products.
The conversation surrounding skincare led me to believe that my issues could be solved with OTC products. It’s worth noting that I live in Canada, where prescription medication is more accessible than in the States. Even then, the mentality that OTC products could fix any acne was so ingrained in me that it took far too long to seek the help I needed.
Since my doctor’s visit a little under a year ago, my skin is infinitely better. The trendy serums and masks that used to crowd my medicine cabinet have been swapped out for simple face washes and prescribed topical creams—and while the packaging is far less attractive, my face is better off for it.
This article originally appeared on VICE US.