As a pharmacist, I’m often asked what works best for breakouts — and the truth is, a few over-the-counter ingredients outperform everything else. These topical actives have clinical backing and real-world results. Let’s break down what I actually recommend (and use) for clear skin.

How Topicals Work Against Acne

Acne forms when oil, bacteria, and dead skin cells clog pores. The ingredients below each target one or more causes of acne: inflammation, excess sebum, clogged pores, or bacterial overgrowth.

My Top OTC Acne Ingredients

Salicylic Acid (BHA)

Best for: Oily skin, blackheads, whiteheads
Mechanism: Exfoliates inside pores, dissolves debris, and reduces inflammation
Pharmacist tip: Start with a 2% formula 3x per week

Try these:

• CeraVe SA Cleanser

• Paula’s Choice BHA Liquid

Benzoyl Peroxide

Best for: Red, inflamed breakouts
Mechanism: Kills C. acnes bacteria and reduces swelling
Pharmacist tip: Choose 2.5–5% to reduce irritation

Try these:

• PanOxyl 4% Wash

• Clean & Clear Persa-Gel

Azelaic Acid

Best for: Acne + hyperpigmentation
Mechanism: Gently unclogs pores and fades dark spots
Pharmacist tip: Use consistently for at least 8–12 weeks

Try this:

• Paula's Choice BOOST 10% Azelaic Acid Booster Cream Gel

Niacinamide

Best for: Redness, oil control, skin repair
Mechanism: Balances sebum, reduces irritation, and strengthens barrier
Pharmacist tip: Pair with active ingredients to buffer irritation

Try this:

• SEONGLOW 15% Vegan Niacinamide+ 3% Tranexamic Acid Serum

Tips for Better Results

• Introduce new products one at a time (to track irritation or purging)

• Give ingredients 6–12 weeks for full results

• Use SPF every day, especially with acids or retinoids

• Keep your routine simple: cleanse, treat, moisturize

• Never mix strong actives unless advised by a professional

• Hormonal acne may also need internal support (covered in the next post)

Final Thoughts

Acne doesn’t need a 10-step routine. Stick to ingredients that are clinically proven, and your skin will thank you.