Squeeze, pop, wipe, and forget. This isn’t a long-term solution for many people who struggle with acne. If you want long-lasting relief and better-looking skin, now and in the future, it’s best to talk to a dermatologist. Acne medications are among the most important parts of acne treatment. They allow pimples to heal without scarring and while minimizing discomfort. They also prevent acne from returning. Learn about the different types of acne medication and then schedule a consultation to get an expert medical evaluation and a personalized treatment plan.
How Acne Medications Work
Not all acne medications work the same way. Acne is caused by a handful of factors, each of which may be treated individually or in combination. For the worst acne sores, antibiotics are often necessary to fight off the infection and help the body heal. Anti-inflammatories can also help minimize the extent of an acne-based infection while also helping to open pores. Other treatments work by reducing the oil secretions that commonly clog pores and create acne in the first place. Additionally, most over-the-counter products work by removing dead skin and promoting new skin growth, which is another a good protective factor against acne.
In addition to having multiple methods, the best acne medication treatment plan has multiple goals. You want to clear up any current pimples and acne lesions, reduce the chances and appearance of any acne scars, and then prevent future outbreaks as much as possible. The ingredients, actions of mechanism, and delivery method are all factors in how your medication works, but most acne medications can be divided into two types: Oral medications that you take by moth and topical medications that are applied directly to the acne.
Oral Acne Medications
- Antibiotics: The underlying cause of acne is clogged pores created from too much oil production. That said, if an infection takes hold, antibiotics can help kill it off and accelerate the healing process. The most common bacteria, propionibacterium acnes, is always present on our skin, and it creates an opportunistic infection when pores are blocked. Rather than using a full course of antibiotics to completely eliminate a one-time infection, antibiotics should be used for the shortest time possible to reduce the chances of developing a resistance. Most antibiotics for acne are either a tetracycline or a macrolide. Some antibiotics, such as clindamycin (Cleocin), are available as both an oral and topical prescription-strength medication for acne.
- Oral Contraceptive for Hormonal Acne: Oral contraceptives that use both estrogen and progestin can be effective at managing the hormonal acne of adolescence, early adulthood, and menopause. This is an option for many women who are not trying to get pregnant. However, it often takes several months to show positive effects, so other acne medications and treatments are often prescribed in the meantime. A more aggressive approach to hormonal acne in women is an anti-androgen medication, which blocks androgens from stimulating sebaceous glands. Possible side effects can include breast tenderness and painful periods. You can find more information about hormonal therapy for acne from the American Academy of Dermatology (AAD).
- Isotretinoin: Isotretinoin is a powerful oral medication that may provide long-term benefit to even severe types of acne, but which may also cause very serious side effects. A type of retinoic acid, it is believed isotretinoin works through apoptosis—a natural but highly regulated process—in which cells program themselves to die. Isotretinoin is believed to target sebaceous cells that are responsible for oily skin secretions. Common side effects include dry skin, lips, and inflamed nasal passages. Dry lips are a nearly universal side effect, so lip balm is recommended as part of taking this medication. Unfortunately, this drug can also target other cells in the body, including hypothalamic and hippocampal cells, which may explain why there are potentially serious psychiatric side effects. This can include depression and suicide. Other potential side effects include muscular and joint pain, changes in bone growth, nausea, diarrhea, abdominal pain, dry eye and irritation, reduced libido, and erectile dysfunction. Serious birth defects are common with this drug, and patients must sign a pledge to get access. If you are interested in this drug, we also recommend reading the AAD’s official statement on the use of isotretinoin. Severe, chronic acne can be a disruptive force in a person’s life. Seeking relief may be worth these risks for some people. Nevertheless, isotretinoin is only to be used once you understand all the potential side effects, when agreeing to strictly follow the treatment plan, and under the close supervision of your dermatologist. Brand names for isotretinoin include Absorica®, Accutane®, Amnesteem®, Claravis®, Myorisan®, Sotret®, and Zenatane™.
