Prescription Acne Treatments

If home remedies, complementary, and over-the-counter products don’t provide sufficient relief after two months, consult a physician for one of the many prescription acne treatments available after a consultation with a dermatologist.

• Benzoyl peroxide gels. These are stronger formulations of over-the-counter products. However, they may cause dry skin, reddening, and allergic reactions, and bleach any clothing that comes in contact with the gel.
• Topical retinoids (Retin-A, Renova, Differin). These drugs, derived from vitamin A, come in several forms: gels, creams, and liquids. They keep dead skin cells from clumping together as they move through your pores. They’re effective, but often cause side effects: aggravation of acne for the first few weeks, then skin iritation, redness, peeling, itching, and sun sensitivity. Pregnant women or those attempting to conceive should not use topical because there’s a small risk of birth defects.

  Dermatologists may prescribe topical retinoids in combination with benzoyl peroxide or antibiotics.

• Oral retinoid (Accutane). Chemically known as isotretinoin, this drug reduces sebum production about 80 percent within a month, and eliminates most of the bacteria that contribute to acne. It is particularly effective against severe, stubborn acne.

  But Acutane can cause many side effects: dry skin and eyes, vaginal dryness, nose bleeding, skin reddening, muscle and joint pain, skin infections, elevated levels of liver enzymes, and blood fats (trigylcerides), and depression. Many of these side effects resemble vitamin A overdose, don’t take vitamin A supplements while taking Accutane.

  Other drugs may aggravate Accutane side effects, so talk with your physician about any other medications you are taking before beginning Accutane therapy. In addition, isotretinoin is a potent cause of birth defects.

  NOTE: If you’re pregnant or considering pregnancy, don’t use Accutane. Use a reliable form of birth control and have at least one normal menstrual period after discontinuing the drug before attempting to conceive.

  Sudden eruptions of severe acne in adulthood may be caused by a tumor or other potentially serious condition that affects your hormone production. Consult a physician promptly.

• Antibiotics. Antibiotics can be applied topically as gels or lotions, or taken orally. They eliminate the bacteria invoved in acne. Topical antibiotics may prescribed in combination with benzoyl peroxide or Retin-A.

  In stubborn cases, physicians prescribe oral antibiotics (tetracycline its relatives, minocycline or doxycycline, or erythromycin) often in combination with a topical treatment. Oral antibiotics take several weeks to work and may cause unpleasant side effects: diarrhea, stomach upset, increased sun sensitivity, and an increased risk of vaginal infections (antibiotics alter the vagina’s natural pH).

  Do not take tetracycline with milk, dairy products, or vitamin/mineral supplements, which interfere with the drug’s action. Pregnant women should not take tetracycline. It can discolor the developing baby’s teeth. Avoid exposure to sunlight and/or wear sunblock with SPF 15 or higher when outdoors. Tetracycline can also decrease the effectiveness of oral contraceptives and other forms of birth control should be used while taking this drug.

• Alpha-hydroxy acids. These topically applied acids, used in cosmetic skin peeling, help prevent dead skin cells from clumping together and clogging your pores. Alpha-hydroxy acids may make your acne worse for a few weeks before it starts to get better.
• Azelaic acid (Azelex). Derived from whole grains (wheat, rye, barley), this topical drug reduces inflammation, kills bacteria, and makes dead skin cells less likely to form pore-blocking clumps. It is as effective as benzoyl peroxide and Retin-A, but causes fewer side effects, notably less skin irritation. However, it may cause itching, burning, and stinging, though these problems often subside with continued use.
• Triphasic oral contraceptives (Tri-cyclen). Although some birth control pills can cause or aggravate acne, one type of Pill helps treat it. Triphasic oral contraceptives suppress the androgens that cause acne, according to several studies that persuaded the Food and Drug Administration to approve the medication as a second-line treatment for women with hormonally-linked acne.