Which medications treat acne vulgaris?

Which skin medications do what?

Many benzoyl peroxide, azelaic acid and salicylic acid products are sold without a prescription. Adapalene is also available without a prescription in some countries, while tretinoin generally requires one. Availability depends on where you live, so ask a pharmacist rather than assuming an online product has the same status locally, which gives the shopping list an unexpected interest in borders.15

What should you start with for mild acne?

Mild acne means blackheads, whiteheads and small pimples, rather than large, painful lumps deep under the skin. For mild adult acne, choose one nonprescription product that matches the main problem: salicylic acid for blocked pores, benzoyl peroxide for mild pimples, or adapalene for blackheads, whiteheads and pimples. Azelaic acid also helps with dark marks. For benzoyl peroxide, start with 2.5% rather than jumping to 10% to reduce dryness, irritation and burning.4

A clinician can combine different treatment types for better results. Prescription combinations include adapalene with benzoyl peroxide and clindamycin with benzoyl peroxide. This differs from adding several new products yourself at once: when starting a nonprescription treatment for mild adult acne, use that product as directed for 6 to 8 weeks before adding another.345

How do you apply acne medication?

1. 1Clean the affected skin gently with a mild cleanser and water. Wash twice daily rather than scrubbing or repeatedly washing.
2. 2Apply a thin layer to clean, dry skin across the affected area, rather than putting medication only on individual spots.
3. 3Follow the product or prescription directions for frequency and timing. A nighttime application is a common approach for topical treatment, but do not add morning applications unless the directions allow them.
4. 4Continue consistently while watching for irritation. Stop the product and ask your doctor for advice if irritation becomes severe.

Topical treatments can cause redness, dryness and peeling. Dryness is common during the first 2 to 4 weeks, and skin often adjusts. Tretinoin and adapalene can initially cause peeling and dryness, so sensitive skin needs particular attention to tolerability. Avoid harsh skincare and excessive exfoliation while treating acne. Benzoyl peroxide can also bleach or discolor towels and clothing.156

How long does treatment take?

Most acne treatments take at least 4 to 6 weeks to make a noticeable difference. Effective medication for mild adult acne can produce fewer breakouts in 4 to 8 weeks, with clearing around 16 weeks. Oral treatment courses often last several months. If spots are not improving after about six weeks, ask a doctor about the plan; do not wait through months of worsening acne or new scars.145

When are antibiotic tablets used?

Oral antibiotics are options when acne is more widespread or has not cleared with topical treatment. Examples include doxycycline and lymecycline; they reduce bacteria and inflammation. Prescription treatments include both skin medicines and tablets.1

Antibiotic use should be limited where possible because bacteria can develop resistance, making antibiotics less effective. Both topical and oral antibiotics should be used alongside benzoyl peroxide. Do not treat antibiotics as an indefinite maintenance plan: after oral antibiotics stop, continuing topical treatment helps maintain control. Your prescriber should decide the course length and accompanying skin treatment.35

Which medicines address hormonal acne?

Combined oral contraceptives and spironolactone are prescription options for hormonal acne in women. The combined pill lowers testosterone, a hormone that increases skin oil production. Spironolactone can help when hormones cause or worsen acne. Birth control pills help some women but can worsen acne in others, so the choice needs a medical discussion rather than simply choosing any contraceptive pill.16

When is isotretinoin considered?

Oral isotretinoin is used for severe acne or acne that has not responded to standard topical or oral treatment. It reduces inflammation and oiliness and helps prevent spots. It can be very effective and sometimes clears acne for good, but treatment requires close supervision because of side effects. Blood tests are part of monitoring. Severe acne should be managed by a dermatologist, rather than by repeatedly switching pharmacy products.1236

Isotretinoin must not be taken during pregnancy because it causes severe birth defects. Pregnancy prevention requirements apply during treatment; in the United States, patients must enroll in the iPledge program. If you are pregnant or trying to become pregnant, consult a dermatologist before starting acne treatment yourself, including products sold without a prescription.46

When should you see a doctor?

Get medical help for deep or painful spots, lots of spots, scarring, worsening acne or treatment that is not helping. Seek assessment for possible infection if skin becomes hot, swollen and red; redness can be harder to see on brown or black skin. Acne affecting your mental health also warrants help. Persistent dark spots after acne clears are another reason to see a dermatologist. For individual large acne bumps, a clinician can consider a corticosteroid injection for faster relief of inflammation and pain.347

What helps alongside medication?

Do not pick or squeeze spots because this can cause scars. For body acne, loose, breathable clothing helps when exercising or sweating. Protect your skin outdoors with sunscreen and clothing rather than using tanning as acne treatment. Extra vitamins and minerals have not been proved to help, and dietary changes have weak support, so neither should replace an effective medication plan.157