OTC acne treatments compared: benzoyl peroxide vs salicylic acid vs adapalene vs azelaic acid vs sulfur

Which OTC acne treatment should I use?

Active	OTC strengths (US)	What it does	2024 AAD guideline	Best for	Watch out for
Benzoyl peroxide (BPO)	2.5–10%	Reduces acne bacteria; helps unclog pores	Strong recommendation	Red pimples, body acne; pairs well with adapalene	Bleaches fabric; dryness, irritation
Adapalene	0.1% gel	Retinoid: clears pores, prevents new comedones; can lighten dark spots	Strong (topical retinoids)	Blackheads, whiteheads, ongoing prevention	Early irritation; acne may seem worse at first; sun sensitivity
Salicylic acid	0.5–2%	Exfoliates and opens clogged pores	Conditional	Mild comedones, sensitive skin, body washes	Dryness; easy to double up by accident
Azelaic acid	Prescription 15–20%; lower-strength cosmetic products	Keeps pores clear, targets bacteria, calms inflammation, fades dark spots	Conditional	Acne plus dark marks or redness	Mild stinging or irritation
Sulfur	3–10%	Antibacterial, antifungal and exfoliating effects	Not among the guideline’s recommendations	Masks and spot treatments	Smell; dryness
Hypochlorous acid	Sold as cosmetic sprays and gels	Antimicrobial, anti-inflammatory (early research)	Not assessed	Not established for acne	Evidence is preliminary

Sources: 2024 AAD guidelines, FDA OTC acne monograph, AAD, DermNet.

The US strengths above come from the FDA’s acne monograph, which sets the legal OTC range for benzoyl peroxide, salicylic acid and sulfur. If an active is listed in the Drug Facts panel, the product is regulated as an acne drug. Adapalene 0.1% is a separately approved OTC drug.

Benzoyl peroxide

Benzoyl peroxide reduces acne-causing bacteria, and the AAD notes it’s usually paired with another treatment. The 2024 guidelines give it a strong recommendation.

• Strength: higher isn’t automatically better. For the back, the AAD says a 5.3% foam is less likely to irritate, with 10% the strongest OTC option.
• Washes need contact time. The AAD recommends leaving a BPO wash on the back for 2 to 5 minutes before rinsing. See body acne.
• It bleaches towels, sheets and clothes.
• Benzene: in March 2025 the FDA reported testing 95 benzoyl peroxide acne products. Six had elevated benzene and were recalled. The FDA said more than 90% had undetectable or extremely low levels, that the cancer risk is very low even with daily use for decades, and that consumers should throw away expired products.

Adapalene (retinoid)

Adapalene 0.1% gel was the first retinoid approved for OTC sale in the US, in 2016. The AAD says retinoids clear pores, treat blackheads, whiteheads and some pimples, and can lighten dark spots left after acne. Topical retinoids get a strong recommendation in the 2024 guidelines.

From the Drug Facts label: use once a day as a thin layer over the whole affected area; acne may seem to worsen in the early weeks before it improves; irritation usually lessens with continued use; limit sun and use sunscreen; for ages 12 and up.

Cosmetic retinol is related but isn’t regulated or tested as an acne drug. See our retinol page.

Salicylic acid

The AAD says salicylic acid opens clogged pores and exfoliates, and works best on whiteheads and pimples. It has a conditional recommendation in the 2024 guidelines. It’s in a huge number of cleansers, toners, pads and moisturisers, which makes it the easiest active to double up on without realising. See hidden actives. If you want it in a wash, CeraVe Renewing SA Cleanser is sold as fragrance free.

Azelaic acid

Azelaic acid keeps pores clear, targets bacteria, reduces inflammation and can fade dark spots (AAD). DermNet describes it as well tolerated by most people and useful for post-acne pigmentation, particularly in darker skin. Medical-strength products (a 20% cream, and a 15% gel approved in the US for rosacea) are prescription; cosmetic products contain it at lower strengths. It’s a good choice if you have acne and dark marks. Among cosmetic products we’ve checked, COSRX Azelaic Acid 10 B5 Redness Soothing Cream lists it at 10%.

Sulfur

Sulfur is an FDA-monograph acne active at 3–10%. A review in Cutis describes it as having keratolytic (exfoliating), antibacterial and antifungal effects. It’s mostly found in masks and spot treatments, such as Dermalogica Deep Acne Invisible Liquid Patch at 5%. It isn’t among the treatments the 2024 AAD guidelines recommend, so treat it as a mild extra rather than a first choice. Its antifungal effect is why it comes up for fungal acne, though we found no trials for that use.

Hypochlorous acid

Hypochlorous acid sprays are popular, but the evidence for acne is early:

• A 2026 perspective in Cutis says preliminary studies suggest lesion reductions comparable to benzoyl peroxide with better tolerability, pending larger controlled trials.
• A 2025 review found clinical reports across several skin conditions including acne, but said results aren’t entirely consistent and dosing needs more research.

It’s a reasonable, gentle extra if you like it, but not a proven acne treatment.

Skin Realist check: more products is not more treatment. The AAD says applying more medication than recommended doesn’t clear acne faster. One well-chosen active, used consistently, beats four used on and off.

Should I use more than one acne treatment?

Sometimes, but not at the start. The AAD suggests:

1. Start with one treatment and use it consistently.
2. If there’s no improvement after 4 to 6 weeks, add a second product with a different active ingredient, such as benzoyl peroxide, a retinoid or salicylic acid.
3. Limit yourself to one or two products to avoid stressing your skin.

Good pairings work in different ways: adapalene + benzoyl peroxide is the classic one (the AAD says adapalene works better alongside it). Using two products with the same job, such as a salicylic acid cleanser, toner and serum, mostly adds irritation.

US acne drug labels carry the warning that skin irritation and dryness are more likely if you use another topical acne medication at the same time, and to use only one at a time if irritation occurs. See building an acne routine for how to layer.

When do you need more than OTC treatment?

See a dermatologist if OTC treatment hasn’t helped after 6 to 8 weeks, or straight away for deep, painful nodules or cysts. Prescription options include stronger retinoids, topical and oral antibiotics, hormonal treatments and isotretinoin. See prescription vs OTC acne treatments for what each adds, clindamycin vs benzoyl peroxide for why antibiotics are paired with BPO, and when to see a dermatologist.