Acne Vulgaris - Medications

Medications

Medications can help manage the severity and frequency of acne outbreaks. A number of medications are available. Your treatment will depend on the type of acne you have (pimples, whiteheads, blackheads, or cystic lesions). These medications improve acne by:

• Unplugging skin pores and stopping them from getting plugged with oil (tretinoin, which is sold as Retin-A).
• Killing bacteria (antibiotics).
• Reducing the amount of skin oil (isotretinoin).
• Reducing the effects of hormones in producing acne (certain oral contraceptive pills for women).

The best medical treatment for acne often is a combination of medications. These could include medication that you put on your skin (topical) and medication that you take by mouth (oral).

Medication Choices

Treatment of acne depends on whether inflammation or bacteria are present. Some acne consists only of red bumps on the skin with no open sores (comedonal acne). Topical creams and lotions work best for this type of acne. However, if bacteria or inflammation is present with open sores, oral antibiotics or isotretinoin may work better.

The most common types of medications that doctors use to treat acne include:²

• Benzoyl peroxide, such as Benoxyl, Benzac, and Clearasil.
• Salicylic acid, such as Clearasil, Propa pH, and Stri-Dex.
• Topical and oral antibiotics, such as clindamycin (Cleocin, for example), sodium sulfacetamide (Novacet), erythromycin (E-Mycin, for example), and tetracycline (Achromycin, for example).
• Topical retinoid medications, such as tretinoin (Retin-A), adapalene (Differin), and tazarotene (Tazorac).
• Azelaic acid, such as Azelex, a topical cream.
• Isotretinoin, an oral retinoid.
• Low-dose birth control pills that contain estrogen (such as Estrostep Fe, Ortho Tri-Cyclen, or Yaz), which work well on moderate acne in women and for premenstrual flare-ups. Estrogen softens the effects of testosterone by lowering oil production.
• Androgen blockers, such as spironolactone. Androgen blockers can be useful in treating acne. These medicines decrease the amount of sebum (oil) made in your pores.

Medication side effects In general, doctors prefer to use topical products for acne rather than oral antibiotics, which are more likely to have side effects. Oral antibiotic side effects can include:^{3, 4}

• Yeast infections (women).
• Diarrhea.

What To Think About

If you are pregnant, talk to your doctor about whether you should take antibiotics for acne. Erythromycin is the only safe antibiotic to treat acne for women who are pregnant.⁵

Over time, bacteria can become resistant to antibiotics, which means that the antibiotics are no longer effective at killing or controlling the bacteria causing the acne. This is called drug resistance. When this occurs, a different antibiotic may be used.

After acne is under control, you often need ongoing treatment to keep it from returning. This is the maintenance phase of treatment. Your doctor may suggest treatments other than antibiotics for long-term use, to avoid the risk of drug resistance.

Topical medications usually have fewer and less serious side effects than oral medications. However, topical medications may not work as well as oral medications for severe acne.

Isotretinoin (such as Accutane) and tazarotene (Tazorac) can have serious side effects. Women who take isotretinoin or tazarotene need to use an effective birth control method, to avoid having a baby with serious birth defects. The U.S. Food and Drug Administration (FDA) has announced that the companies that make isotretinoin have a program to register doctors who prescribe isotretinoin and the people who take it. The program is to ensure that women taking this medicine understand the risk of birth defects, take precautions to avoid pregnancy, and know what to do if they become pregnant. If your doctor suggests that you take isotretinoin, you must be registered with iPLEDGE in order to get the drug. You can get more information and register at www.ipledgeprogram.com or by telephone at 1-866-495-0654.

The FDA’s Center for Drug Evaluation and Research division has also warned that isotretinoin (such as Accutane) may be associated with depression, psychosis, and, in rare cases, suicidal thoughts or attempts. The link between this medicine and depression is not clear and is being watched very closely. Talk to your doctor about the side effects of isotretinoin to decide whether it is right for you. If you are taking isotretinoin and feel depressed, see your doctor for treatment.

Should I take isotretinoin (such as Accutane) for acne?