Acne is a common skin condition that can affect people of all ages, skin types and walks of life. The impact of living with acne can be both cosmetically and psychologically significant. Thankfully there are a huge number of easily accessible treatments for acne and for the majority of people, over-the-counter skincare is enough. However, in stubborn or more severe acne, you may need to consider prescription medicine treatments. In this post we review the best topical and oral medications for acne. We explore which medicines can successfully treat acne, 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 cause or trigger acne.
In general, acne manifests as three different types of lesions. These are comedones (blackheads and whiteheads), pimples (papules and pustules) and deeper lumps (cysts or nodules). Individuals may only have one type of acne or several forms lesions at the same time. In addition, acne can have secondary side effects which may be even more devastating than the initial lesions. This includes rough texture, scars and post inflammatory hyperpigmentation or erythema.
Most people self-diagnose their acne as its very common and there is a lot of information about it. In professional circles, dermatologists assess the type, severity, and distribution of acne, which can vary from mild, non-inflammatory comedones to severe, inflammatory cysts. They also consider factors such as age, skin type, lifestyle and any potential triggers like hormonal changes, diet or stress. In some cases, especially when there is a suspicion of hormonal imbalances, you may need other tests like blood work. All together, this information can help put together a more complete and effective treatment plan.
The best treatment for acne requires an individualised approach. This should take into account the cause, type and severity of your acne as well as your individual skin type, goals and overall health. It is also really important to be aware that what works for one person may not for another.
The cornerstone of acne treatment involves a over the counter skincare products such as retinol, benzoyl peroxide, and salicylic acid. These can help to unclog pores, reduce oil production and reduce bacterial growth. However, for more stubborn or severe cases of acne, you might need medicines like antibiotics, hormonal treatments or isotretinoin. Beyond that, medical procedures like chemical peels, laser therapy or photodynamic therapy might be helpful to tackle resistant acne or address scars.
Regardless of the treatment you choose and need, there are some important things to remember. Firstly, patience and perseverance are key, as acne treatments often take time to show results. You might also need a trial-and-error approach to find the most effective regimen. Lastly, don’t forget the boring stuff! Lifestyle changes, including a balanced diet, good hydration, stress management, and regular exercise can also play a significant role in managing acne.
Who Should Consider Medicine Treatments for Acne
Deciding when and if you need to step up to prescription medicine for acne is a really tough and important point in your journey. Whilst there are no hard or fast rules, it’s usually time to consider medicine for acne when over-the-counter treatments aren’t helping or if 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 impacts 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 are designed to target acne more aggressively and comprehensively. Acne medicines can address underlying issues like hormonal imbalances, excessive oil production, or deep-seated bacteria. They can also treat scars and skin discolouration left behind by acne.
Topical Medications for Acne
Topical acne medications are usually gels or creams that you apply directly to the skin. These target acne from different directions such as killing bacteria, regulating oil, unclogging pores or lowering inflammation. Topical acne medications are generally safe with little risks if prescribed correctly. That being 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 increasing skin turnover thus helping unclog pores and prevent new lesions. They can also help with post acne hyperpigmentation and scars. They can help all forms of acne but require consistent and long term use to see visible results.
- Topical Antibiotics: This includes antibiotics like clindamycin and erythromycin. Topical antibiotics reduce inflammation and bacteria on the skin. They are often formulated with other treatments like Tretinoin or benzoyl peroxide to enhance their effects.
- Azelaic Acid: Higher concentrations of azelaic acid (over 10%) are only available by prescription in the UK. It is effective for mild to moderate acne especially in those with sensitive skin or who have rosacea. Azelaic acid is a useful topical acne medication as it has antibacterial, anti-inflammatory and exfoliating properties.
- Dapsone: Although this is technically sulphonamide antibiotic, it also acts as an anti-inflammatory drug. For this reason it may be prescribed for people with inflammatory acne.
Oral Medications for Acne
For more severe or stubborn form of acne, oral medications may help. These types of acne medicines are varied and help address the different causes or triggers. The main pathways these medicines target are reducing inflammation, fighting bacteria, regulating oil and even balancing hormones. Oral acne medicines however carry greater risks and side effects than topical acne treatments because they affect the whole body. Below ate the most common prescription oral acne medications:
- Oral Antibiotics: These are commonly used and include doxycycline, limocycline, clindamycin amongst others. Antibiotics are usually prescribed for moderate to severe inflammatory acne. They reduce bacteria and inflammation. Whilst multiple treatment courses of 3 months at a time are often needed, long-term use is avoided 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. Normally a course for treatment lasts between 6-12 months based on your response. Due to potential serious side effects, including liver problems and birth defects, strict monitoring and contraception are required during the treatment.
- Oral Contraceptives: The combined (oestrogen and progesterone) birth control pill can balance hormones that trigger acne. This is particularly beneficial for teenage acne or hormonal acne due to conditions like polycystic ovarian syndrome.
- Spironolactone: This is a blood pressure medication that also blocks the male hormones (androgens) which can cause acne. It is particularly effective for women with hormonal acne, especially those who experience flare-ups around menstruation. Spironolactone regulates oil production.
Choosing the Right Acne Medicine
Everyone is different and there are many factors which determine the best acne medicine for you. Your doctor will take into account your type of acne (inflammatory or non-inflammatory), severity, skin type and overall health. Based on this they may prescribe topical or oral acne medications or a combination of the two. If you have medical problems, allergies or take medications that may put you at a greater risk of side effects, they may advise against any type of acne medicine and instead recommend over the counter and professional skin treatments. Ultimately, the best way to treat acne is with a personalised approach. As such, everyone’s acne treatment plan will differ. The only unifying experience is to find a sympathetic and experienced doctor to help support you during your acne journey.
Although acne is a complex skin condition, there are a number of medical and non medical treatment options. For those with stubborn or severe acne, medications might be a viable option. Your doctor will help you decide whether oral and/or topical acne medicines can help clear up your skin as well as treat any discolouration, scars or texture left behind by acne. Despite the effectiveness of acne medicines, there is no instant cure for acne. You will still need to follow a consistent acne skincare routine and use any medications regularly and for month or longer to see visible results. You will also need to maintain your results with a good skincare routine after your treatment and may suffer intermittent relapses every now and again that need a shorter course of acne medicine.
At City Skin Clinic, we are intensely passionate about personalised skincare. Our doctors offer safe and effective treatments like Tretinoin and Hydroquinone through our online skin clinic. We treat skin conditions like acne, hyperpigmentation, melasma and skin ageing. To start your personalised skincare plan, book a virtual video consultation or use our online consultation form. The journey towards great skin starts here.