Choosing the Right Acne Cleanser: A Pharmacist's Guide
An evidence-based look at how to choose the right cleanser—and 6 top formulas worth recommending in 2025.
By Chisom Onuora, PharmD, Founder of Esther’s Wellness
An ideal acne cleanser lifts oil and impurities while preserving the skin barrier, allowing topical treatments applied afterward to work their best. The best cleanser supports your treatment plan—it doesn’t compete with it. Choosing the right acne cleanser isn't about finding the strongest formula—it's about understanding what the skin actually needs.
Understanding Acne: The Foundation
Acne develops through four key mechanisms:
Abnormal keratinization — Dead skin cells clump together, plugging follicles
Excess sebum production — Hormones trigger oil overproduction
Bacterial colonization — C. acnes proliferates in clogged pores
Inflammation — Triggering redness, swelling, and breakouts
Each of these factors feeds into the others, creating a self-sustaining cycle of obstruction, inflammation, and recurrence.
So What Should a Cleanser Actually Do?
1. Remove Surface Oil and Debris
Acne begins with microcomedone formation—the earliest stage of a clogged pore. Daily cleansing removes excess sebum, dead skin cells, makeup residue, and environmental pollutants that perpetuate follicular obstruction, making even the best active treatments less effective.
2. Support the Skin Barrier
A compromised barrier leads to increased water loss, elevated pH (where acne bacteria thrive), inflammation, and compensatory oil overproduction. Harsh surfactants like sodium lauryl sulfate strip protective lipids—the ideal cleanser uses gentle surfactants that clean without stripping.
3. Optimize Skin for Active Treatments
The skin barrier directly affects how well prescription treatments are tolerated. A well-formulated cleanser maintains physiologic pH (4.5-5.5), preserves ceramides, reduces inflammation, and prepares skin to effectively absorb and tolerate retinoids, acids, and other acne treatments.
How to Identify a Quality Cleanser?
1. Surfactant System (One of the Most Important Factors)
Surfactants are the "cleaning" molecules in your cleanser. While pH and added ingredients also matter significantly, the surfactant system has the most direct impact on barrier integrity.
Surfactants to be cautious of:
Sodium lauryl sulfate (SLS) in high concentrations — can cause protein damage and strip protective lipids
Sodium laureth sulfate (SLES) — slightly gentler than SLS, but can still be irritating in high concentrations or poorly formulated products
Ammonium lauryl sulfate — similar irritation profile to SLS
Important nuance: The key word here is "formulation." SLES can be acceptable when used in lower concentrations and balanced with gentle co-surfactants, humectants, and barrier-supportive ingredients. Well-formulated products can mitigate potential irritation through careful ingredient pairing.
Some gentle surfactants that are preferable:
Sodium cocoyl isethionate — derived from coconut, mild and effective
Cocamidopropyl betaine — amphoteric surfactant with gentle foaming
Sodium lauroyl sarcosinate — amino acid-based, maintains barrier integrity
Decyl glucoside — sugar-based, extremely mild
Sodium methyl cocoyl taurate — gentle and maintains physiological pH
Disodium laureth sulfosuccinate — a sulfosuccinate (not a sulfate), often used in "sulfate-free" formulations
2. pH Level (Aim for 4.5–6.0)
Your skin's natural pH is 4.7-5.0. This acidic environment inhibits pathogenic bacteria, maintains optimal lipid- processing enzymes and supports natural antimicrobial peptides. Alkaline cleansers (pH 8–10) disrupt all of these functions.
3. Barrier-Supportive Ingredients
The right cleanser will have any of the following:
Ceramides (especially ceramides 1, 3, and 6-II) — the primary lipids in your skin barrier
Humectants (glycerin, hyaluronic acid, panthenol) — draw moisture into the skin
Niacinamide — reduces inflammation and regulates sebum production
Amino acids — building blocks of your skin's natural moisturizing factor
Red Flags: Signs Your Cleanser Isn't Right for You
Tight or "squeaky clean" feeling — This is a sign that skin barrier damage has occurred, not cleanliness
Increased redness or stinging after washing — Sign of irritation and inflammation
Breakouts worsen after 4 - 6 weeks of use — The cleanser may be disrupting your barrier or causing irritation
Acne treatments become unbearable — A harsh cleanser compounds irritation from actives
You need moisturizer immediately after cleansing — A sign that your barrier has been stripped
Should Your Acne Cleanser "Treat" Acne or Just Clean?
