Choosing the Right Skin Care for You

Understanding the differences between over-the-counter, maximum, and prescription-strength skin-care products.

    Selecting skin-care products can be a daunting task, what with all the choices filling pharmacy aisles. You'll find dozens of over-the-counter products with such labels as "maximum strength," "clinical strength," and "original prescription strength" - plus seemingly identical products that are available only by prescription. What do all these labels mean, and how do you know which product is the best one for you? Here are some answers.

How Much Active Ingredient?

    The active ingredient in an over-the-counter product is often the same as the one found in its prescription counterpart, but at a lower dosage. Over-the-counter dandruff shampoo contains a lower dosage of the active ingredient ketoconazole (1 percent), while the prescription-strength versions contain 2 percent. In hydrocortisone anti-itch cream, the maximum over-the-counter dosage is 1 percent, while prescription-strength creams contain 2.5 percent. According to U.S. Food and Drug Administration (FDA) regulations, once a product's active ingredient reaches a certain percentage -such as 1.5 percent for hydrocortisone, or 2 percent for salicylic acid in acne treatments - it requires a prescription from a doctor.

Sometimes It's Just a Marketing Strategy

    Because the FDA does not closely regulate over-the-counter skin-care products, a company can label a product "maximum strength" or "clinical strength" for any reason it sees fit - and the label is no guarantee that the product will actually be any stronger than others on the market. The best way to find out whether you are really getting the "maximum" strength of an ingredient is to check the ingredients label, says Robyn Gmyrek, MD, assistant clinical professor of dermatology at Columbia University College of Physicians and Surgeons. "Compare the label with other products on the shelf," says Dr. Gmyrek, and check the percentage of the active ingredient in each product.

     Although an increase in the active ingredient in a product of 1 percent may not seem as though it would significantly affect the strength, it can, says dermatologist Doris Day, MD, director of Day Cosmetic, Laser and Comprehensive Dermatology in New York City and a professor at NYU Medical School. For this reason, it's best to test a new skin-care product by applying a dime-sized amount on your forearm, to see if it causes a reaction.

Prescription Products Must Be Approved by the FDA

    For the FDA to approve a product's switch from over-the-counter to prescription-strength status, regulations require a company to show that even a slight increase in the amount of active ingredient (for example, 1 percent) "changes the structure or function of the skin." All prescription products are reviewed by the FDA and have gone through numerous clinical trials, says Debra Jaliman, MD, a New York City dermatologist. The FDA also decides what dosage level constitutes a prescription. Some OTC products may be labeled "original prescription strength," which means a prescription from a doctor was once required, but the product is now available without one.

Finding the Right Product for You

    How do you know which product to try? Stronger dosages can have harsher effects on your skin, so it's generally safer to start with a lower dosage. Try the basic OTC product for a minimum of two weeks to gauge the results, then move on to a maximum- or clinical-strength product, if necessary, or request a prescription, says Dr. Day. For acne, you should expect to wait a little longer - from four to six weeks - to see results. And if any product irritates your skin or makes symptoms worse, see your doctor immediately.