Dr. Pimple Popper's Perspective: OTC vs. Prescription Skincare

Trying to figure out whether your skin concern can be solved by a simple trip to the store — or whether you need to skip straight to the dermatologist for a prescription — can be confusing. We’ve talked about the difference between over the counter and prescription skincare before, but we wanted to get more insight.

So we went right to the source: as a board-certified dermatologist who also has her own skincare line, Dr. Sandra Lee (aka Dr. Pimple Popper) is exceptionally qualified to shed light on the subject. Here, she offers her personal perspective on over the counter vs. prescription skincare.

Dermatologist Dr. Sandra Lee aka Dr. Pimple Popper uses over the counter and prescription skincare

6 minute read

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What’s the difference between prescription and over the counter skincare ingredients?

This really comes down to two things: which ingredient we’re talking about, and how strong it is. Some ingredients are available over the counter, which just means that the FDA — the government agency that regulates food and drugs in this country, has determined that an ingredient is safe enough for a person to use without seeing a doctor for it.

A prescription product or ingredient, on the other hand, is one that requires a doctor’s supervision — because the condition we’re treating needs a doctor’s attention, and maybe the remedy has potential side effects we need to keep an eye on. A common situation would be when we prescribe antibiotics for something like a staph infection, which needs to be monitored.

The second part of the equation is the strength, or concentration, of a particular ingredient. In some cases, you can buy weaker versions over the counter, and the stronger versions need a prescription. This makes sense, because when you’re using a very high concentration of an acid, for example, you can really damage your skin if you don’t have medical training.

Are over the counter products FDA approved?

Many people have this misconception that the FDA is regulating and approving all the products we buy. While sometimes that’s true — in the case of certain brand-name drugs, for example — most of the time they’re just evaluating the ingredients that go into those products, giving a ruling and issuing guidelines about how they should be used and labeled.

It’s kind of confusing, but this is how it works whether we’re talking about prescription or over-the-counter products. Retinoids are a good example: you can get the strongest version, called tretinoin, by prescription only. It’s available as a generic version, but many people still call it Retin-A, because that was the brand name given to a specific tretinoin product that was really popular. Over the counter, you can buy retinol, which isn’t as strong, but still works quite well.

Are prescription products better than over the counter ones?

People get hung up on this, but here’s the truth: prescription products aren’t necessarily better — remember they’re either stronger, or they’re used for conditions that need medical attention (oftentimes, both). If you’re dealing with a condition that you know doesn’t require a visit to the dermatologist — dry skin, or some mild acne, for example — starting with over the counter products is the way to go.

The reason for this is that we really don’t want to overtreat a problem. Your skin is an incredible organ: it’s tough enough to protect us from all sorts of dangers in our environment, but it’s actually operating in a very intricate balance. So if we use a product or an ingredient that’s too strong for what we need, we run the risk of upsetting that balance and possibly doing more harm than good.

No matter whether you’re one of my patients, or someone searching online for skincare, my advice is the same: start with the lowest concentration of active ingredients recommended for your skin concern. Now you have to be patient — it can take a few months to see results when you’re dealing with something like mild to moderate acne, or hyperpigmentation.

On the other hand, if you’ve got something like a spreading rash, or cystic acne that could scar, then you want to get into your dermatologist’s office to take care of it. Maybe you’ll need a prescription, maybe you won’t, but only a doctor will know.

What are some of your favorite active ingredients for skincare?

As a dermatologist there are a handful of ingredients that I use to manage common skin concerns, like acne, bumps like keratosis pilaris, and more acute conditions like infections and rashes. Many of these are available without a prescription.

ACNE

To manage both inflammatory and non-inflammatory acne, I recommend a combination of salicylic acid, benzoyl peroxide (or sulfur if you have sensitive skin) and retinol. Those are all available over the counter, and you can get them together as part of my SLMD Acne System and Body Acne System, which are designed to work in tandem so you don’t have to worry about whether the products and concentrations work well together.

If you’ve followed a routine for at least three months and you don’t see any results, then it’s time to visit your dermatologist. We can prescribe oral or topical antibiotics, retinoids, or higher concentrations of benzoyl peroxide.

WELL AGING

If you’re trying to reduce the signs of premature aging, ingredients like retinol and antioxidants like vitamin C are all backed by years of scientific research — and available in non-prescription strengths. I recommend my SLMD Retinol Serum (or Dream On if you’re looking for something more moisturizing), Dark Spot Fix, and Bright Future Vitamin C Serum. And don’t overlook the eyes — this area is very delicate and often shows the first signs of aging. My Night Light Retinol Eye Cream also has caffeine and hyaluronic acid.

If you’ve got melasma or stubborn sun spots, we can try higher prescription strengths of certain topicals. For wrinkling and textural issues, in the office we can use chemical peels with stronger concentrations of alpha hydroxy acids.

DRY SKIN/KP/IRRITATION

If you’ve got super dry skin, try using colloidal oatmeal — that’s a clinically-proven ingredient made from oats, in my SLMD Body Seal. For keratosis pilaris, glycolic acid is my go-to, which you can find in my Body Smoothing System. It’s a powerful exfoliant that we use in higher concentrations when we do chemical peels in the office.

One thing that I always recommend people have in their medicine cabinets is an over-the-counter strength hydrocortisone cream. It really helps to reduce inflammation and manage the itch from bug bites, rashes, even razor burn. It’s not something that you want to use long term, so if your condition doesn’t clear up in a week, call your dermatologist.

Can you get prescription skincare without seeing a dermatologist?

I know there’s definitely some of this going on: people are buying prescription-strength products like tretinoin and hydroquinone from websites without ever really speaking to a doctor. While some of these sites do require a provider questionnaire, there’s just no substitute for visiting a dermatologist who takes the time to get to know you.

Please, do not purchase things like high concentration skincare, chemical peels and other risky DIY dermatology products online. The same goes for using someone else’s prescription skincare — you could end up doing more harm than good, especially if you’ve misdiagnosed your condition on Google.

If you’re trying to manage a skin concern, start with a high-quality product from the store, and give it a chance. If your problem gets worse, or doesn’t change over time, call your dermatologist for help.

—Dr. Sandra Lee

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