Medications used to treat acne

Which medication is used to treat acne?

The choice depends on the type of spots, not on which product name sounds most like laboratory equipment, however convincing the extra syllables look on the box. Blackheads and whiteheads need treatment for blocked pores; inflamed pimples also need treatment for bacteria and inflammation. Deep, painful lumps, scarring or acne that has not improved with treatment need a medical assessment rather than another purchase from the same shelf.23

Medicines you apply to your skin

Some acne medicines are available without a prescription, including benzoyl peroxide and salicylic acid; adapalene is also available without a prescription in the US. Prescription options include other retinoids and topical antibiotics. Availability differs by country, so check with a pharmacist rather than assuming every retinoid has the same buying rules, which makes the shopping list an unexpectedly geographical document.25

Why are several medicines prescribed together?

Acne treatment can combine medicines that work in different ways, rather than asking one medicine to do every job. A plan can address blocked pores, bacteria and inflammation together. Several medicines can be combined to tackle different causes of acne. Antibiotic use should be limited, and oral antibiotics should be combined with benzoyl peroxide and other topical treatments. Use the prescribed combination rather than keeping only the tablet and abandoning the skin treatment.1

Antibiotic tablets for acne

Oral antibiotics include doxycycline, minocycline, sarecycline and lymecycline. They treat bacteria involved in inflamed acne. They can treat moderate to severe pimples, but not nodular acne, which causes deeper lumps. Courses are usually limited to several months, using the shortest period needed. Antibiotics are not a permanent maintenance plan.123

What should you know before taking doxycycline?

Doxycycline is taken once or twice daily depending on the product and prescription. Drink a full glass of water with each dose. Food or milk can help if your stomach becomes upset; ask your pharmacist how to take your particular product. Do not substitute a different doxycycline product without checking. If you miss a dose, take it when remembered unless the next dose is nearly due. Never double the dose.6

Doxycycline can increase sensitivity to sunlight, so avoid prolonged exposure and use sunscreen and protective clothing. Tell your prescriber about all medicines and supplements: iron, antacids and mineral supplements can need separate dosing times. Doxycycline can harm a fetus; tell your doctor if you are pregnant or planning pregnancy, and call immediately if you become pregnant while taking it. Discuss breastfeeding and contraception with your prescriber.6

Nausea, vomiting and diarrhea can occur. Contact your doctor if these are severe or persistent. Get immediate medical advice for headache, blurred or double vision, blistering skin, difficulty breathing or swallowing, or swelling of the face or throat. Watery or bloody diarrhea with cramps or fever also needs immediate advice, including when it occurs after treatment has ended.6

Hormonal medicines and isotretinoin

For women whose acne is caused or worsened by hormones, spironolactone or certain birth control pills can help. Combined oral contraceptives are an acne treatment option, but some birth control pills can worsen acne. Choosing contraception for acne needs a prescription discussion, not simply switching to any pill.5

Isotretinoin is an oral retinoid used for cystic acne and scarring. It reduces inflammation and oiliness and helps prevent spots. Treatment requires close monitoring and regular blood tests because of its side effects. Isotretinoin must not be taken during pregnancy because it causes severe birth defects. In the US, treatment requires enrollment in iPledge; women taking it must use two forms of birth control before starting. Men must also enroll.45

How do you use acne medication?

1. 1Wash gently with a mild cleanser. Avoid scrubbing or repeatedly washing the same area.
2. 2Apply your topical medicine according to its label or prescription, using it sparingly. More medicine does not clear acne faster.
3. 3For a retinoid, follow the prescribed schedule, often in the evening. If irritation develops, discuss using less, using it less often or applying moisturizer first.
4. 4Protect exposed skin from the sun. With retinoids, use sunscreen with broad spectrum protection, SPF 30 or higher and water resistance.

Acne products can cause redness, dryness and excessive peeling. Benzoyl peroxide can also bleach towels and clothing. Follow the directions carefully, and discuss troublesome irritation before changing a prescription routine. Do not pick or squeeze spots, because this can cause infection, slower healing and scarring.5

How long does treatment take, and when should you get help?

Expect at least 6 to 8 weeks before fewer breakouts become noticeable. Acne can flare again, and treatment sometimes needs adjustment. Contact a doctor if self treatment is not helping after several months, acne is worsening or scars are developing. Seek help sooner for deep painful spots, numerous spots, hot and swollen skin suggesting infection, or acne affecting your mental health.45