Prescription topical treatments for hormonal acne

What makes an acne treatment hormonal?

Androgens are hormones that stimulate the skin's oil glands. Their activity contributes to excess oil and inflammation. Most people with acne have normal circulating hormone levels, so acne does not automatically mean your blood hormone levels are high. A topical antiandrogen targets androgen activity in the skin. Other acne medicines address blocked pores, inflammation or bacteria, and a dermatologist can combine treatments that address different parts of the problem.1

Which prescription topicals are options?

Clascoterone has stronger clinical support than compounded topical spironolactone, including two large randomized trials. Topical spironolactone has limited, sometimes conflicting results and uncertain absorption into the body. A compounded spironolactone cream is not interchangeable with oral spironolactone simply because the names match.1

Which option should you discuss with your dermatologist?

If you want a topical treatment that directly targets androgen activity, ask about clascoterone. It is an acne treatment for both men and women, with limited systemic effects on reproductive hormones. Cost can be a barrier, which makes the pharmacy counter an awkward place for a plot twist. Ask about the cost before filling clascoterone, which leaves the receipt with less dramatic material.4

If blocked pores and pimples are the main concern, discuss a retinoid: adapalene helps clear blackheads, whiteheads and pimples. If dark marks remain after spots clear, azelaic acid is another ingredient to discuss because it treats acne and can fade those marks. Not every useful acne ingredient needs a prescription, and availability depends on the medicine and market.3

How do you use prescription acne topicals?

1. 1Wash gently. Use a gentle cleanser twice a day, and do not scrub your skin.
2. 2Apply the medication as prescribed. General acne application guidance is a thin layer over the whole acne prone area, not just visible spots.
3. 3Follow the schedule for your specific prescription. Clascoterone 1% was studied twice daily; other medicines need their own directions.
4. 4Use moisturizer daily if treatment makes your skin dry. Applying moisturizer after washing helps retain water in the skin.

Use acne medication consistently rather than only when a spot appears. Treating the whole acne prone area addresses existing acne and helps prevent the next breakout. If your dermatologist prescribes several medicines, follow that combined plan rather than adding more acne products on your own.3

How long does treatment take?

For acne medication generally, fewer breakouts can appear after 4 to 8 weeks, with clearing around 16 weeks when treatment works. Clascoterone trials measured improvement at 12 weeks. Those are different milestones: early improvement is not the same as clearing. If the plan is not producing the results you need after weeks of regular use, arrange a review rather than repeatedly changing products.13

What if your skin becomes dry or irritated?

Adapalene, tretinoin and tazarotene tend to dry and irritate skin, as do benzoyl peroxide and salicylic acid. Daily moisturizer can help your skin tolerate these medicines. Choose a moisturizer labeled "oil free", "noncomedogenic" or "won't clog pores"; these descriptions mean it is unlikely to cause acne. The moisturizer container offers more useful reading than the product name, for once, which is a modest literary achievement for packaging.5

What about pregnancy or trying to conceive?

If you are pregnant or trying to become pregnant, discuss acne treatment with a dermatologist before starting it yourself. A medicine being applied to the skin does not make pregnancy safety automatic. Check with your healthcare provider before starting or stopping a medicine during pregnancy, including prescription treatments and products bought without a prescription.36

When is a topical treatment not enough?

Moderate to severe acne that is not adequately controlled with topicals can require treatment taken by mouth. Oral hormonal options include spironolactone and combined oral contraceptives; they are generally used in female patients. These are separate treatment decisions, not stronger versions of the same cream.1

• See a doctor for deep, painful lumps, lots of spots or acne that is causing scars.
• Arrange a review if treatment is not helping or acne is affecting your mental health.
• Seek medical assessment for hot, swollen, red skin, which can indicate infection. Redness can be harder to see on brown and black skin.
• Discuss persistent dark marks with a dermatologist, especially when new spots keep leaving more marks.