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Prescription Medications for Treating Acne
A variety of prescription medications are
used today to clear acne. Topical (applied to the skin) medications may
be prescribed for mild to severe acne. Systemic (works internally)
therapy is needed to treat severe acne and may be used for moderate
cases. These medications, which play an important role in acne
treatment, attack the different factors that lead to acne. To achieve
long-term control and resolution, dermatologists may combine therapies.
The following describes the prescription medications used in the United
States to treat acne:
Interlesional Corticosteroid Injection
When an acne cyst becomes severely inflamed, there is a good chance that
it will rupture and
scarring may result. To treat these severely inflamed cysts and prevent
scarring, dermatologists may inject such cysts with a much-diluted
corticosteroid. This lessens the inflammation and promotes healing. An
interlesional corticosteroid injection works by "melting" the cyst over
a period of 3 to 5 days.
Isotretinoin
Isotretinoin is a potent oral retinoid that is reserved for treatment of
very severe cystic acne and severe acne that has proven itself resistant
to other medications. For more information about isotretinoin, see
Treating Severe Acne.
Oral Antibiotics
For patients with moderate to severe and persistent acne, oral
antibiotics have been a mainstay of therapy for years. Like topical
antimicrobials, oral antibiotics work to reduce the
P. acnes population
(a contributing factor in acne), which, in turn, decreases inflammation.
Treatment with oral antibiotics usually begins with a higher dosage,
which is reduced as acne resolves. Generally, antibiotics are prescribed
for six months or less.
Over time, the P. acnes bacteria can become resistant to the antibiotic
being used to treat it. When resistance occurs, acne is no longer
controlled. Another antibiotic or alternative treatment can be
prescribed. Numerous studies support the effectiveness of the following
oral broad-spectrum antibiotics, which are used to treat acne in the
United States:
- Erythromycin. It is effective against a broad spectrum of bacteria,
including P. acnes. The most common side effect is irritation of the
gastrointestinal tract.
- Tetracycline and derivatives. Tetracyclines reduce the
papules and
pustules (inflammatory lesions) of acne. These medications should not be
taken by children younger than 8 years of age because they can affect
growth and stain teeth. They should also not be taken by a woman who is
pregnant or breast feeding. During pregnancy and breastfeeding, tetracyclines can affect the development of the child’s bones and teeth,
leading to skeletal defects.
A typical tetracycline regimen for treating moderate to
severe acne starts with a dose of 500 to 1000 milligrams a day, which is
decreased as improvement occurs. Long-term, low-dose tetracycline
therapy may be continued for many months to suppress acne. Higher doses
may be prescribed for very severe acne.
Two synthetic derivatives of
tetracycline used to treat acne are doxycycline and
minocycline. Doxycycline proves especially effective in treating
inflammatory acne. It can cause sun sensitivity in some patients.
Minocyline has a long history of use in treating acne. It is often
effective in treating acne that has not responded to other oral
antibiotics. Minocycline also seems to produce fewer incidents of
antibiotic resistance.
Oral Contraceptives
Oral contraceptives have been shown to effectively clear acne in women
by suppressing the overactive sebaceous glands and can be used as
long-term acne therapy. However, oral contraceptives should not be
prescribed to women who smoke, have a blood-clotting disorder, are older
than 35 or have a history of migraine headaches—without the advice of a
gynecologist.
Topical Antimicrobials
Topical antimicrobials work to inhibit the
P. acnes populations and are
used to treat patients with mild to moderately severe inflammatory acne.
They may be used alone or combined with a medication that works on
another factor that leads to acne aside from P. acnes. A dermatologist
can determine whether a topical antimicrobial is appropriate for a
patient and if so which topical antimicrobial should be prescribed.
