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Acne and rosacea are common inflammatory processes historically classified in the same disease category, but evolving understanding of their disparate pathophysiology and exacerbating factors have generated an enormous armamentarium of therapeutic possibilities. Patients seek over-the-counter therapies first when managing cutaneous disease; therefore, this review defines ingredients considered to be effective over-the-counter acne and rosacea products, their mechanisms, and safe formulations, including botanical components, oral supplements, and other anecdotal options in this vast skin care domain., (©2016 Frontline Medical Communications.)

The beneficial effects of alpha-hydroxyacids (AHAs) on skin were discovered by Drs. Van Scott and Yu in the early 1970s, including exfoliation, skin smoothing, and antiaging effects. A new generation of AHAs, called polyhydroxy acids (PHAs), was discovered that provide similar effects as AHAs but do not cause the sensory irritation responses that can limit the use of classical AHAs. PHAs have been found to be compatible with clinically sensitive skin, including rosacea and atopic dermatitis, and can be used after cosmetic procedures. PHAs provide additional humectant and moisturization properties compared with AHAs and can enhance stratum corneum barrier function, therefore increasing the skin's resistance to chemical challenge. Most PHAs also possess antioxidant properties. PHAs such as gluconolactone or lactobionic acid may be used in combination with other products, ingredients, or procedures such as laser and microdermabrasion to provide additional benefits to therapy or to enhance the therapeutic effect. Several studies were conducted in support of this, and methods and results are discussed. In summary, PHA-containing products were used in combination with retinoic acid in treating adult facial acne and were found to be well tolerated. PHAs plus retinyl acetate (pro-vitamin A) in a cream base exhibited significant antiaging skin benefits such as skin smoothing and plumping. PHAs plus hydroquinone showed excellent improvement in antiaging and skin lightening parameters. Finally, PHA-containing products were shown to be compatible with African American, Caucasian, and Hispanic/Asian skin and provided significant improvements in photoaging in these populations.

A number of genetic, intrinsic, and extrinsic factors can cause conditions of problem dry skin, marked by unusual dryness, rough texture, and extreme flaking and scaling, that are generally not controlled by conventional moisturizers. A study was undertaken to evaluate the safety and efficacy of two novel alpha hydroxy acid (AHA)-containing creams in reducing the appearance and symptoms of problem dry skin on subjects with a range of dry skin conditions, including xerosis, epidermolytic hyperkeratosis, and ichthyosis. Twenty subjects completed a course of treatment with either regular or extra strength AHA-blend cream on a test site, compared with a currently marketed, non-AHA moisturizing lotion on a control site. Subjects were treated for 4 weeks, with clinical evaluations performed at weeks 0, 2, and 4. The test for mulations reduced symptoms and improved cosmetic appearance following 2 weeks of use, with continued improvement following 4 weeks of use. Improvements were significant compared to baseline and compared to sites treated with the control lotion. Some patients experienced mild to moderate local adverse effects; all subjects were able to continue using the test product for the duration of the study.