Most Popular Prescription Drugs for Acne

Many prescription medications are used these days in acne prevention and treatment. Topical medications that are applied on the skin and used to treat mild to severe acne are usually prescribed by dermatologists.  As acne progresses, simple OTC medications alone may not be sufficient in controlling outbreaks. There is an increase in blackheads, whiteheads, pustules and papules as acne progresses from mild to moderately severe. In such cases, dermatologists will turn to prescriptions medications to control outbreaks.

The following are some of the popular prescription drugs used in treating acne. They are all used in treating moderate to severe acne. We will see their uses and a few side effects they cause. All these prescription medications must be given only by a certified doctor / dermatologist. These are not OTC products. They must not be shared between patients.

Adapalene
Adapalene usually goes by the brand name ‘Differin’. This topical retinoid acts on acne by slowing skin cell accumulation and reduces inflammation.   Adapalene helps control outbreak of blackheads and whiteheads. It can reduce the frequency and severity of acne and is very effective when combined with benzoyl peroxide. 

Common side effects of adapalene are burning sensation, redness, irritation and dry skin. Less common side effects are dermatitis, itching, acne and sensitivity to the sun. When serious side effects like swelling, erythema or eyelid itching occurs, you must consult your doctor. 

Azelaic Acid
Azelaic acid is available as a topical cream – ‘Azelex’ that contains 20% concentration of this acid. Since it helps skin renew itself swiftly, it aids in preventing clogging of hair follicles by preventing cell buildup. This reduces formation of pimples and blackheads, kills P.acnes bacteria and reduces inflammation. 

Prolonged usage of azelaic acid can cause resistance, so patients must be careful. It is not meant for children below 12 years.    Some side effects that patients can experience include swelling, burning, itching, dryness, stinging, skin rash, changes in skin color and increased redness of the skin. Side effects from azelaic acid are rare and occur only in 1-5% of patients. 

Benzoyl Peroxide
This is a popular prescription drug for acne that is also sold as an OTC product. It is available as a cream, gel or washes and is an excellent anti-bacterial agent.   It is cheap and very effective in fighting bacteria, preventing accumulation of excess sebum and clogging of pores.   There are also benzoyl peroxide soaps, pads, scrubs and washes available that can treat mild acne. 

A few common side effects include blistering, burning, redness, swelling, rashes, warm feeling on the skin, stinging or tingling sensation and dry or peeling skin. Benzoyl peroxide can bleach hair or clothes, hence use this product with care. 

Clindamycin
This is an antibiotic used in the treatment of severe acne and available as liquids, pads, lotions, gels or jelly.   A small amount of this prescription drugs for acnetopical medication applied on affected areas produces excellent results in 4-5 weeks. Clindamycin is often combined with benzoyl peroxide for better effects on severe acne. It possesses anti-inflammatory properties and helps treat acne lesions by killing P.acnes bacteria.

This product is well tolerated by most people and it produces only mild side effects like scaling, skin irritation, peeling and redness. To prevent dryness and scaling, a mild moisturizer can be used.

Dapsone
Dapsone helps control inflammatory acne. It also has anti-bacterial and anti-oxidant properties. Usually dapsone topical gels contain 5% of this medication.   Dapsone is an antibiotic that is used in combination with other acne medications or alone. Affected areas must be washed before applying a thin layer of dapsone. Each patient will have differing dosages. Hence doctor’s prescription must be carefully followed.

Some common side effects of dapsone are – dryness, oiliness, peeling, redness and warm skin. Less common but more serious side effects could be headache, itchy skin, tightness of chest, shortness of breath, joint pain, lethargy, and diarrhea, burning and such. Report if you experience any serious side effects. 

Erythromycin
Erythromycin to treat acne is available as both a topical and oral medication. Topical gels, swabs, solutions or ointments work on the skin and treat acne. Oral erythromycin works on deep-seated lesions by reaching deep into hair follicles and attacking the infection.   Before using topical erythromycin, the affected areas must be washed and dried and a thin layer of the medicine applied. Erythromycin kills P.acnes bacteria and has anti-inflammatory and anti-microbial effects on acne. It is one of the popular prescription drugs used in the treatment of mild or moderately severe acne for it is very effective and produces few side effects. 

Some side effects are redness, skin rash, swelling, peeling and dryness of skin, eye irritation, stinging or burning, itching and tenderness of the skin. 

Isotretinoin
This medication is meant solely for the treatment of severe nodular acne that has not responded to all other acne medications. It is the only treatment known to provide long-term remission from severe acne. It is a vitamin A derivative and hence called a retinoid.   It treats all the major causes of acne – clogged pores, inflammation, excess sebum production and P.acnes. This medication can be used as a standalone treatment for severe nodular acne. 

Isotretinoin produces many side effects like nosebleeds, sweating, changes to the voice, fatigue, bleeding gums, changes in skin color and such. More serious side effects also occur that must be reported.   This medication must not be given to pregnant women for it causes fetal abnormalities. So, women of childbearing age will be given special precautions that must be strictly followed when using isotretinoin. 