It depends on your skin barrier integrity, current treatment regimen, and goals.
The Contact Time Problem
Cleansers are rinse-off products with contact time of 30–90 seconds. However, certain actives can still work effectively in that short window:
Benzoyl peroxide: Even short-contact BPO (5-10%) applied for 1.5–5 minutes can reduce C. acnes colonization by 90%. Wash formulations are genuinely effective.
Salicylic acid: Being lipophilic (oil-loving), it penetrates follicles relatively quickly. A 60-second contact still provides comedolytic benefits.
Glycolic/AHA acids: In cleanser format (30-90 seconds contact), benefit is limited to surface exfoliation.
Clinical takeaway: Cleansers with actives can provide supportive benefit, but they're most effective as adjuncts to leave-on treatments, not replacements. Benzoyl peroxide washes are the notable exception—they remain clinically effective acne treatments even with brief contact time.
When Active Cleansers Make Sense
An active cleanser may be right if:
Mild acne with no prescription treatments
Body, chest, or back acne (larger surface areas where leave-on products are impractical)
Need for bacterial control when leave-on benzoyl peroxide isn't well-tolerated
Oily skin with excellent barrier function
When Gentle, Non-Active Cleansers Are Better
A gentle, non-active cleanser is the better choice if:
Using prescription retinoids (tretinoin, adapalene, tazarotene)
Taking oral isotretinoin (Accutane)
Managing sensitive, dry, or combination skin
Already using multiple active treatments
Dealing with redness, inflammation, or a compromised barrier
Emerging Ingredients in Acne Care
1. Hypochlorous Acid (HOCl) — 0.01–0.02%
What it is:
Hypochlorous acid is a naturally occurring molecule produced by white blood cells as part of the body's innate antimicrobial defense system.
How it works: Antimicrobial (kills bacteria, viruses, and fungi), reduces inflammation, accelerates wound healing, and maintains a pH around 5.5—ideal for skin.
Why it matters: Unlike antibiotics or benzoyl peroxide, bacteria cannot develop resistance to HOCl. It's non-cytotoxic, non-sensitizing, and safe for even the most sensitive or post-procedure skin Journal of Integrative Dermatology. Research has demonstrated HOCl's antimicrobial effects are comparable to or traditional antiseptics like benzoyl peroxide.
Already on shelves: Over ten branded aqueous hypochlorous acid formulations have been cleared by FDA for topical wound management. HOCl is now available in stabilized formulations as a topical spray - Tower 28 SOS Rescue Spray, Prequel Universal Skin Solution Dermal Spray, Magic Molecule Spray (*pH found to be above 7).
Clinical takeaway: HOCl offers antimicrobial efficacy with exceptional tolerability and less resistance potential—making it particularly valuable for inflammatory and barrier-compromised acne.
2. Probiotics & Postbiotics
Recent 2025 research analyzing 811 patients found that both oral and topical probiotics significantly reduced acne lesions, improved skin barrier function, and decreased inflammation PubMed.
How they work: These beneficial bacteria help control pathogenic C. acnes strains and modulate immune responses - addressing acne through multiple mechanisms including competitive inhibition and anti-inflammatory pathways PubMed Central.
Why it matters: Traditional antimicrobials kill bacteria indiscriminately, potentially disrupting skin barrier function. Probiotics and postbiotics offer a targeted approach—controlling pathogenic C. acnes strains while preserving beneficial flora like Staphylococcus epidermidis PubMed Central. This rebalances the skin's microbial environment rather than eliminating protective bacteria.
Postbiotics—the metabolic byproducts of probiotics—also show promise. Recent research combining postbiotics with microneedling demonstrated improvement in mild-to-moderate acne ReachMD, with the added advantage of greater stability and easier formulation compared to live bacteria PubMed Central.
Already on shelves: Brands like La Roche-Posay's Toleriane line and Aveeno now incorporate postbiotic compounds PubMed Central.
The key strains: Look for Lactobacillus plantarum, Lactobacillus rhamnosus, and Bifidobacterium species in both supplements and topical products.
