Does Prescription Skin Care Really Work Better?
Sometimes prescription skin care products work better than over-the counter (OTC) skin care products, and sometimes they don’t – it depends. For example, 2.5 % benzoyl peroxide OTC FDA regulated “drug” will work better for acne than prescription topical antibiotic skin care drugs. That's because the acne causing bacteria C. acnes is resistant to antibiotics, but still sensitive to benzoyl peroxide.
Also, prescription tretinoin may be more effective than OTC retinol creams for anti-aging collagen formation. But we aren't sure. Rigorous studies were done on the original Retin-A formulation of tretinoin to prove efficacy, but not for retinol products because studies are expensive; also because OTC retinol is not a patentable pharmaceutical.
The same dilemma holds true for other ingredients like vitamin C and other antioxidants.
We won’t see good studies proving or disproving efficacy of many ingredients. This is due to the financial reality of study costs, especially for drug claims for ingredients and products that can’t protect with a patent. - Dermatologist Dr. Bailey
I've heard the cost to take a patented product through the FDA mandated study process to make a drug claim is at least 19 million dollars and possibly even billions! As a physician, I know there are good OTC skin care products, including cosmeceuticals, that can work to improve skin problems. Because of the cost to jump the FDA hoop, they won't be invested in and rigorously tested so that they can make an FDA approved 'drug claim'. Some of these are great products that belong in a robust skin care routine because they can 'fight', 'help', 'improve the appearance of' your skin problems without claiming to 'treat' them like a drug.
Results on your skin is what counts
To determine efficacy of a prescription or non-prescription product, I combine scientific knowledge, clinical experience and observation to decide if a product is of benefit.
- I use what I know about the physiology of the skin problem first.
- Then I look for sensible products and/or ingredients based on my understanding of the science.
- I try a product on myself.
- I then ask staff and interested patients to try them.
- We observe if the product seems to work based on physical exams and user feedback.
How research is done matters
Are research studies claiming to work on real live human skin or in a cell culture in a petri dish?
They are not the same! A really important aspect of product efficacy and claims is the difference between in-vitro results and product use claims.
Do the seemingly impressive in-vitro results (meaning in the laboratory, but not on a living organism) reported from a lab study really mean a product will work on your skin?
The answer most the time is nope! A solution of cells or chemical reactions swirling in a test tube does not compare to your skin.
Just because an ingredient does something miraculous in a test tube does not mean that the ingredient will work on your skin. - Dr. Bailey
Mixing the ingredient with others in a product formulation is one reason. The other is that your skin has a tenacious barrier and complex physiology. That's why I test products on enthusiastic people.
Does stronger prescription strength always mean better?
Another example of an ingredient that has OTC versus prescription variability is hydroquinone. We know the prescription strength of 4% and higher works better than OTC 2% strength for lightening hyperpigmentation. It is also more effective than the non-prescription botanical pigment lighteners.
But hydroquinone breaks down fast by a process called oxidation. A hydroquinone product with amber color is oxidized and doesn't work. That said, hydroquinone is the most effective pigment lightening ingredient. A good OTC hydroquinone product of 2% in a product that has not oxidized will work to help fix uneven skin hyperpigmentation. Rx strength is more effective but not if it has oxidized.
High potency AHAs started prescription and are now OTC
One of my favorite products and ingredients are the alpha hydroxy acids (AHA). I've been using them since the 1980's, on patients' skin and my own. AHAs are OTC, but the very first good product was a 12% lactic acid that was prescription. That very same 12% lactic acid cream is now available nonprescription.
AHA products are widely available in many different forms. Efficacy varies based on the AHA (there are different types) and the strength and pH of the product. This means formulation of a product matters. AHAs that work well must be formulated by good cosmetic chemists to an acidic pH, and free acid content of over 10%. All of my glycolic acid products are formulated this way; they are stronger and more effective than the original AHA lactic acid product that was prescription.
AHAs are a work horse ingredient for non-prescription anti-aging skin care, clogged pores, and acne. They can even be used as body lotions to keep the large surface area of skin on your body soft, supple and young. Trust me on this - my 63-year-old skin would look very different without AHAs! When you build your complete skin care routine, there are so many considerations to take into account.
OTC dandruff shampoos can work as well as prescription ones
Pyrithione zinc and selenium sulfide shampoos are trusted, effective OTC dandruff shampoos. Rx options include Loprox. Ketoconazole started prescription and now it is also OTC.
Interestingly, when a product is prescription, the primary source of money for the purchase comes from one's medical insurance company. The consumer pays the cost a product is not covered in their plan or they have not met their deductible. They also pay a portion of the cost as a co-pay. When a product is non-prescription, the consumer always pays out of their pocket.
Price matters when deciding prescription versus non-prescription skin care products.
Do you have easy access to a dermatologist for prescription skin care? Do you have good insurance coverage for prescriptions? What is your overall skin care budget? Prescription prices have soared out of reach for many, even with health insurance. Practicing dermatology for 35 years and studying skin care science obsessively, I know which OTC products will get results. My goal is to help my readers build their own targeted and scientifically correct Complete Skin Care Routine to reach their goals, fit their budget, and use the best OTC skin care products to accomplish it.