Oral Antibiotics
Oral antibiotics for acne are given as pills. The common ones are tetracycline, minocycline, doxycycline and bactrim. Oral antibiotics kill P.acnes bacteria and fight inflammation.   Doctors will usually prescribe higher doses of oral antibiotics and slowly reduce the dosage if acne lesions respond to treatment.   When oral antibiotics are taken for long periods, patients can develop resistance and the treatment will have to be altered. 

Side effects from oral antibiotics can be stomach cramps, diarrhea, loss of appetite, vomiting and nausea, skin discoloration, sun sensitivity, blistering of the skin and dizziness. 

Oral Contraceptives
Oral contraceptives that contain estrogen and progesterone are popular prescription drugs used in treatment of mild to severe adult acne in women. They work by reducing testosterone levels that can be high in women who are menstruating or post menopausal women. About 30%-60% of acne lesions show a dramatic improvement, when oral contraceptives are used as treatment.   Hormonal therapies like oral contraceptives can control oil production by sebaceous glands.   There are three specific birth control pills, which act on acne. Each contain the same the same type of estrogen but use different types of progesterone.

Oral contraceptives are used only when other treatment options for acne do not work. They can produce constipation, gingivitis, nausea and vomiting, bloating sensation, abnormal hair growth, weight loss or gain, tender breasts, painful periods and other side effects. If you are unable to manage the side effects, you can report to your doctor. 

Sodium Sulfacetamide
This medication is used along with benzoyl peroxide, azelaic acid or topical antibiotics to treat mild or moderately severe acne outbreaks. It helps by inhibiting P.acnes population that causes inflammatory acne.   Available as a cream, wash or lotion, sodium sulfacetamide is also used in certain cosmetics like concealers that can cover redness caused by inflammatory acne.  

It takes a few weeks before improvement can be noted and the strong odor of sulfur can turn off many consumers. Some side effects are lethargy, fever, nausea, and loss of appetite, joint pain, itching and such. Those who are allergic to sulfa drugs cannot use this medication. 

Spironolactone
This medication is available as a tablet. It is employed as an androgen-receptor blocker as it is a potassium-sparing diuretic. It is used to treat acne and hirsutism – unusual hair growth in women.  

Some side effects of spironolactone can be vomiting, diarrhea, loss of appetite, dry mouth, excessive thirst, dizziness, enlarged and tender breasts, unusual vaginal bleeding, drowsiness, stomach pain or cramps.

Tazarotene
Tazarotene is a vitamin A derivative and is a topical gel prescribed in the treatment of mild to severe inflammatory acne, blackheads and whiteheads. It works by influencing cell growth.   Tazarotene is often combined with topical antibiotics in acne treatment. It can unclog pores, therefore providing free access to hair roots for topical antibiotics to act. 

Skin irritation, scaling, peeling, inflammation, dry and itchy skin are some of the common side effects that often disappear when tazarotene usage is stopped. 

Tretinoin
Tretinoin is also a topical retinoid used in treating mild to moderate acne. It is available as creams, gels and liquids. It acts on acne by unplugging hair follicles.  By clearing pores, it reduces inflammation and helps in rapid cell turnover. This results in growth of new cells. Old cells with pimples give way to new cells and clear skin.   Tretinoin also helps to prevent formation of acne scars and is an integral part of overall acne treatment regimen. 

Side effects of tretinoin are sun sensitivity, itching, dry skin, warm skin, redness, peeling and chapping skin, stinging sensation and scaling. These symptoms are mild and will soon disappear.

General Instructions when using popular prescription drugs

Most popular prescription drugs especially topical retinoids cause sun sensitivity. Hence, you must use an adequate sunscreen (SPF 15 and above) and avoid sun lamps and tanning beds. Inform your doctor about all medications you are taking including OTC products, nutritional supplements, vitamins or herbal products, antibiotics and such. Doctors must also be aware of any illness you suffer from including all skin conditions and allergies. 

Patients are usually advised not to use various acne medications at the same time for this can cause skin irritation. They must also avoid skin care, cosmetic and bath products that contain harsh chemicals, alcohol or are abrasive on the skin. 

Severe allergic reactions to prescription drugs include hives, itching, or swelling, tightness of the chest and tingling and trouble breathing. When such symptoms occur, cease using the medication and rush to the nearest hospital at once. 

All popular prescription drugs for acne must be stored at room temperature and way from heat, light and moisture. They must be kept out of reach of children and pets. Dispose off all unused and expired medications safely. Do not flush them down toilets or pour them down the drain. 

Summary

Popular prescription drugs are the mainstay in moderate or severe acne treatment. They are often prescribed when milder OTC medications do not produce the desired effect. While the occasional pimple may not require strong medications and will disappear with an OTC cream, prescription medications are required to inhibit sebum production, clear pores and kill P.acnes bacteria that cause inflammatory acne.