Clinical takeaway: Probiotics and Postbiotic skincare offers a novel way to manage acne as adjunct therapy—particularly valuable in patients intolerant to traditional antimicrobial regimens or those with barrier sensitivity.
Top 6 Acne Cleansers I Recommend (and Why)
1. iS Clinical Cleansing Complex — Luxury That Delivers
Key ingredients: Salicylic acid, glycolic acid, antioxidants, chamomile extract
Best for: Acne with texture concerns, adult acne, aging skin, hyperpigmentation
Why I recommend it:
One of the most balanced “luxury” cleansers available. The combination of glycolic and salicylic acids gently refines pores and improves texture without compromising the barrier, while chamomile and antioxidants calm redness.
2. SkinCeuticals LHA Cleansing Gel — The Medical-Grade Deep Clean
Key ingredients: LHA (lipohydroxy acid), glycolic acid, salicylic acid
Best for: Oily skin, adult acne, stubborn clogged pores, uneven texture
Why I recommend it:
This combines three exfoliating acids for multi-depth pore clearing. LHA is more tolerable compared to traditional salicylic acid alone. It’s often recommended for mature or oily skin with persistent clogged pores and texture irregularities.
3. Kate Somerville EradiKate 3% Sulfur Foaming Cleanser — For Stubborn Breakouts
Key ingredients: 3% sulfur, soothing botanicals
Best for: Stubborn inflammatory acne, oily skin, benzoyl peroxide-sensitive skin
Why I recommend it:
Sulfur shows keratolytic, antimicrobial action with fewer irritation reports than benzoyl peroxide, making it ideal for oily or combination skin that hasn't responded well to other actives.
4. CeraVe Hydrating Cream-to-Foam Cleanser — The Non-Medicated Hero
Key ingredients: Amino acids, ceramides, amino surfactants
Best for: Sensitive skin, dry skin, retinoid users, post-procedure recovery
Why I recommend it:
Sometimes the best acne cleanser is one that doesn’t contain actives. This gentle cleanser removes oil and makeup while restoring hydration through ceramides—ideal when using strong actives.
5. La Roche-Posay Toleriane Purifying Foaming Cleanser — The Dermatologist Favorite
Key ingredients: Ceramide-3, niacinamide, prebiotic thermal water
Best for: Oily, acne-prone, sensitive skin; those who can't tolerate harsh cleansers
Why I recommend it: There's a reason this cleanser is recommended by over 100,000 dermatologists worldwide—its gentle yet effective, ph 5.5. The prebiotic thermal water contains selenium, a natural antioxidant that calms sensitive skin. Niacinamide reduces inflammation and strengthens the barrier, while ceramide-3 helps maintain moisture.
6. PanOxyl Maximum Strength Antimicrobial Acne Foaming Wash — The Heavy Hitter
Key ingredients: 10% benzoyl peroxide (maximum FDA-approved strength)
Best for: Moderate to severe acne, inflammatory breakouts, cystic acne, body acne, those who need aggressive treatment
Why I recommend it: Maximum FDA-approved strength for aggressive antimicrobial action. Contact therapy delivers antimicrobial benefits with better tolerability than leave-on gel, perfect for widespread acne, body breakouts, or when layering with other actives like retinoids.
Pro Tip: Start with 30-sec - 1 minute contact therapy, gradually increase to 2-5 minutes as tolerated. The higher strength means higher efficacy, but also greater potential for dryness, irritation, and bleaching of fabrics. Not ideal for sensitive or barrier-compromised skin.
The Bottom Line
The goal is to remove impurities effectively while protecting the skin barrier. If a cleanser causes irritation or dryness, patients are less likely to tolerate the retinoids, acids, prescriptions or in office treatments that actually clear acne.
When recommending a cleanser, consider:
Skin type and sensitivity
Current treatment regimen
Whether active or barrier-supportive care is most appropriate
The right cleanser is the one that aligns with their regimen, complements skin physiology and supports treatment success.
Need help refining your skincare recommendations?
Partner with Esther's Wellness for pharmacist-led consulting support. We help medical practices and aesthetic providers build evidence-based product protocols that improve client outcomes and boost retail performance.
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References
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