Acne is a common skin condition that can affect people of all ages, skin types and walks of life. Living with acne can take a real toll, both cosmetically and psychologically. Thankfully, there are a huge number of easily accessible treatments for acne, and for most people, over-the-counter skincare is enough. However, for stubborn or more severe acne, you may need to consider prescription medicines. In this guide, we review the best topical and oral medications for acne. We also explore which medicines work, when to seek help and their potential risks or side effects.
Understanding & Diagnosing Acne
Acne is a complex condition with a number of causes and triggers. It is mainly a disease of the sebaceous glands, involving clogged pores, excess oil production and inflammation. Factors like hormonal fluctuations, genetics, stress, diet, medications and lifestyle can all cause or trigger it.
In general, acne shows up as three different types of lesion. These are comedones (blackheads and whiteheads), pimples (papules and pustules) and deeper lumps (cysts or nodules). Some people have just one type, whilst others have several at once. In addition, acne can have secondary effects that are sometimes more distressing than the original lesions. These include rough texture, scars and post-inflammatory hyperpigmentation or erythema.
Most people self-diagnose their acne, since it is very common and there is plenty of information about it. In professional circles, dermatologists assess the type, severity and distribution of the acne, which can range from mild, non-inflammatory comedones to severe inflammatory cysts. They also consider your age, skin type, lifestyle and any potential triggers like hormonal changes, diet or stress. In some cases, especially where there is a suspicion of hormonal imbalance, you may need other tests like blood work. Together, all of this helps build a more complete and effective acne treatment plan.
Treating Acne
The best treatment for acne takes an individualised approach. It should account for the cause, type and severity of your acne, as well as your skin type, goals and overall health. It is also important to remember that what works for one person may not work for another.
The cornerstone of acne treatment is over-the-counter skincare with ingredients such as Retinol, benzoyl peroxide and salicylic acid. These help unclog pores, reduce oil production and slow bacterial growth. However, for more stubborn or severe cases, you might need medicines like antibiotics, hormonal treatments or isotretinoin. Beyond that, medical procedures like chemical peels, laser therapy or photodynamic therapy may help tackle resistant acne or address scars.
Whatever treatment you choose, there are some important things to remember. Firstly, patience and perseverance are key, because acne treatments often take time to show results. You might also need some trial and error to find the most effective regimen. Lastly, do not forget the boring stuff. Lifestyle changes, including a balanced diet, good hydration, stress management and regular exercise, can also play a big role in managing acne.
Who Should Consider Medicine Treatments for Acne?
Deciding when, and if, you need to step up to prescription medicine is a tough but important point in your journey. Whilst there are no hard and fast rules, it is usually time to consider medicine when over-the-counter treatments are not helping, or when your acne is quite severe to begin with. Examples of the latter include painful cystic or nodular acne, which can lead to scars. In addition, prescription medicines can be vital when acne affects not just your skin but also your self-esteem and quality of life. These are the most common reasons people arrange a consultation with a dermatologist or other experienced skin doctor.
Doctors can prescribe more potent oral and topical acne medications. These acne medicine treatments target acne more aggressively and thoroughly. They can address underlying issues like hormonal imbalances, excess oil production or deep-seated bacteria. They can also treat the scars and discolouration left behind by acne.
| Medication | Route | Examples | Best for |
|---|---|---|---|
| Retinoids | topical | tretinoin, adapalene, tazarotene | most acne types, plus scars and marks |
| Topical antibiotics | topical | clindamycin, erythromycin | inflammatory acne (with benzoyl peroxide) |
| Azelaic acid | topical | azelaic acid over 10% | mild to moderate, sensitive or rosacea-prone skin |
| Oral antibiotics | oral | doxycycline, lymecycline | moderate to severe inflammatory acne |
| Isotretinoin | oral | Accutane, Roaccutane | severe, cystic or treatment-resistant acne |
| Hormonal | oral | spironolactone, the combined pill | hormonal acne in women |
Topical Medications for Acne
Topical acne medications are usually gels or creams that you apply directly to the skin. They tackle acne from different directions, such as killing bacteria, regulating oil, unclogging pores or lowering inflammation. On the whole, topical acne medications are safe, with little risk when prescribed correctly. That said, they can still cause dryness or irritation in some people. Below are the most commonly used topical prescription medications for acne:
- Retinoids: prescription Retinoids like tretinoin, adapalene and tazarotene work by speeding up skin turnover, which helps unclog pores and prevent new lesions. They can also help with post-acne hyperpigmentation and scars. They work for all forms of acne, but need consistent, long-term use to show visible results.
