How do you select an OTC facial cleanser for acne patients?

Zoe Diana Draelos, MDIt is sometimes challenging to pick a facial cleanser for acne patients because skin irritation and dryness can be magnified by improper cleansing techniques.  Many prescription acne medications, such as benzoyl peroxide/clindamycin, adapalene, adapalene/benzoyl peroxide, tretinoin, tretinoin/clindamycin, and tazarotene, are damaging to the stratum corneum thus causing erythema, desquamation, and noxious sensory stimuli.  In order to increase the tolerability of these medications, it is important not to remove the intercellular lipids between the keratinocytes with aggressive detergents. 

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Cleansing should remove excess sebum, environmental dirt, cosmetics, bacteria, and other unwanted materials on the skin surface and leave the skin barrier intact. Unfortunately, detergents cannot tell the difference between intercellular lipids, oily environmental dirt, and sebum. All are removed without discrimination. This is where the problems arise in the acne patientMany medicated cleansers are available OTC that contain ingredients from the acne monograph, such as salicylic acid and benzoyl peroxide. While these ingredients are effective, they only contact the skin surface for a short period during the cleansing process. 

For patients who are experiencing irritation, better acne efficacy might be achieved by putting the irritating medication in the leave on product and making the cleanser a bland formulation. Liquid cleansers tend to rinse better than bar cleansers in young hands and may be preferred.  Most liquid cleansers are based on sodium lauryl sulfate or sodium laureth sulfate, which are excellent detergents for sebum removal.  Products that list sodium laureth sulfate as the first detergent are milder, however.  

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