Using prescription medications to treat acne

Acne treatments that work

There are many medications available only by prescription for persons that suffer from acne. Topical medications are applied directly to one's skin and may be helpful in cases of acne found to be mild to severe. Systemic medications work internally and are often useful for moderate acne problems. These medications can offer important help in the treatment of acne and work by attacking factors that cause acne. For the best long-term solution to an acne problem, your doctor might combine different therapies. The following are some of the prescription acne medications for adults that work best:

Interlesional Corticosteroid Injection

Often, acne cysts that are severely inflamed will eventually rupture leading to scarring. In order to treat such severely inflamed cysts, the dermatologist might inject each cyst using a diluted corticosteroid, which can reduce the chance of scarring. The medication can reduce the amount of inflammation and allow the cyst to heal. These injections work by causing the cyst to melt within 3-5 days.


This medication is an oral retinoid which is very potent and reserved for use with the most severe cystic acne along with acne that has been shown resistant to other kinds of medication. You will find more information concerning isotretinoin under Treating Severe Acne.

Antibiotics (Oral)

Many patients who have persistent, severe acne find that oral antibiotics offer an excellent choice for therapy. Like the topical antibiotics, the oral medications work to help reduce the population of the bacteria P. acnes and in turn reduce the inflammation. Treatment using oral antibiotics requires an initial higher dosage that is gradually reduced as the problem is resolved. In most cases, the antibiotics are used for less than six months.

As time passes, antibiotics become less effective on P. acnes bacteria as they grow in resistance to it. When the bacteria becomes resistant the antibiotics can no longer control it. At that time, the treatment must be changed to an alternative treatment or antibiotic prescribed by the dermatologist. Broad-spectrum oral antibiotics have been shown as effective in use for the treatment of acne, including:

- Erythromycin

This broad spectra antibiotic is effective against many bacteria, including those responsible for acne. Gastrointestinal irritation is the most common side effect.

- Tetracycline and derivatives

These antibiotics are effective at reducing papules and pustules or the inflammatory lesions caused by acne. The medications are not appropriate for children younger than 8 due to the possibility of affecting growth and staining teeth. In addition, they should be avoided by pregnant or breastfeeding women. Tetracycline, when used during pregnancy or breastfeeding may affect child development of bones and teeth, resulting in skeletal defects.

Typical regimes for moderate to severe cases of acne often begin with a 500-1000 mg dose daily that is then decreased as the patient experiences improvement. These low dose tetracycline therapies can be continued long term for many months of suppression of acne. In cases of very severe acne, the dermatologist may prescribe higher dosages of the antibiotic medication.

There are two synthetic tetracycline derivatives (redoxycycline and minocycline) that are often used for treatment of acne. Doxycycline often is most effective with cases of inflammatory acne. Doxycycline can cause some patients to be extra sensitive to the sun. Minocycline has long been used in the treatment of acne. It is often effective when acne has not responded to other antibiotics taken orally. In addition, Minocycline seems to cause fewer cases of resistance to antibiotics.

Oral Contraceptives

These medications are often effective at clearing acne in women with overactive sebaceous glands and offer a solution for long-term therapy for treatment of acne. These oral contraceptives are not appropriate for women who use tobacco, have blood-clotting disorders, over age 35 or those with a history of migraines, unless so advised by a gynecologist.

Topical Antimicrobials

Topical medications can also help to inhibit the populations of P. acnes and are useful in treatment of patients who experience mild or moderate cases of inflammatory acne. Topical medications can be used in combinations with other medications that prevent acne other than P. acnes or can be used alone. Your dermatologist is the best resource in determining if the topical medication is appropriate for the patient and, if so, the correct medication to prescribe. Topical prescription antimicrobials for use with acne in the U.S. include:

- Azelaic Acid

This antimicrobial occurs naturally in the skin and provides treatment for mild to moderate cases of both non-inflammatory and inflammatory acne. The theory behind this medication is that it reduces the number of P. acnes on the skin, decreases the abnormal skin cell shedding and reduces the inflammation of acne. The medication can also prevent dark skin spots that some acne patients develop. The medication is well tolerated by many and can be used safely for years. Side effects can include lightening of skin and skin dryness in the areas of application.

- Benzoyl Peroxide

This antimicrobial works to kill the P. acnes bacteria. It does not offer; however, the anti-inflammatory abilities of other medications. Benzoyl peroxide is available in several strengths and sold as a wash, cream, cleanser, lotion and gel. There are many over the counter preparations that include this medication and it is shown to improve the effectiveness of other medications, including erythromycin and clindamycin. If used with antibiotics, benzoyl peroxide can help to reduce the risk of developing antibiotic resistance. This medication can cause skin irritation, possible allergic reactions and will bleach hair or fabrics.

- Clindamycin

This topical medication is a semi-synthetic antibiotic with a long history of success in the treatment of acne. It reduces P. acnes and helps to decrease inflammation. The topical form is well tolerated and generally safe. Possible side effects include skin irritation and dryness. Use according to directions to decrease the possibility of bacterial resistance.

- Erythromycin

This broad-spectrum antibiotic is effective against many bacteria, including P. acnes. When used topically this medication offers both anti-inflammatory and antimicrobial properties that are helpful with acne. When combined with benzoyl peroxide, the two medications provide effective relief using the effects of both medications. Topical erythromycin often leads to skin dryness and may result in irritation. Bacterial resistance can occur unless used as directed.

- Sodium Sulfacetamide

This topical antibiotic can help to inhibit P. acnes while also opening clogged pores and is useful in treatment of inflammatory acne. Many acne products containing the medication also include sulfur. Many patients prefer avoiding the smell of sulfur and its grittiness. Newer products containing sulfur help to avoid these problems.

Topical Retinoids

Topical Retinoids, derivatives of Vitamin A and an acne treatment cornerstone are prescribed for acne that ranges from mild to moderate. Retinoids help to unclog pores and stop blackheads and whiteheads from forming. Topical retinoids often irritate skin and increase sensitivity to the sun so users will want to apply sun protection and follow the doctor's directions to ensure maximum relief. These medications are also effective at diminishing fine lines or wrinkles that develop due to aging. Current Topical retinoids used in the US include:

- Adapalene

This synthetic retinoid can be applied as a cream or gel to unclog pores and provide anti-inflammatory properties. Usually results in improvement within 8-12 weeks. The medication may cause dryness or minor skin irritation.

- Tazarotene

This synthetic retinoid is also available in cream or gel form and works to clear the pores, providing effective acne treatment. Women who are pregnant should avoid use of this medication and sexually active women should have effective contraception, as it is known to produce birth defects in laboratory animals. A possible side effect is skin irritation.

- Tretinoin

Tretinoin was the first retinoid developed for use topically and is a natural retinoid. It gradually works to unclog pores and maintain them in an unclogged state. Many patients in the past found the medication to be too harsh for the skin, but newer forms are less irritating. The side effects include dryness, scaling, redness, burning and itching. If you experience these side effects, speak with your doctor as adjustment of the amount of medication and when it is applied can help to manage side effects.