- Topical antibiotics: these include clindamycin and erythromycin. They reduce inflammation and bacteria on the skin, and doctors often formulate them with other treatments like tretinoin or benzoyl peroxide to boost their effect.
- Azelaic acid: higher concentrations of azelaic acid (over 10%) are only available on prescription in the UK. It works well for mild to moderate acne, especially in sensitive or rosacea-prone skin, because it has antibacterial, anti-inflammatory and exfoliating properties.
- Dapsone: although dapsone is technically an antibiotic, it also has anti-inflammatory effects. So, doctors may prescribe it for inflammatory acne.
Oral Medications for Acne
For more severe or stubborn forms of acne, oral medications may help. These acne medicines are varied and target the different causes and triggers. The main pathways they work on are reducing inflammation, fighting bacteria, regulating oil and even balancing hormones. However, oral acne medicines carry greater risks and side effects than topical treatments, because they affect the whole body. Below are the most common prescription oral acne medications:
- Oral antibiotics: these are common and include doxycycline, lymecycline and clindamycin, among others. Doctors usually prescribe them for moderate to severe inflammatory acne, where they reduce bacteria and inflammation. Whilst several courses of three months at a time are often needed, doctors avoid long-term use to prevent antibiotic resistance.
- Isotretinoin (Accutane or Roaccutane): this oral retinoid is the most powerful option for severe, cystic or treatment-resistant acne. Isotretinoin targets oil production, pore clogging, bacteria and inflammation all at once. A course normally lasts 6 to 12 months, depending on your response. Because of potential serious side effects, including liver problems and birth defects, it needs strict monitoring and contraception throughout treatment.
- Oral contraceptives: the combined (oestrogen and progesterone) pill can balance the hormones that trigger acne. This is particularly helpful for teenage acne or hormonal acne from conditions like polycystic ovary syndrome.
- Spironolactone: this blood-pressure medication also blocks the male hormones (androgens) that can drive acne, and it helps regulate oil production. Spironolactone is particularly effective for women with hormonal acne, especially those who flare around menstruation.
Choosing the Right Acne Medicine
Everyone is different, and many factors determine the best acne medicine for you. Your doctor will take into account the type of acne (inflammatory or non-inflammatory), the severity, your skin type and your overall health. Based on this, they may prescribe topical or oral medications, or a combination of the two. If you have medical problems, allergies or take medicines that raise your risk of side effects, they may advise against acne medicine altogether and recommend over-the-counter and professional skin treatments instead. Ultimately, the best way to treat acne is with a personalised approach, so everyone’s plan will differ. The one thing that helps everyone is finding a sympathetic and experienced doctor to support you through your acne journey.
Although acne is a complex condition, there are a number of medical and non-medical treatment options. For stubborn or severe acne, medicines might be a good option. Your doctor will help you decide whether oral and/or topical medicines can clear your skin and treat any discolouration, scars or texture left behind. However, even the best acne medicines are not an instant cure. You will still need a consistent skincare routine, and to use any medicine regularly for months or longer, to see visible results. After treatment, you will need to maintain your results with a good routine, and you may have occasional relapses that need a shorter course of medicine.
At City Skin Clinic, we are passionate about personalised skincare. Whilst we do not prescribe oral medications, our doctors offer safe and effective topical acne treatments using ingredients like tretinoin, azelaic acid, clindamycin, niacinamide and spironolactone where appropriate through our online clinic. Our doctors treat acne, hyperpigmentation, melasma, rosacea and skin ageing through bespoke compounded treatments designed around you. To start your personalised plan, book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any health concerns or questions you might have.
