Over-the-counter spot treatments seem downright miraculous, claiming to zap zits in a matter of hours. As it turns out, that’s not how anything works—and if you break out all over your face, selectively treating a few spots is, at best a pretty inefficient strategy.
The spot treatment pitch seems credible enough: get a zit, apply an overnight spot treatment, and wake up the next morning zit-free and ready to party. In reality, of course, it’s way more complicated. Acne is influenced by everything from genetics to hormones to the types of skincare products you use, so I talked to some professionals to help sort it out.
If You’re Spot Treating, It’s Already Too Late
Cosmetic marketers love impressive-sounding statistics. Nowhere is this more obvious than in the marketing copy for acne treatments, nearly all of which claim to shrink pimples by an impossibly specific percentage, within a certain amount of time—or both. Only some bother to cite results from in-house “clinical studies” as proof.
Unsurprisingly, these studies deliberately omit a big piece of the puzzle: visible acne lesions are already nearing the end of their life cycle. If your job is to “prove” that a product heals a lesion that’s already mostly healed itself, you can easily cherry-pick data to back up that claim—especially if you’re not beholden to pesky things like rigorous experimental methodology, or knowing the difference between correlation and causation.
Spot treatments do not prevent acne from forming, so [they] don’t offer an effective, long-term treatment.
Between misleading marketing jargon, conflicting Internet anec-data, and a high barrier to proper medical care, it’s no wonder that lots of people have some backwards ideas about how acne treatments work. Here’s what Dr. Ivy Lee, a board-certified dermatologist practicing in Pasadena, CA, said when I asked her about common misconceptions about spot treatments:
The biggest misconception is that spot treatments can effectively treat acne on their own. Spot treatments are just that..they treat the spot that you apply it on, and often [don’t] even treat the spot effectively. Spot treatments do not prevent acne from forming, so [they] don’t offer an effective, long-term treatment.
Or, in the words of New Jersey dermatologist Dr. Rebecca Baxt: “By the time you need a spot treatment, the cat is out of the bag, so to speak.”
So spot treatments are a total scam, right? Technically, no. The ingredients in spot treatments are proven to reduce inflammation and kill acne bacteria, but they need weeks and months of consistent application over the entire affected area to work their magic. A few hours on one little spot won’t do much of anything. You can play Whack-A-Zit with spot treatments if you want, but a product designed for allover daily use is more likely to actually prevent breakouts. They probably have the same active ingredients, anyways.
What’s in a Spot Treatment?
Most over-the-counter acne treatments, from ointments to creams to cleansers, are formulated to address either the clogging or bacterial component of a zit. Their active ingredients usually fall into one of four categories:
Exfoliants like salicylic, glycolic, or azelaic acid, which work by dissolving pore-clogging clumps of dead skin cells;
Antibacterial agents, like benzoyl peroxide and sulfur, which treat inflammation by killing acne bacteria;
Retinoids like adapalene and retinol, which speed up the healing process—and unclog pores—by increasing cell turnover;
Steroids like hydrocortisone cream, which decrease inflammation.
Some ingredients do multiple things—sulfur and azelaic acid are both antibacterial and exfoliating—but because acne thrives on excess sebum, all of them will probably dry out your skin. Just keep an eye out for adverse reactions: according to Dr. Baxt, between five and ten percent of people are allergic to benzoyl peroxide. Mild redness and irritation is normal, but if you develop swelling, welts, rashes, or hives, stop using the product immediately.
The dermatologists I interviewed agreed that while all of the ingredients above are effective to some degree, exfoliants and/or retinoids work better on clogged pores, and inflamed zits respond best to benzoyl peroxide. Furthermore, no matter what the ad copy says, multiple active ingredients don’t make a formula more effective. As Dr. Lee puts it: “There is no robust evidence to support the use of combination products for spot treatment, [and] combination products may cause more irritation and dryness.” Orlando-based dermatologist Dr. Allison Arthur agrees, but notes one exception: a hydrocortisone ointment or cream can be layered on top of a spot treatment if needed. Overall, though, you’re better off not playing mixologist—or spending tons of money on “dual-action” products that mix actives.
The bottom line: spot treatments address the symptom, not the cause, of acne. A dab of benzoyl peroxide gel might clear up the occasional spot, but if you have recurring, widespread breakouts, a dermatologist is your best bet.