Acne Treatments and Medications

Although it’s often associated with teens and adolescents, acne is the most common skin condition in the United States and can affect people of any age. Acne is a skin condition involving blockage and inflammation of hair follicles and their corresponding sebaceous glands by oil, dead skin, and sometimes bacteria.

What is acne?

The National Center for Biotechnology Information explains that acne can manifest as whiteheads, blackheads, and pimples that occur mainly on the face, chest, upper back, and shoulders.

As stated earlier, acne is one of the most common skin conditions in the U.S., especially among adolescents. The main causes of acne include hormonal fluctuations that cause the sebaceous glands in the skin to produce excess oil and/or the presence of bacteria.

Types of acne

Acne often falls into two categories: non-inflammatory or inflammatory. Non-inflammatory acne occurs when oil clogs pores and creates whiteheads and blackheads. Inflammatory acne occurs when bacteria infect clogged pores, causing papules (pimples that do not contain pus), pustules (pimples that do contain pus), and/or cysts (inflammatory nodules).

The development of new treatments and research on acne is ever ongoing. Acne is a visible skin condition that often causes scarring and dark spots. Many people are affected psychologically by acne and experience symptoms like low self-esteem. Researchers are always looking for new ways to treat acne to bring relief to those who live with it, but the reality is that every management approach takes trial and error, as well as time.

This guide explains the different types of acne treatments that a healthcare provider may recommend or prescribe. These include over-the-counter products, topical prescription products, and some oral medication strategies.

How is acne diagnosed?

If over-the-counter medications have not helped after several months, or if acne worsens, it may be time to contact a healthcare provider. Your general care practitioner may diagnose and treat acne, then refer you to a dermatologist, especially if the initial recommendations do not work.

The appearance of papules (pimples that do not contain pus), pustules (pimples that do contain pus), or cysts often leads to a diagnosis. Lab tests are unnecessary for diagnosis. However, a healthcare provider may occasionally swab or scrape a pustule or lesion to rule out infection.

A healthcare provider may ask the following questions to help confirm a diagnosis:

• When did you first start experiencing acne?

• How long have you been experiencing acne?

• What have you tried to treat your acne so far?

• Are you currently taking any medications?

Acne treatment options

Different subtypes of acne require different treatment options. For example, many people who suffer from non-inflammatory mild acne start with natural treatments or over-the-counter (OTC) medications before they seek professional advice and prescription medications. Natural treatments often focus on washing the skin, moisturizing, treating with tea tree oil, and exfoliating to help remove dead skin cells. Skincare routines that include acne-specific washes and OTC creams containing chemicals like benzoyl peroxide can help manage breakouts and blemishes.

On the other hand, treatments for moderate acne or severe inflammatory cases of acne may require a specialist for prescriptions or other treatment options including laser removal, dermabrasion, chemical peels, or phototherapy.

Regardless of the severity of your acne, the American Academy of Dermatology is an excellent resource for both the public and dermatologists alike, as it provides valid information for someone looking to learn more about acne.

Acne medications

Acne medications fall into the following classes: over-the-counter topical medications, antibiotics, hormonal treatments (including birth control pills), retinoids, and more specialty therapies. Some types of medications can be taken orally or applied topically. A skin care specialist will determine the proper dosage and form of medication on a case-by-case basis.

Over-the-counter (OTC) topical medications

Many acne products available at drugstores contain ingredients known to help combat acne. These products can be in the form of cleansers, toners, moisturizers, creams, or gels.

Perhaps the most popular topical treatment is benzoyl peroxide. Benzoyl peroxide products are available over-the-counter in varying strengths, and should be applied to the entire affected area—not just each pimple—to help prevent future breakouts.

Other active ingredients in over-the-counter medications include salicylic acid and azelaic acid, and there is now the option of prescription-turned-OTC Differin 0.1% (adapalene) gel. These products function through different mechanisms, including exhibiting antimicrobial properties, removal and loosening of dead skin cells, and encouragement of cell turnover.