Prescription topical antimicrobials used to treat
acne vulgaris in the
United States include:
- Azelaic acid. Naturally occurring in the skin, azelaic acid is used to
treat mild to moderate inflammatory and non-inflammatory acne. It is
believed that azelaic acid clears acne by reducing the populations of P.
acnes, decreasing the abnormal shedding of skin cells and reducing
inflammation. This medication has also proven effective in treating the
dark spots that develop in some acne patients with skin of color. Azaleic acid is well tolerated by most people and can be safely used for
years. Side effects may include skin dryness and lightening of the skin
where applied.
- Benzoyl peroxide. Benzoyl
peroxide works by killing P. acnes. However, it does not have
anti-inflammatory abilities. It is available in a wide range of
strengths and can be found as a gel, lotion, cleanser, cream and wash.
Many acne preparations include benzoyl peroxide because research shows
that benzoyl peroxide increases the effectiveness of some medicines,
such as erythromycin and clindamycin. When used in combination with
antibiotics, benzoyl peroxide also reduces the likelihood of a patient
developing resistance to the antibiotic. The most common side effects
are skin irritation, the potential to bleach hair and fabrics as well as
possible allergic reaction.
- Clindamycin. A semi-synthetic antibiotic, topical clindamycin has a long
history of successfully treating acne. It works by reducing P. acnes and
decreasing inflammation. In topical form, clindamycin has proven safe
and is well tolerated. Skin dryness and irritation are possible side
effects. It is important to use as directed to decrease bacterial
resistance that can occur with antibiotic use.
- Erythromycin. This topical antibiotic is active against a broad spectrum
of bacteria, including P. acnes. Topical erythromycin, which is an
antimicrobial and anti-inflammatory, is used primarily to treat acne.
When topical erthyromycin is combined with benzoyl peroxide, the
combination proves to be quite effective as the patient gets the effects
of two antimicrobial agents. Like topical clindamycin, erythromycin may
cause skin dryness and possible irritation. It is important to use as
directed to decrease bacterial resistance that can occur with antibiotic
use.
- Sodium sulfacetamide. A topical antibiotic that inhibits
P. acnes and
opens clogged pores, sodium sulfacetamide is effective in treating
inflammatory acne. Many products containing sodium sulfacetamide include
sulfur. Some patients do not like the smell of the sulfur or its
grittiness. Usually, the newer products that contain sulfur do not have
these problems.
Topical Retinoids
Prescribed to treat acne ranging from mild to moderately severe, topical
retinoids are a derivative of vitamin A and considered a cornerstone in
acne treatment. Retinoids work to unclog pores and prevent whiteheads
and blackheads from forming. Topical retinoids can irritate the skin and
increase sun sensitivity so it is important to use sun protection and
follow the dermatologist’s directions to maximize effectiveness. An
added benefit in using topical retinoids is that they may help diminish
the signs of aging, such as fine lines and wrinkles. Topical retinoids
currently prescribed for acne treatment in the United States include:
- Adapalene. A synthetic retinoid applied as a gel or cream, adapalene
unclogs pores and possesses moderate to potent anti-inflammatory
abilities. Improvement is usually seen in 8 to 12 weeks. Side effects
include minor skin irritation and dryness.
- Tazarotene. A synthetic retinoid available as a gel or cream, it works
to keep the skin’s pores clear and has proven effective in treating
acne. This medication should not be used by women who are pregnant, and
effective contraception is needed while taking tazarotene because the
medication has produced birth defects in animals. Skin irritation is a
possible side effect.
- Tretinoin. The first retinoid developed for topical use, tretinoin is a
natural retinoid. It works to gradually unclog pores and keep them
unplugged. In the past, many patients found tretinoin too harsh for
their skin; however, the newer forms are proving less irritating. Side
effects include redness, scaling, dryness, itching and burning. If these
occur, talk with the dermatologist who prescribed tretinoin as these
side effects can be managed by adjusting the amount applied and when it
is applied.
Reference
Thiboutot, D. “New Treatments and Therapeutic Strategies for Acne.”
Archives of Family Medicine 2000: 9:179-187.
More Information
Acne Severity
Acne Therapies
Acne Skin Care Guidelines |