Topical Acne Medications
- Benzoyl Peroxide: Benzoyl peroxide is an anti-bacterial and an anti-inflammatory that works to reduce comedone pimples and oily skin secretions. It also prevents bacteria from developing a resistance to antibiotic treatment. For this reason, benzoyl peroxide topical treatment is commonly prescribed in conjunction with antibiotics. It’s also often used in combination with a retinoid cream. Like other acne medications, benzoyl peroxide tends to dry out the skin. It shouldn’t be used anyplace where you have a sunburn. Serious allergic reactions do happen, but they are very rare. For some people, the most annoying side effect isn’t a medical concern but the potential to stain your clothing and hair. Be careful during application, be sure to wash your hands afterward, and wait for the product to absorb and dry before covering with clothing. While available as an over-the-counter treatment, higher concentrations of benzoyl peroxide require a prescription.
- Retinoids: These treatments include adapalene (Differin), tretinoin (Avita, Retin-A), and tazarotene (Tazorac, Avage). Topical treatments include creams, lotions, and gels which may be available over the counter or through a prescription-strength medication. A derivative of vitamin A, these medications work deep into the skin to open follicles, fight bacteria, reduce oil production, and increase skin cell growth. They’re also an anti-bacterial. It’s a good idea to discuss the different classifications of retinoids with your doctor to help determine the best treatment for your type of acne. Retinoic acid is the active form of vitamin A and can immediately bind with skin cells start to work on your pores and suppress oil glands. Retinol and retinaldehyde are chemical precursors that your body must first convert to retinoic acid. Especially when using retinoic acid, it’s best to gradually increase the frequency of use. If you skin isn’t acclimated to this medication, it can suffer from excessive dryness. Other potential side effects skin irritation, burning, stinging, discoloration, and sore throat. Strong retinoids are usually prescribed for severe cases of acne after initial medications have failed to work. They are also used to treat wrinkles, warts, and psoriasis.
- Salicylic acid: As an exfoliant, this treatment helps break down oil, remove dead skin cells, and prevent clogged pores from underneath the skin. It does not, however, kill bacteria or reduce oil production from the sebaceous glands. For people who experience mild and intermittent acne pimples, this is a great product to have around. At the first signs of a pimple, apply this treatment and you can often stop acne in its tracks. Salicylic acid is a staple of most acne treatment regimens but is rarely enough on its own for moderate-to-severe acne problems. Salicylic acid is available as an over-the-counter medication but may also be part of prescription-strength acne treatments. Possible side effects include skin irritation with a mild stinging sensation, but it is often less severe than a retinoid acne treatment.
- Alpha hydroxy acids. These exfoliants also remove dead skin and debris to reveal new layers of skin. However, because alpha hydroxy acids are water-based, they cannot penetrate to the deeper layers of skin. This can be an effective for combination treatment when another acne medication is working to fight infection and open pores from underneath the skin. It can also be an effective treatment for mild acne and to reduce the appearance of acne scars. Glycolic acid and lactic acid are the two most common alpha hydroxy acids used for acne treatment. Glycolic acid is a stronger treatment in that its smaller molecule size allows it to penetrate more deeply in the skin. Lactic acid, however, is available in a wider range of concentrations, making it easier to find the optimal dosage for mild acne. These alpha hydroxy acids also point to the connection between natural remedies and over-the-counter treatments. Glycolic acid is naturally occurring in sugarcane and pineapples; lactic acid is naturally occurring in milk and milk byproducts.
- Natural/Home Remedies: There are also several natural home remedies that people use to treat and prevent acne. The evidence for the effectiveness of these treatments is limited. Topical treatments include tea tree oil, green tea, apple cider vinegar, witch hazel, fish oil, aloe vera, antioxidant facial masks, and bovine cartilage. Oral treatments include zinc and Hansen CBS (brewer’s yeast). Along with a healthier diet, exercise and stress management can also help balance hormone levels and reduce acne. Along with home remedy products, you should follow an acne self-care routine designed to treat and prevent acne. This includes habits like gentle daily washing, trying not to touch your face, and staying out of the sun and tanning beds. Certain self-care habits can also reduce and prevent acne outbreaks. Wash your skin twice a day, especially after sweating, using lukewarm water and fingertips, not a washcloth or sponge, to apply non-abrasive cleansers. Avoid rubbing or scratching your skin. Keep your hands away from your face as much as possible.
Get a Consultation from a Dermatologist
More than a generic list of things and products that you might try for acne, letting a board-certified dermatologist look at your acne will provide the best guidance, short-term and long-term, for acne medications. Schedule an appointment with our dermatology clinic in Chesterfield, MO.
*Results may vary per patient.