Skin does so much — it protects us from germs, ultraviolet radiation, viruses and infections. It repels water and contains our veins and muscles. It’s no wonder we often assume that products applied to the skin can’t hurt it. But some can.
Unfortunately, skin care is one of those areas the FDA doesn’t tightly regulate, despite the fact that many skincare products contain ingredients that can be harmful to our health. While over-the-counter acne treatments list the more common side effects on their product labels, they fail to inform people of rare but very serious side effects that can occur.
Here we explore a well-known acne treatment brand — Proactiv.
Proactiv Acne Treatment
Proactiv is a 3-step skincare routine based on the active ingredients benzoyl peroxide, glycolic acid (an alpha hydroxy acid), hyaluronic acid and salicylic acid. The major ingredient, a 2.5% concentration of benzoyl peroxide, is in steps 1 and 3 of the Proactiv Solution regimen and steps 1 and 2 of the Proactiv+ regimen.
Proactiv’s multi-step system works via “the low concentration benzoyl peroxide cleanser, an alcohol-free toner, and the low concentration salicylic acid lotion,” says board-certified dermatologist Dr. Jessie Cheung. “The same exact ingredients are available much cheaper at the drugstore, but not as a simple 1-2-3 step program.”
What Causes Acne?
“Most skin diseases are a manifestation of some sort of inflammation,” says Dr. Cheung. “Acne is a culmination of clogged pores, oil, and bacteria, but it is fundamentally triggered by inflammation.”
The resident bacteria present in the skin’s pores is known as propionibacterium acnes (P. acnes). Benzoyl peroxide has an antibacterial effect on P. acnes, acts as an anti-inflammatory agent, and as a peeling agent that sheds the skin’s exterior.
Is Proactive Effective?
“Proactiv is effective for mild acne,” says Dr. Cheung. “Since it kills off the acne-causing bacteria, benzoyl peroxide is a very commonly prescribed medication for acne.” In fact, because studies have shown it to be so effective, the American Academy of Dermatology recommends benzoyl peroxide as a first-line acne treatment.
Clinical trials have shown at least 50% of people have some type of adverse reaction.
A few small clinical trials have shown Proactiv or similar products to be effective at reducing the number of acne lesions by an average 47%, reducing red, inflamed skin by an average 10%, with 85.6% of people noticing at least mild overall improvements. It should be noted however, that these studies have been sponsored by Proactiv’s manufacturer, and therefore may contain bias.
When it comes to consumer opinion, Proactiv gets an average rating, based on review on Acne.org
Side Effects of Proactiv
Clinical trials have shown at least 50% of people have some type of adverse reaction. These are mainly dryness, skin infections and infestations and nasopharyngitis (swelling of the nasal passage and back of the throat). A few people in trials have also experienced burning at the application site, influenza, sinusitis, and gastroenteritis.
“Even though Proactiv has these active ingredients in a very low concentration, the products can still be irritating,” says Dr. Cheung. “The most common complaints that I have heard are dry and flaky skin.
“People should be aware that with most acne treatments, you may see an initial flare up when starting treatment, as cell turnover speeds up. But, the skin should begin to clear up after the first few weeks. If it gets even worse, the products may be irritating the skin too much,” adds Dr. Cheung.
While the majority of people won’t see more than the common side effects mentioned by Dr. Cheung, there are other rare but serious side effects to be aware of.
The FDA has issued consumer warnings about potentially severe side effects that products such as Proactiv do not list on the product label. There have been 131 severe allergic and hypersensitivity reactions to these products, with 44% of these requiring hospitalization.
The severe reactions reported include throat tightness, shortness of breath, wheezing, low blood pressure, fainting or collapse. These have arisen within minutes and up to 24 hours of application. People have also reported hives, swelling of the eyes, face and lips, and itching of the face or body (even on parts of the body where there was no application of the product). It’s unknown exactly what substance in the product causes these adverse reactions. But if you experience any of these severe side effects, seek immediate medical attention.
And just be cautioned: If you’re already using an acne treatment or prescribed skincare product, it’s advised to consult a doctor or dermatologist to ensure there is no clash between the products that could cause a negative reaction.
What is the Most Effective Acne Treatment?
Dietary changes can help address the systemic inflammation that causes acne. For instance, “a high fat, high sugar diet increases systemic inflammation and results in an increase in a hormone called cortisol,” says dermatologist and dermatologic surgeon Dr. Ariel Ostad. “Cortisol is responsible for an increase in oil gland production thus increasing acne breakouts.”
“It’s important to eat low-glycemic carbohydrates to control inflammation,” adds Dr. Ostad. He suggests eating complex carbohydrates such as sweet potatoes, quinoa and steel-cut oats, along with plenty of fresh vegetables for their antioxidant content and anti-inflammatory properties.
For skin outbreaks that are still troubling you after dietary changes, “most dermatologists would agree that any acne treatment regimen should include a retinoid and topical antibiotic,” says Dr. Cheung. “If the acne fails to respond to that, adding an oral antibiotic or anti-androgen is usually the next step.”
“For severe cases of acne the most effective treatment is Accutane, but we reserve this medication for severe cases of acne only, since monthly monitoring with blood tests are required as it can affect the liver and cholesterol,” adds Dr. Cheung. (See our article on Accutane, which has many concerns.)
In short, you can probably achieve similar results to Proactiv by using other over-the-counter acne medications that cost a lot less. Also, making certain dietary changes may help to reduce acne on your face, and doesn’t have any side effects to worry about. And eating better has other health benefits too.