Health Education

The ultimate guide to acne treatments and medications

Jessy Humann headshot By | August 23, 2019

What is acne?

Although it’s often associated with teens and adolescents, acne is the most common skin condition in the United States. It can affect people of any age. It’s estimated that 50 million people experience acne every year. Acne treatments range from home remedies and over-the-counter cleansers to acne medications and skin therapies. However, the first step to treat acne is identifying what type of acne you have.

The National Center for Biotechnology Information explains that acne can manifest as black and white comedones, nodules and cysts, papules, or pustules. These are more commonly referred to as whiteheads, blackheads, and pimples, and occur mainly on the face, chest, upper back, and shoulders.

The main causes of acne include hair follicles being clogged by oil and dead skin cells, hormonal fluctuations that cause the sebaceous glands in the skin to produce excess oil, and bacteria.

Types of acne

Acne often falls into two categories: inflammatory or non-inflammatory. Non-inflammatory acne occurs when oil clogs pores and creates whiteheads and blackheads. Inflammatory acne occurs when bacteria infects clogged pores, causing cystic acne, papules, and pustules.

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 can experience things like low self esteem. Doctors are always looking for new ways to treat acne to bring relief to those who live with it.

This guide explains the different types of acne treatments that a dermatologist may prescribe or recommend. These include but are not limited to: retinoids, antimicrobials, combination therapies, over-the-counter products, and antibiotics.

How is acne diagnosed?

Acne is a skin problem caused by clogged hair follicles, hormonal imbalances, or bacterial infection, among other things. Adolescents are especially at risk for acne, as their hormones tend to fluctuate.

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

The appearance of pustules, papules, or cysts often lead to a diagnosis. Lab tests are unnecessary for diagnosis. However, a doctor may occasionally swab or scrape a pustule or lesion to rule out infection.

A doctor 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 medications before they seek professional advice and stronger medications. Skincare routines that include acne-specific washes and over-the-counter creams containing chemicals like benzoyl peroxide can help manage breakouts and blemishes. Natural treatments often focus on washing the skin, moisturizing, spot treating with tea tree oil, and exfoliating to help remove dead skin cells.

On the other hand, treatments for moderate acne or severe inflammatory cases of acne may require a specialist. Such treatments may include 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 therapies. Some types of medications can be taken either orally or applied topically. A skincare specialist will determine the proper dosage and form of medication on a case-by-case basis.

Over-the-counter 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. One study done by Johnson & Johnson Consumer and Personal Products Worldwide explains how effective it can be when used appropriately on the skin.

Other active ingredients in over-the-counter medications include salicylic acid, azelaic acid, and dapsone gel. These products are antimicrobial, remove and loosen dead skin cells, and encourage cell turnover.

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

Antibiotics

Antibiotics work to reduce the amount of acne-causing bacteria and diminish inflammation.

Erythromycin is a topical antibiotic used for inflammatory acne, though your dermatologist can also prescribe it orally. 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. Clindamycin phosphate is another example of a topical antibiotic.

Amoxicillin, taken orally, can help kill acne-causing bacteria. Doxycycline works in a similar manner, though it’s used more commonly for people with rosacea. Common side effects from oral antibiotics include allergic reactions, nausea, or vomiting.

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. Physicians 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. Other types of FDA-approved birth control include Estrostep and Yaz. Hormonal treatments can cause mood swings, allergic reactions, and breast growth and/or tenderness.

Retinoids

Retinoids and retinols are derivatives or relatives of vitamin A, which works by targeting how much oil the skin produces. Retinols are weaker forms of retinoids used in over-the-counter medications. Retinoids require a prescription.

Topical retinoids (retinols) 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. It works by helping to reduce 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.

Therapies

Acne therapies often include chemical peels, photodynamic therapy, extractions, and phototherapy. A skincare specialist or dermatologist can perform these therapies. Some estheticians can perform both extractions and certain chemical peels. Phototherapy often requires multiple visits to a dermatologist.

Extractions are a popular acne treatment. 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.

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 doctor 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.

