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In summary, the two best products for treating acne and acne scarring are Adapalene (which is a retinoid) and benzoyl peroxide, which is essentially like a bleach or antiseptic.
You can buy these products separately or premixed together.
We sell Adapalene as a product called Differin.
We sell benzoyl peroxide as a product called Benzac AC.
Together, adapalene + benzoyl peroxide is sold as a product called EPIDUO.
The best topical treatment for acne and acne scarring, according to various studies (which will be linked later in this article) seems to be adapalene + benzoyl peroxide together. As this combines the effects of two of the best products for treating acne. However, this may be overkill for some forms of acne, especially those that don’t have scarring, in which case adapalene (Differin) alone will be ideal.
Using Retinoids for acne treatment
Retinoids are a certain class of chemicals which help the skin. They are only available on prescription, but a weaker version called retinols is available over the counter.
There are around six different retinoids, but the best one for acne and acne scarring is called adapalene.
What causes acne and how do retinoids treat the cause?
Acne is essentially caused by ‘abnormal keratinisation’, which means the skin grows too fast.
This blocks pores in the skin. Pores fill up with sebum, which is the natural oil that your skin produces to protect it from drying out.
The normal bacteria on the skin starts to over-grow, because they eat this oil which is now overflowing from the pore.
This causes inflammation in the pore.
Adapalene helps reduce acne by stopping its root cause, which is this ‘abnormal keratinisation’.
This means your pores don’t become clogged in the first place, stopping oil build up and inflammation before it even starts.
Using Differin Gel (adapalene) as a treatment for acne
Differin gel contains the active ingredient ‘adapalene’, which is the best retinol for treating acne and acne scarring.
Differin gel is available in two strengths.
Differin gel 0.1% is available to buy over the counter.
Differin gel 0.3% is available as a prescription only.
The difference between over-the-counter Differin 0.1% Gel and prescription strength Differin 0.3% gel
The fundamental difference is that the prescription strength is three times stronger, and that means the side effects, which are usually felt during the first 2-4 weeks, will be three times stronger.
This is why it’s best to start on 0.1% adapalene and after the first month is over, then get a prescription for 0.3%.
0.3% Differin gel will give you more noticeable effects in a shorter period.
But starting on 0.1% will make the adaptation period easier and have less side effects. Read more on the adaptation period and side effects later in this article.
Using adapalene (Differin gel) for treating acne scars
A study published on PubMed on subjects ages 18-50 years, with moderate to severe facial acne, found that adapalene gel worked well.
50-80% of subjects reported improvement in skin texture after 24 weeks. Subjects were satisfied and reported quality of life improvements.
However, these studies used the prescription strength of Differin 0.3% gel.
Studies on Differin 0.1% gel didn’t have such a large impact on scarring, however, it stopped new scarring from forming and reduced the amount of acne significantly. So it may be best to get Differin 0.1% Gel immediately over the counter, start applying that, and after a few weeks, if it goes well, then get a prescription.
The reason I suggest starting with 0.1% is the skin goes through an adaptation period when using Differin.
Adapting your skin to adapalene (Differin) and the side effects when you start using it.
Differin gel contains the retinoid adapalene, and the skin takes time to adapt to using any type of retinol.
Adapalene is the best type of retinol for acne and acne scarring.
Adapalene is also regarded as the most tolerable.
The side effects are mild and generally decrease over time.
For the first few weeks, your skin may become more red, more dry and acne can even seem to get worse at first.
But don’t worry, this effect is temporary and goes away.
After this initial adaptation period, which can be 2-4 weeks, the skin’s appearance will improve week after week.
That’s why we say it’s best to start with Differin 0.1%, especially so this initial adaptation period is not three times stronger compared to if you were using 0.3%. That’s why this is a prescription only medicine.
Results will really become noticeable from 12 weeks and after 24 weeks, the difference will be dramatic. See the images below.
However, as long as you keep using Differin (adapalene) during the difficult period of being a young adult, it will certainly help.
Note that acne can get worse during the first weeks of treatment and it takes 8-12 weeks until you get the full benefit.
But often the full benefit is a dramatic difference, so use it regularly and on an on-going basis to get significant results.
Using Benzoyl peroxide for treating acne
Benzoyl peroxide has similar effects as adapalene.
Both work by helping the skin to shed more which results in pores getting clogged less.
It also dries the skin, leading to less sebum (oils).
Benzoyl peroxide also kills bacteria directly, which retinoids like adapalene (Differin) do not.
NOTE: While benzoyl peroxide sounds good, topical retinoids like adapalene are considered the first line of treatment. The reason being is that retinoids have other benefits like helping boost collagen production. Adapalene works better for whiteheads and blackheads and also for acne scars.
WARNING: benzoyl peroxide can and most likely will bleach your hair, clothes and bedding. It’s best to completely avoid your hair and eyes, and wash immediately if you touch them with benzoyl peroxide. If you are going to use benzoyl peroxide on your body before putting clothes on, or getting into bed, best to wear white clothes and use white sheets to minimise the bleaching effect.
Cautions and side effects of benzoyl peroxide
Common side effects that affect more than 1 in 10 people are:
burning or stinging feeling.
Serious side effects are rare and happen in less than 1 in 1,000 people.
the skin that you’re treating becomes swollen
you get blisters on your skin
if either of these happen immediately stop using benzoyl peroxide and contact a doctor if they don’t get better within a couple of days
Rare side effects
If you have a serious allergic reaction (anaphylaxis) then call an ambulance or go to hospital immediately.
IMPORTANT: Benzoyl peroxide can bleach or discolour your hair, as well as clothes, towels and bedding. Keep it away from hair and coloured fabrics.
Adapalene (Differin) is a retinoid and is considered the best retinoid and the first line of action is sold as a product called Differin. It works by increasing collagen production, which increases the turnover of skin cells, which stops pores from getting blocked and makes skin fuller and fresher looking, which can help reduce scarring too.
Benzoyl peroxide is an antibiotic bleaching agent and skin peeler. This also stops pores from getting blocked and also kills the bacteria and dries out oil, which the bacteria feed on and cause spots. However, it can bleach your clothes, hair and bedding and can cause a burning feeling.
Both adapalene and benzoyl peroxide reduce acne, and both have their pros and cons and it depends on the type of acne you have.
Most often, adapalene (Differin) is probably the best choice to go with if you want to buy something over the counter, especially because it won’t bleach your clothes, hair and bedding like benzoyl peroxide can.
But if your acne is bad, especially if you have scarring, best to see a dermatologist. They might prescribe you a stronger version with both adapalene and benzoyl peroxide.
Sources & further reading material
This information is intended solely for New Zealand residents and is of a general nature only. No person should act in reliance on any statement contained in the information provided, but at all times should obtain specific advice from a health professional.