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Does Prescription Skin Care Really Work Better?

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 “drug” will work better for acne than prescription topical antibiotic skin care drugs. That's because the acne causing bacteria p. 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. It also may be more effective in lowering the malignant transformation of sun damaged skin cells into precancerous and cancerous growths. 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 anti-oxidants. 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 you can’t protect by patent. I've heard the cost to take a patented product through the FDA mandated study process to make a drug claim is at least 9 million dollars! It may even be much more. 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 rigorously tested and so can't make the claims. Some of these are great products that belong in a robust skin care routine aimed to fix your skin problems.


To determine efficacy, 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. Another really important aspect of product efficacy and claims is the difference between in-vitro results and product use claims. Does the fancy in-vitro (meaning in the laboratory, but not on a living organism) results seen in a lab 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. 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. Another example of an ingredient that has OTC versus prescription variability is hydroquinone. We know its 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. Hydroquinone breaks down fast too. A hydroquinone product with amber color is broken down. That said, hydroquinone is the most effective pigment lightening ingredient. good OTC hydroquinone product of 2% will work to help fix uneven skin hyperpigmentation. Rx strength is more effective though.


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%. In this form, expect a product to sting and irritate. It is why I have a lot of information on my AHA product pages to teach patients to use and trouble shoot their AHA products. There are still risks involved. 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 almost 60 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. Do you have easy access to a dermatologist for prescription skin care? What is your budget? Prescription prices have soared out of reach for many, even with health insurance. Practicing dermatology for 30 years and studying skin care science obsessively, I know what OTC products will get results. My goal is to help my readers build their own complete skin care routine that reaches their goals, fits their budget, and uses the best OTC skin care products.