Drug Name Drug Class Administration Route Standard Dosage Side Effects
Amoxicillin  Antibiotic Oral One 500 mg capsule taken daily as directed by a doctor Diarrhea, hives, or trouble breathing
Oracea
(doxycycline)
Antibiotic Oral One 40 mg delayed-release capsule taken daily on an empty stomach Diarrhea, headaches, or stomach pain
Absorica
(isotretinoin)
Retinoid Oral One 10 mg capsule taken twice daily Nosebleeds, rash, or dry mouth
Ortho Tri-Cyclen Lo
(ethinyl estradiol-norgestimate)
Contraceptive Oral One tablet taken daily at the same time every day Hives, breast tenderness, or vaginal bleeding
Tazorac
(tazarotene)
Retinoid Topical Applied as a thin layer to affected area as directed Skin itching, hives, or blisters
Retin-A
(tretinoin)
Retinoid Topical Applied as a thin layer to affected area as directed Burning skin, redness, or hives

A doctor determines the best dosage based on medical conditions, response to treatment, age, and weight.

Other possible side effects exist. This is not a complete list.

What are some common side effects of acne medications?

As with any medication, there are always potential side effects. Many topically applied acne medications may result in itchy, red, or burning skin. Oral medications may result in nausea, vomiting, or diarrhea. These side effects may occur upon beginning treatment, but they should subside. Contact your doctor or pharmacist if your side effects persist or worsen.

Acne medications may also cause allergic reactions that result in hives, difficulty breathing, or dry eyes, throat, and mouth. You should seek immediate medical care if you believe you are experiencing an allergic reaction.

This list of side effects is not comprehensive. Ask a healthcare professional for more details regarding the possible side effects of a particular medication.

Home remedies for acne

Many people rely on home remedies and natural treatments to alleviate their acne symptoms. Certain lifestyle changes may help prevent acne from worsening or recurring. Home remedies, natural treatments options, and lifestyle changes are all ways that people who live with acne can try to reduce their symptoms. Many natural supplements taken by people to help with their acne are not approved by the FDA. Here are some popular home and natural remedies for acne:

  • Reduce stress. You can reduce stress by exercising, sleeping more, or meditating. Hormones released during moments of stress have been shown to increase the skin’s oil production, which can cause more acne.
  • Make dietary changes. Eat foods high in vitamin A, zinc, and omega-3 fatty acids. These nutrients are known to reduce inflammation and support aspects of skin health such as healthy collagen production. The FDA doesn’t regulate supplements as drugs to treat conditions, but this shouldn’t deter you from speaking with a skincare professional about them.
  • Use tea tree oil. Spot treat blemishes with tea tree oil or use cleansers, moisturizers, or scrubs that contain it. Tea tree oil naturally fights bacteria and reduces inflammation.
  • Apply witch hazel. After cleansing, use witch hazel as a toner. Witch hazel is antibacterial and has anti-inflammatory and healing qualities.
  • Exfoliate regularly. Exfoliation helps remove dead skin cells, which can clog pores and worsen acne.
  • Try non-comedogenic products. Purchase non-comedogenic acne products that are made for acne-prone skin and that won’t clog pores. Many companies, like Neutrogena and Proactiv, sell non-comedogenic face washes, scrubs, and moisturizers.

Frequently asked questions about acne treatment

How can I clear up my acne fast?

Unfortunately, there is no fast fix for acne. Many people have success with over-the-counter topical applications and proper skincare routines, but the skin takes time to adjust and heal. Spot treatments may be the quickest way to treat breakouts, and many people choose products with active ingredients like tea-tree oil, salicylic acid, or benzoyl peroxide in such cases.

How long does it take acne to go away?

If home remedies or over-the-counter products, such as benzoyl peroxide or salicylic acid, don’t clear up acne within a couple of months, it may be time to visit a general care practitioner or dermatologist. Some naturopathic doctors treat acne as well. Still, oral medications prescribed by a healthcare professional can sometimes take several months to see results.

What would a dermatologist prescribe for acne?

A dermatologist may prescribe antibiotics, retinoids, hormonal therapy, isotretinoins, photodynamic therapy, chemical peels. They also may suggest lifestyle changes or natural remedies.

Is there a pill for acne?

Many dermatologists may prescribe antibiotics, retinoids, hormonal contraceptives, or isotretinoins for cases of severe acne.

Related resources for acne: