{
  "name": "Acne actives by acne type",
  "description": "Eight over-the-counter acne actives graded against the four things people call acne, including the one that is not acne at all. Every grade names the studies it rests on. Concentrations and citations are read from the ingredient dossiers rather than retyped.",
  "license": "CC BY 4.0",
  "license_url": "https://creativecommons.org/licenses/by/4.0/",
  "source_page": "https://verifiedbeautydata.com/acne/",
  "publisher": "Verified Beauty Data",
  "generated": "2026-08-25",
  "aligned_to": {
    "name": "Guidelines of care for the management of acne vulgaris (AAD, 2024)",
    "id": "PMID:38300170",
    "url": "https://pubmed.ncbi.nlm.nih.gov/38300170/",
    "note": "The protocol on this page follows the 2024 American Academy of Dermatology algorithm: a topical retinoid and benzoyl peroxide as first-line for mild-to-moderate acne, multiple mechanisms rather than one stronger agent, and no topical-antibiotic monotherapy."
  },
  "grade_scale": {
    "A": "Meta-analysis, systematic review, guideline recommendation, or randomised trial in this acne type",
    "B": "Controlled clinical trial in this type, or a strong trial in an adjacent one",
    "C": "Small or open-label human data, or mechanism plus supporting human evidence",
    "D": "In vitro or mechanism only",
    "none": "No evidence located in our corpus for this pairing"
  },
  "acne_types": [
    {
      "id": "comedonal",
      "label": "Blackheads and whiteheads",
      "short": "Blackheads",
      "clinical": "Comedonal acne",
      "plain": "Clogged pores, no redness",
      "tell": "Blackheads and small closed bumps, mostly forehead, nose and chin. Texture rather than anger — little or no redness, not sore to touch.",
      "caution": "Reaching for benzoyl peroxide first. It kills bacteria, and bacteria are not the problem here. The pore is blocked. A retinoid unblocks it.",
      "lesion": "Open comedones (blackheads) and closed comedones (whiteheads)."
    },
    {
      "id": "inflammatory",
      "label": "Red, inflamed spots",
      "short": "Inflamed",
      "clinical": "Inflammatory acne",
      "plain": "Papules and pustules",
      "tell": "Red, raised, tender papules and pustules with visible heads. Sore before they are visible.",
      "caution": "Buying the strongest tube on the shelf. In a head-to-head trial, 2.5% benzoyl peroxide worked as well as 10% and stung far less. Stinging is the top reason people stop.",
      "lesion": "Papules and pustules."
    },
    {
      "id": "hormonal",
      "label": "Hormonal acne and cystic acne",
      "short": "Hormonal",
      "clinical": "Nodulocystic acne",
      "plain": "Deep jawline cysts",
      "tell": "Deep, tender lumps with no head, along the jaw, chin and neck. Flares on a monthly cycle. Slow to come, slow to go.",
      "caution": "Spending months trying stronger creams. Deep cysts rarely clear with creams alone, and they scar. This is the type to take to a doctor.",
      "lesion": "Nodules and cysts."
    },
    {
      "id": "fungal",
      "label": "Fungal acne",
      "short": "Fungal",
      "clinical": "Malassezia folliculitis",
      "plain": "Uniform itchy bumps",
      "tell": "Small bumps that are all the SAME size, often itchy, across forehead, hairline, chest and back. Flares with heat, sweat and occlusion. No blackheads among them.",
      "caution": "Treating it as acne. It is a yeast, not bacteria. Nothing on this page treats it, and many moisturisers feed it. People lose months here.",
      "lesion": "Uniform follicular papules and pustules, no comedones."
    }
  ],
  "not_covered": [
    {
      "name": "Antifungals — ketoconazole, zinc pyrithione, selenium sulfide",
      "why": "These are what actually treat Malassezia folliculitis, and not one of the actives graded above will touch it. We hold no dossier and no product for them yet, so they are named here rather than quietly omitted. If the Decoder says fungal, this is the class to go and find."
    },
    {
      "name": "Oral isotretinoin, oral antibiotics, hormonal therapy",
      "why": "Prescription-only, and for severe, scarring or psychologically distressing acne the AAD guideline is unambiguous that they are the right answer. Nothing on this page substitutes for that conversation."
