What over-the-counter alternatives can I use for acne treatment since adapalene is not available?

Your Current Routine is Excellent—Here's How to Optimize It

Your current regimen already contains the most effective over-the-counter alternatives to adapalene available in Europe, and you're using them correctly. Continue with your glycolic acid and salicylic acid rotation at night, maintain your niacinamide in the morning, and ensure consistent sunscreen use 1, 2.

Why Your Routine Works Without Adapalene

Your alternating use of glycolic acid 7% and salicylic acid 2% provides the comedolytic (pore-clearing) action that retinoids like adapalene would offer 2:

• Salicylic acid (0.5-2%) is the most effective over-the-counter exfoliator specifically for comedonal acne, working as a comedolytic agent that penetrates oil-filled pores 2
• Glycolic acid (an alpha hydroxy acid) provides additional exfoliation and cellular turnover, complementing salicylic acid's action 2
• Alternating these acids rather than using them simultaneously reduces irritation while maintaining efficacy 1

Your Morning Routine is Optimal

• Niacinamide 10% + zinc 1% has supporting evidence for acne treatment, though the evidence base is more limited than for retinoids 1
• La Roche-Posay Anthelios UVMune 400 provides essential photoprotection, which is critical when using any exfoliating acids 1, 2

Critical Optimization: Benzoyl Peroxide Addition

Add benzoyl peroxide 2.5-5% to your routine immediately—this is the single most important missing component 1, 2:

• Apply benzoyl peroxide in the morning after niacinamide or at night before your acid treatment 2
• Benzoyl peroxide is an effective antimicrobial agent that releases free oxygen radicals, and no bacterial resistance has been reported with its use 2
• Lower concentrations (2.5-5%) cause less irritation than higher strengths while maintaining efficacy 2
• Available over-the-counter throughout Europe in various formulations 2

Practical Application Schedule

Morning:

1. CeraVe foaming cleanser
2. Niacinamide 10% + zinc 1%
3. Benzoyl peroxide 2.5-5% (NEW—wait 5 minutes)
4. La Roche-Posay Anthelios UVMune 400

Night:

1. CeraVe foaming cleanser
2. Glycolic acid 7% OR salicylic acid 2% (continue alternating)
3. CeraVe moisturizer PM

When to Escalate Treatment

If your acne is moderate-to-severe with significant inflammatory lesions (papules, pustules, nodules), over-the-counter options are insufficient 1, 2:

• You would need prescription oral antibiotics (doxycycline 100mg daily) combined with topical benzoyl peroxide for 3-4 months maximum 1, 2
• For severe nodular acne or acne causing scarring, isotretinoin is the definitive treatment addressing all pathogenic factors 1, 2
• Consult a dermatologist if you have scarring, significant psychosocial impact, or no improvement after 8-12 weeks of optimized OTC therapy 1, 2

Common Pitfalls to Avoid

• Never use acids on broken skin or active wounds—skip application on those areas 2
• Start benzoyl peroxide every other day initially if you experience excessive dryness, then increase to daily as tolerated 2
• Weather extremes (wind, cold) may increase irritation from your acid treatments—reduce frequency temporarily if needed 1
• If you develop excessive erythema, scaling, or burning, reduce acid frequency to 2-3 times weekly rather than stopping completely 1, 2

Alternative Intensive Option

For resistant comedonal acne, consider salicylic acid chemical peels (20-30%) applied for 2-4 minutes by a dermatologist or trained aesthetician, which provide more intensive treatment than daily home use 2.