When treating acne, there are a number of effective options at the drugstore. But what if they don’t work? We take a look at the prescription acne medications that could help, along with their pros and cons.
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When treating acne, there are a number of effective options available at your local drugstore, and those products are often the first line of treatment for breakouts, as they’re the easiest to get, are generally inexpensive, and, in many cases, do the job.
But, there are some stubborn, frustrating acne cases that just won’t go away with over-the-counter medications alone, no matter how well formulated they are. Instead of spending more money on product after product, if you notice your acne isn’t improving, it’s time to head to a dermatologist. There are a wide variety of prescriptions that can be just what the doctor ordered. Below we describe several, including their pros and cons, so you can make an informed decision.
Topical Prescription Acne Medications
Topical medications, which make up the majority of the prescription anti-acne treatments, generally are applied directly on the site of the breakouts. They include the following:
Prescription topical antibiotics. There are several topical antibiotics to consider; the main ones to discuss with your dermatologist are erythromycin, clindamycin, minocycline, and tetracycline. These can be used alone, but a good deal of research indicates that you can derive greater benefit by combining one of these antibiotics with benzoyl peroxide to create a far more potent and effective treatment. When combined with benzoyl peroxide, the antibiotics act more quickly, are significantly more effective for reducing inflammation and the number of breakouts, and are better tolerated, which should improve your odds of using them daily. These products typically are applied after cleansing and exfoliating.
- Dapsone is a topical disinfectant gel available by prescription in 5% strength. The brand name for this anti-acne drug is Aczone; it’s produced by Allergan (of Botox fame). Dapsone is a drug of the sulfone family of pharmaceuticals, and its relation to sulfur (the stuff that smells like rotten eggs) explains its antibacterial activity.
Double-blind, large-scale studies examining dapsone’s effectiveness on adolescent acne (paid for by Allergan) have shown that it is well tolerated and that it brought about “clinically meaningful” improvements in acne lesion count after 12 weeks, with improvements continuing with ongoing usage. Its side effects are similar to those of the “vehicle gel,” which Allergan did not identify in the studies.
Although Aczone is an option for treating inflammatory acne and the research on its efficacy is positive, it shouldn’t be the first thing your doctor prescribes unless over-the-counter products that contain benzoyl peroxide, retinoids, and salicylic acid have failed you.
Interestingly, there’s research showing that Dapsone is more effective for women with acne than for men with acne, and also that combining Dapsone with the prescription retinoid Tazorac (active ingredient tazarotene) provides better results than using either one alone.
- Retinoids such as prescription tretinoin (Retin-A, Avita, Atralin, and generics) and other vitamin A derivatives, such as tazarotene (Tazorac, Avage) and adapalene (Differin), can play a significant role in an anti-acne treatment routine.
“Retinoid” is the name of the general category for any and all forms of vitamin A. Prescription retinoid options are viable treatments for blemishes because they change the way skin cells are formed in the layers of skin as well as in the pore, improving how skin cells shed while unclogging pores, thereby significantly reducing inflammatory lesions.
Topical tretinoin and many antibacterial agents have complementary actions, and they work well together, but applying both at the same time increases the chance of side effects such as dryness, redness, or peeling. If you experience side effects, it’s best to use the two separately, applying the antibacterial product in the morning and the prescription retinoid (be it tretinoin or another) at night. Benzoyl peroxide does not deactivate modern versions of tretinoin.
- Azelaic acid is believed to work against acne-causing bacteria in concentrations of 15%–20%, and it may also pack an anti-inflammatory punch. Azelaic acid was approved for the treatment of acne in the United States in 2002, and also is prescribed to manage the symptoms of rosacea (some of which are similar to acne). It is definitely on the A-list of options for treating acne.
Oral Prescription Acne Medications
- Oral antibiotics can be extremely effective in controlling acne, but they also pose a risk of serious side effects that you must consider.
Oral antibiotics do indeed kill the bad bacteria, but they also kill the good bacteria in the body. Thus, ongoing use can lead to chronic vaginal yeast infections as well as stomach problems.
In addition, the acne-causing bacteria can become immune or resistant to the oral antibiotic. That means that if you have been taking an oral antibiotic to treat your acne for longer than six months, it can, and almost always does, become effective (but the negative side effects will continue).
New research about taking low doses (“sub-microbial” doses) to fight acne is changing the concern about bacterial resistance and adaptation. Taking such doses of oral antibiotics over the long term can improve acne, while minimizing, if not completely eliminating, the problem of the bacteria becoming resistant. It seems that lower doses of oral antibiotics have anti-inflammatory benefits instead of antibacterial benefits, but they still can kill acne-causing bacteria. However, that doesn’t mean you won’t still suffer possible systemic effects; so, whether you opt for regular or low-dose oral antibiotics, be sure to discuss the pros and cons with your dermatologist.
- Birth control pills (some types) have been shown to reduce acne lesions and oil production, in part by decreasing androgens (male hormones), which are largely responsible for causing blemishes.
Birth control pills are a combination of different synthetic estrogens and progestins (female hormones). Some progestins can increase the amount of androgens in the body, while others block the production of androgens. Because androgens stimulate oil production, blocking androgens for those prone to breakouts and oily skin is a good thing.
As a result, some of the birth control pills that block androgens have been approved by the Food and Drug Administration (FDA) and other regulatory organizations for the treatment of acne, including Ortho Tri-Cyclen (active ingredient norgestimate/ethinyl estradiol), YAZ (active ingredient drospirenone/ethinyl Estradioland), and Estrostep (active ingredient norethindrone/ethinyl estradiol). Diane 35 (chemical name ethinylestradiol cyproterone acetate) has been approved for such use in Canada.
Keep in mind that there are risks associated with taking any type of birth control pill (especially if you smoke), and you should discuss these matters with your doctor. Birth control pills also should not be the sole therapy for acne; think of them as a partner product for use with a skincare routine designed to reduce acne.
The Bottom Line
In the end, it’s important to remember that just because over-the-counter acne treatments haven’t worked for you, it’s not the end of the line as far as finding a skincare solution. A good dermatologist should be able to work with you to come up with a routine that works best for you. Keep in mind that sometimes it can take a few tries to find the solution that does the trick for you; but don’t lose hope! Clear skin can be had even if you’ve reached a point where you just don’t believe it’s possible.