    },
    {
      "name": "Topical antibiotic monotherapy",
      "why": "Deliberately absent. The 2024 AAD guideline recommends against it because of resistance, and advises pairing benzoyl peroxide with any topical antibiotic."
    }
  ],
  "row_count": 32,
  "columns": [
    "active",
    "active_id",
    "inci_name",
    "acne_type",
    "acne_type_id",
    "evidence_grade",
    "evidence_basis",
    "references",
    "working_pct",
    "cheapest_price_per_g_active_usd"
  ],
  "rows": [
    {
      "active": "Adapalene",
      "active_id": "adapalene",
      "inci_name": "ADAPALENE",
      "acne_type": "Blackheads and whiteheads",
      "acne_type_id": "comedonal",
      "evidence_grade": "A",
      "evidence_basis": "guideline recommendation plus network meta-analysis",
      "references": "PMID:38300170 PMID:33825196 PMID:16702497",
      "working_pct": "0.1% (the OTC strength, Differin) and 0.3% (prescription, for moderate-to-severe acne); also in once-daily fixed-dose combinations with benzoyl peroxide 2.5%",
      "cheapest_price_per_g_active_usd": 532.6667
    },
    {
      "active": "Adapalene",
      "active_id": "adapalene",
      "inci_name": "ADAPALENE",
      "acne_type": "Red, inflamed spots",
      "acne_type_id": "inflammatory",
      "evidence_grade": "A",
      "evidence_basis": "randomised trials, fixed-dose combination",
      "references": "PMID:36301750 PMID:38300170",
      "working_pct": "0.1% (the OTC strength, Differin) and 0.3% (prescription, for moderate-to-severe acne); also in once-daily fixed-dose combinations with benzoyl peroxide 2.5%",
      "cheapest_price_per_g_active_usd": 532.6667
    },
    {
      "active": "Adapalene",
      "active_id": "adapalene",
      "inci_name": "ADAPALENE",
      "acne_type": "Hormonal acne and cystic acne",
      "acne_type_id": "hormonal",
      "evidence_grade": "B",
      "evidence_basis": "guideline, as part of multimodal topical therapy",
      "references": "PMID:38300170",
      "working_pct": "0.1% (the OTC strength, Differin) and 0.3% (prescription, for moderate-to-severe acne); also in once-daily fixed-dose combinations with benzoyl peroxide 2.5%",
      "cheapest_price_per_g_active_usd": 532.6667
    },
    {
      "active": "Adapalene",
      "active_id": "adapalene",
      "inci_name": "ADAPALENE",
      "acne_type": "Fungal acne",
      "acne_type_id": "fungal",
      "evidence_grade": "none",
      "evidence_basis": null,
      "references": "",
      "working_pct": "0.1% (the OTC strength, Differin) and 0.3% (prescription, for moderate-to-severe acne); also in once-daily fixed-dose combinations with benzoyl peroxide 2.5%",
      "cheapest_price_per_g_active_usd": 532.6667
    },
    {
      "active": "Benzoyl Peroxide",
      "active_id": "benzoyl-peroxide",
      "inci_name": "BENZOYL PEROXIDE",
      "acne_type": "Blackheads and whiteheads",
      "acne_type_id": "comedonal",
      "evidence_grade": "B",
      "evidence_basis": "review, comedolytic and antibacterial activity",
      "references": "PMID:23839205",
      "working_pct": "2.5-10%",
      "cheapest_price_per_g_active_usd": 0.929
    },
    {
      "active": "Benzoyl Peroxide",
      "active_id": "benzoyl-peroxide",
      "inci_name": "BENZOYL PEROXIDE",
      "acne_type": "Red, inflamed spots",
      "acne_type_id": "inflammatory",
      "evidence_grade": "A",
      "evidence_basis": "randomised comparison across strengths",
      "references": "DOI:10.1111/j.1365-4362.1986.tb04534.x PMID:32175593",
      "working_pct": "2.5-10%",
      "cheapest_price_per_g_active_usd": 0.929
    },