The most common side effects of topical medications include dryness, itching, or staining of clothes and bed linens (specific to benzoyl peroxide). Those with sensitive skin should take extra care to ensure their skin doesn’t dry out too much from these products. Using oil-free moisturizers after application may help with symptoms of dryness.

Antibiotics

Antibiotics work to reduce the amount of acne-causing bacteria and diminish inflammation, so are generally reserved for the inflammatory category of acne.

The Indian Journal of Dermatology explains how important it can be to combine a topical antibiotic with other acne treatments like topical retinoids or benzoyl peroxide to not only improve efficacy but also to prevent the development of antibiotic resistance. Topical antibiotics available include clindamycin and erythromycin, with some data suggesting clindamycin should be preferred due to better efficacy. Topical antibiotic application may be recommended in patients with symptoms of inflammatory acne ranging from mild to severe.

For patients with moderate to severe inflammatory acne, oral antibiotics are often prescribed as add-on therapy to topical antibiotics and also possibly topical benzoyl peroxide. Oral antibiotics may also be added to a regimen managing mild inflammatory acne for extensive or hard-to-reach locations (such as the back). The most common class of oral antibiotics prescribed for acne are tetracyclines, including doxycycline and minocycline. Common side effects from oral antibiotics include allergic reactions, nausea, or vomiting.

Retinoids

Retinoids and retinol are relatives of vitamin A and function to improve overall skin appearance, including inflammation. Retinoids, with the exception of Differin (adapalene) gel, as discussed above, require a prescription. Retinols are weaker forms of retinoids used in over-the-counter medications.

Topical retinoids are commonly used to treat dark spots from acne scarring and work as keratolytic treatments that dissolve dead skin layers. Tazorac (tazarotene), Differin (adapalene), and Retin-A (tretinoin) are popular examples of topical retinoids.

Isotretinoin is an oral retinoid (Absorica) used to treat severe nodular acne. While its exact mechanism is unknown, when administered pharmacologically it reduces the amount of oil produced by the skin and encourages cell turnover. Pregnant women should not use isotretinoin, as it may cause birth defects.

Any medication taken orally can potentially cause allergic reactions; most topical retinoids can give people hives, itching, or burning skin.

Hormonal treatments

Many people suffer from acne for hormonal reasons. Imbalanced hormones (androgens) can cause the skin to produce more sebum (an oily substance), which can clog pores. Providers often prescribe oral contraceptives to women, not only as a birth control method but also to help with adult acne. The estrogen and progesterone in birth control pills lower the amount of androgens produced by the body, which helps control acne.

Spironolactone is an anti-androgen that limits hormonal fluctuations that could cause acne. It can be an effective treatment for acne when taken with birth control. Ortho Tri-Cyclen Lo is a contraceptive containing progesterone and estrogen that inhibits ovulation. Some contraceptives contain drospirenone, which is similar to spironolactone, and generally, the combination of spironolactone with an oral contraceptive containing drospirenone should be avoided.

Hormonal treatments can cause mood swings, allergic reactions, and breast growth and/or tenderness.

Specialty therapies

Specialty acne therapies include phototherapy, extractions, and chemical peels. A skin care specialist or dermatologist can perform these therapies.

Phototherapy often requires multiple visits to a dermatologist. Extractions are a popular acne treatment in which a trained esthetician can remove blackheads and whiteheads without damaging the skin. Alpha hydroxy acids (one example of which is glycolic acid) are used in chemical peels to deeply exfoliate and peel the outer layer of the skin. This process reveals a smooth layer underneath and can stimulate collagen production. Very strong chemical peels, if not applied correctly and with care, can potentially cause hyperpigmentation or other complications. Some estheticians can perform both extractions and certain chemical peels.

What are the best medications for acne?

There is no one universal acne treatment that’s best for everyone. Skin types, conditions, and responses to treatment vary. A healthcare professional can determine the best medication for acne based on an individual’s symptoms, medical history, and response to treatments. Here’s an overview of popular acne medications that a doctor may prescribe.

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Best medications for acne