    {
      "active": "Benzoyl Peroxide",
      "active_id": "benzoyl-peroxide",
      "inci_name": "BENZOYL PEROXIDE",
      "acne_type": "Hormonal acne and cystic acne",
      "acne_type_id": "hormonal",
      "evidence_grade": "B",
      "evidence_basis": "review",
      "references": "PMID:32175593",
      "working_pct": "2.5-10%",
      "cheapest_price_per_g_active_usd": 0.929
    },
    {
      "active": "Benzoyl Peroxide",
      "active_id": "benzoyl-peroxide",
      "inci_name": "BENZOYL PEROXIDE",
      "acne_type": "Fungal acne",
      "acne_type_id": "fungal",
      "evidence_grade": "none",
      "evidence_basis": null,
      "references": "",
      "working_pct": "2.5-10%",
      "cheapest_price_per_g_active_usd": 0.929
    },
    {
      "active": "Salicylic Acid (BHA)",
      "active_id": "salicylic-acid",
      "inci_name": "SALICYLIC ACID",
      "acne_type": "Blackheads and whiteheads",
      "acne_type_id": "comedonal",
      "evidence_grade": "A",
      "evidence_basis": "comedolytic assay in acne patients plus controlled trial",
      "references": "PMID:6191495 PMID:1535287 21 CFR 333.310",
      "working_pct": "0.5-2% (OTC acne); up to 30% (professional peels)",
      "cheapest_price_per_g_active_usd": 1.1257
    },
    {
      "active": "Salicylic Acid (BHA)",
      "active_id": "salicylic-acid",
      "inci_name": "SALICYLIC ACID",
      "acne_type": "Red, inflamed spots",
      "acne_type_id": "inflammatory",
      "evidence_grade": "C",
      "evidence_basis": "mechanism plus small clinical",
      "references": "PMID:30972839",
      "working_pct": "0.5-2% (OTC acne); up to 30% (professional peels)",
      "cheapest_price_per_g_active_usd": 1.1257
    },
    {
      "active": "Salicylic Acid (BHA)",
      "active_id": "salicylic-acid",
      "inci_name": "SALICYLIC ACID",
      "acne_type": "Hormonal acne and cystic acne",
      "acne_type_id": "hormonal",
      "evidence_grade": "C",
      "evidence_basis": "mechanism",
      "references": "PMID:30972839",
      "working_pct": "0.5-2% (OTC acne); up to 30% (professional peels)",
      "cheapest_price_per_g_active_usd": 1.1257
    },
    {
      "active": "Salicylic Acid (BHA)",
      "active_id": "salicylic-acid",
      "inci_name": "SALICYLIC ACID",
      "acne_type": "Fungal acne",
      "acne_type_id": "fungal",
      "evidence_grade": "none",
      "evidence_basis": null,
      "references": "",
      "working_pct": "0.5-2% (OTC acne); up to 30% (professional peels)",
      "cheapest_price_per_g_active_usd": 1.1257
    },
    {
      "active": "Azelaic Acid",
      "active_id": "azelaic-acid",
      "inci_name": "AZELAIC ACID",
      "acne_type": "Blackheads and whiteheads",
      "acne_type_id": "comedonal",
      "evidence_grade": "B",
      "evidence_basis": "double-blind trials in acne vulgaris",
      "references": "PMID:16281587",
      "working_pct": "10-20%",
      "cheapest_price_per_g_active_usd": 4.0577
    },
    {
      "active": "Azelaic Acid",
      "active_id": "azelaic-acid",
      "inci_name": "AZELAIC ACID",
      "acne_type": "Red, inflamed spots",
      "acne_type_id": "inflammatory",
      "evidence_grade": "A",
      "evidence_basis": "combined double-blind trials",
      "references": "PMID:16281587 PMID:26244354",
      "working_pct": "10-20%",
      "cheapest_price_per_g_active_usd": 4.0577
    },
    {
      "active": "Azelaic Acid",
      "active_id": "azelaic-acid",
      "inci_name": "AZELAIC ACID",
      "acne_type": "Hormonal acne and cystic acne",
      "acne_type_id": "hormonal",
      "evidence_grade": "B",
      "evidence_basis": "trial evidence in inflammatory acne",
      "references": "PMID:16281587",
      "working_pct": "10-20%",
      "cheapest_price_per_g_active_usd": 4.0577
    },
    {
      "active": "Azelaic Acid",
      "active_id": "azelaic-acid",
      "inci_name": "AZELAIC ACID",
      "acne_type": "Fungal acne",
      "acne_type_id": "fungal",
      "evidence_grade": "none",
      "evidence_basis": null,
      "references": "",
      "working_pct": "10-20%",
      "cheapest_price_per_g_active_usd": 4.0577
    },
    {
      "active": "Mandelic Acid (AHA)",
      "active_id": "mandelic-acid",
      "inci_name": "MANDELIC ACID",
      "acne_type": "Blackheads and whiteheads",
      "acne_type_id": "comedonal",
      "evidence_grade": "B",
      "evidence_basis": "randomised peel comparison in active acne",
      "references": "PMID:19076192",
      "working_pct": "5-10% (OTC leave-on); up to 45% (professional chemical peels)",
      "cheapest_price_per_g_active_usd": 2.6375
    },
    {
      "active": "Mandelic Acid (AHA)",
      "active_id": "mandelic-acid",
      "inci_name": "MANDELIC ACID",
      "acne_type": "Red, inflamed spots",
      "acne_type_id": "inflammatory",
      "evidence_grade": "B",
      "evidence_basis": "randomised peel comparison in active acne",
      "references": "PMID:19076192",
      "working_pct": "5-10% (OTC leave-on); up to 45% (professional chemical peels)",
      "cheapest_price_per_g_active_usd": 2.6375
    },
    {
      "active": "Mandelic Acid (AHA)",
      "active_id": "mandelic-acid",
      "inci_name": "MANDELIC ACID",
      "acne_type": "Hormonal acne and cystic acne",
      "acne_type_id": "hormonal",
      "evidence_grade": "C",
      "evidence_basis": "sebum secretion study",
      "references": "PMID:24278065",
      "working_pct": "5-10% (OTC leave-on); up to 45% (professional chemical peels)",
      "cheapest_price_per_g_active_usd": 2.6375
    },
    {
      "active": "Mandelic Acid (AHA)",
      "active_id": "mandelic-acid",
      "inci_name": "MANDELIC ACID",
      "acne_type": "Fungal acne",
      "acne_type_id": "fungal",
      "evidence_grade": "none",
      "evidence_basis": null,
      "references": "",
      "working_pct": "5-10% (OTC leave-on); up to 45% (professional chemical peels)",
      "cheapest_price_per_g_active_usd": 2.6375
    },
    {
      "active": "Niacinamide (Vitamin B3)",
      "active_id": "niacinamide",
      "inci_name": "NIACINAMIDE",
      "acne_type": "Blackheads and whiteheads",
      "acne_type_id": "comedonal",
      "evidence_grade": "C",
      "evidence_basis": "clinical, sebum endpoint",
      "references": "PMID:16766489",
      "working_pct": "2–5%",
      "cheapest_price_per_g_active_usd": 2.0288
    },
    {
      "active": "Niacinamide (Vitamin B3)",
      "active_id": "niacinamide",
      "inci_name": "NIACINAMIDE",
      "acne_type": "Red, inflamed spots",
      "acne_type_id": "inflammatory",
      "evidence_grade": "C",
      "evidence_basis": "clinical, sebum and barrier endpoints",
      "references": "PMID:16766489 PMID:10971324",
      "working_pct": "2–5%",
      "cheapest_price_per_g_active_usd": 2.0288
    },
    {
      "active": "Niacinamide (Vitamin B3)",
      "active_id": "niacinamide",
      "inci_name": "NIACINAMIDE",
      "acne_type": "Hormonal acne and cystic acne",
      "acne_type_id": "hormonal",
      "evidence_grade": "C",
      "evidence_basis": "sebum endpoint",
      "references": "PMID:16766489",
      "working_pct": "2–5%",
      "cheapest_price_per_g_active_usd": 2.0288
    },
    {
      "active": "Niacinamide (Vitamin B3)",
      "active_id": "niacinamide",
      "inci_name": "NIACINAMIDE",
      "acne_type": "Fungal acne",
      "acne_type_id": "fungal",
      "evidence_grade": "none",
      "evidence_basis": null,
      "references": "",
      "working_pct": "2–5%",
      "cheapest_price_per_g_active_usd": 2.0288
    },
    {
      "active": "Glycolic Acid (AHA)",
      "active_id": "glycolic-acid",
      "inci_name": "GLYCOLIC ACID",
      "acne_type": "Blackheads and whiteheads",
      "acne_type_id": "comedonal",
      "evidence_grade": "C",
      "evidence_basis": "peel review in active acne",
      "references": "PMID:28274356",
      "working_pct": "4-10% (OTC cosmetic leave-on); 20-70% (professional peels)",
      "cheapest_price_per_g_active_usd": 0.8152
    },
    {
      "active": "Glycolic Acid (AHA)",
      "active_id": "glycolic-acid",
      "inci_name": "GLYCOLIC ACID",
      "acne_type": "Red, inflamed spots",
      "acne_type_id": "inflammatory",
      "evidence_grade": "C",
      "evidence_basis": "peel review in active acne",
      "references": "PMID:28274356",
      "working_pct": "4-10% (OTC cosmetic leave-on); 20-70% (professional peels)",
      "cheapest_price_per_g_active_usd": 0.8152
    },
    {
      "active": "Glycolic Acid (AHA)",
      "active_id": "glycolic-acid",
      "inci_name": "GLYCOLIC ACID",
      "acne_type": "Hormonal acne and cystic acne",
      "acne_type_id": "hormonal",
      "evidence_grade": "none",
      "evidence_basis": null,
      "references": "",
      "working_pct": "4-10% (OTC cosmetic leave-on); 20-70% (professional peels)",
      "cheapest_price_per_g_active_usd": 0.8152
    },
    {
      "active": "Glycolic Acid (AHA)",
      "active_id": "glycolic-acid",
      "inci_name": "GLYCOLIC ACID",
      "acne_type": "Fungal acne",
      "acne_type_id": "fungal",
      "evidence_grade": "none",
      "evidence_basis": null,
      "references": "",
      "working_pct": "4-10% (OTC cosmetic leave-on); 20-70% (professional peels)",
      "cheapest_price_per_g_active_usd": 0.8152
    },
    {
      "active": "Retinol (Vitamin A)",
      "active_id": "retinol",
      "inci_name": "RETINOL",
      "acne_type": "Blackheads and whiteheads",
      "acne_type_id": "comedonal",
      "evidence_grade": "C",
      "evidence_basis": "retinoid class evidence, weaker than adapalene",
      "references": "PMID:20442078 PMID:17515510",
      "working_pct": "0.1-1%",
      "cheapest_price_per_g_active_usd": 62.8941
    },
    {
      "active": "Retinol (Vitamin A)",
      "active_id": "retinol",
      "inci_name": "RETINOL",
      "acne_type": "Red, inflamed spots",
      "acne_type_id": "inflammatory",
      "evidence_grade": "C",
      "evidence_basis": "retinoid class evidence",
      "references": "PMID:20442078",
      "working_pct": "0.1-1%",
      "cheapest_price_per_g_active_usd": 62.8941
    },
    {
      "active": "Retinol (Vitamin A)",
      "active_id": "retinol",
      "inci_name": "RETINOL",
      "acne_type": "Hormonal acne and cystic acne",
      "acne_type_id": "hormonal",
      "evidence_grade": "none",
      "evidence_basis": null,
      "references": "",
      "working_pct": "0.1-1%",
      "cheapest_price_per_g_active_usd": 62.8941
    },
    {
      "active": "Retinol (Vitamin A)",
      "active_id": "retinol",
      "inci_name": "RETINOL",
      "acne_type": "Fungal acne",
      "acne_type_id": "fungal",
      "evidence_grade": "none",
      "evidence_basis": null,
      "references": "",
      "working_pct": "0.1-1%",
      "cheapest_price_per_g_active_usd": 62.8941
    }
  ]
}