Prescription acne medication: what are your options? 

Most of us have experienced acne at some point in our lives. You may have tried various over-the-counter (OTC) acne creams and home remedies with varying degrees of success. But what about prescription acne medication? Read on to learn more about these acne treatment options and potential side effects. 

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Most acne treatments target the underlying causes of acne, namely (Sutaria, 2021):

• Clogging of skin pores with oil (sebum) and dead skin cells

• Bacterial growth

• Inflammation

If your acne is mild or responding to over-the-counter treatments, stick with what is working.

However, if your acne is not improving or leaving dark spots or scars, it’s probably time to discuss prescription acne treatment options with a dermatologist (skin specialist). 

People with moderate to severe acne often don’t see enough improvement from OTC acne creams, so they turn to acne prescription medication for help. Fortunately, there are many options to treat acne; you can find both oral (by mouth) and topical (applied to the skin) prescription acne treatments. Some prescription medications are also available over-the-counter; usually, the stronger formulations are prescription only.

Prescription acne creams

• Topical retinoids: Retinoids are some of the most popular and effective prescription acne creams. These include tretinoin (brand name Retin-A), adapalene, and tazarotene. They work by unclogging pores, decreasing oil production, and reducing inflammation (Leyden, 2017). 

• Topical antibiotics: These medications not only kill the bacteria that contribute to acne but also have anti-inflammatory effects. Because using these antibiotics alone may contribute to antibiotic resistance, most dermatologists will recommend you use them together with other non-prescription treatments, like benzoyl peroxide. The most commonly used topical antibiotics include clindamycin and erythromycin (Zaenglein, 2018).

• Azelaic acid (15% or higher): Higher doses of azelaic acid are sometimes used to lighten dark acne scars (aka post-inflammatory hyperpigmentation). Azelaic acid can also help kill skin bacteria and improve inflammation (Zaenglein, 2016). 

• Topical dapsone 5% or 7.5% gel: Scientists don’t understand the precise way this drug works, but it helps to reduce the inflammation in acne. And it seems to work better in women than in men (Zaenglein, 2016).

Prescription pills for acne

• Isotretinoin (brand name Accutane): This oral retinoid is one of the most effective prescription treatments for moderate to severe acne. It treats skin bacteria, clogged pores, increased oil production, and inflammation. However, as we’ll discuss in the next section, this medication can cause some severe side effects, so it’s not right for everyone (Fallah, 2021). 

• Oral antibiotics: Just like their topical counterparts, antibiotic pills kill bacteria and have anti-inflammatory properties. In general, dermatologists use them for the shortest time possible to avoid antibiotic resistance, and they are often combined with other treatments. The most commonly used antibiotic acne pills are the tetracyclines, namely doxycycline, minocycline, and sarecycline (brand name Seysara). Other options include erythromycin, azithromycin, trimethoprim/sulfamethoxazole (TMP/SMX) (Zaenglein, 2016; Moore, 2020).

• Combined oral birth control pills: These drugs contain estrogen and progesterone to help restore hormone balance. Oral birth control also decreases levels of androgen, a type of hormone that makes you more prone to oily skin and acne. This combination of features makes them an effective hormonal acne treatment. The FDA currently approves four oral birth control combinations for treating acne (but others may be used off-label). 

• Spironolactone: Another type of hormonal acne treatment, spironolactone works by blocking androgens in the skin and lowering free testosterone levels to decrease breakouts and skin oiliness (Zaenglein, 2016).

All medications can cause side effects—the trick is to balance the risks with the benefits. Topical treatments like creams and gels generally have fewer side effects than pills. Acne creams only act where you put them, whereas acne pills can have effects throughout the body. Let’s dive into a few of the most common side effects of the various prescription acne medications.

Topical retinoids

Topical retinoids make you more sensitive to the sun and more likely to sunburn, so you need to apply sunscreen (at least SPF 30) to your face, wear protective clothing, and avoid excessive sun exposure (Yoham, 2021).

Other common side effects include (Yoham, 2021):

• Dry skin

• Itching

• Skin redness

• Burning or stinging sensation

• Peeling

If you are pregnant or breastfeeding, you should avoid topical retinoids (Williams, 2020).

Topical antibiotics

These acne creams increase your risk of developing antibiotic resistance if you use them as your only acne treatment. Your dermatologist will likely recommend that you combine them with another form of acne therapy. Otherwise, topical antibiotics are generally well-tolerated with minimal side effects (Zaenglein, 2016). 

Azelaic acid 

Common side effects of azelaic acid include (Zaenglein, 2016):

• Itching

• Burning or irritation

• Redness

• Dryness or skin peeling

• Rash

• Allergic contact dermatitis

Dapsone gel

Like many of the other acne creams, common side effects of dapsone gel include (Zaenglein, 2016): 

• Skin peeling

• Dryness

• Redness

• Burning

• Itching

Dapsone is often used in combination with other non-prescription and prescription acne treatments. However, if you combine it with benzoyl peroxide (a common OTC acne cream), you may notice an orange-brown skin discoloration. But don’t worry—you can wash it off.

Isotretinoin

While oral isotretinoin is an effective acne treatment, it comes with some serious warnings. Women who haven’t gone through menopause yet must take serious precautions to avoid pregnancy before or during treatment with isotretinoin because the drug has a high risk of causing harm to a fetus. To help decrease the risk of birth defects, you will need to use two forms of birth control during your oral retinoid therapy and must be willing to take regular pregnancy tests (Pile, 2021).

Other potential side effects include (Pile, 2021): 

• Dry lips

• Skin dryness

• Eye inflammation

• Dry eyes

• Dry mouth and nose

Like the topical retinoids, isotretinoin also makes your skin more sensitive to the sun and more likely to burn, so wearing sunscreen and protecting yourself from sun exposure is a must. 

Oral antibiotics

Because these prescription acne medications can affect your whole body, they tend to have more side effects than their topical counterparts. Common side effects of the tetracycline class of antibiotics include (Shutter, 2022):

• Upset stomach

• Diarrhea

• Skin discoloration

• Skin that is more sensitive to the sun and sunburns

Also, pregnant women and children under eight years old should not use tetracyclines because it can permanently discolor kids’ teeth and prevent long bone growth. 

Combined birth control pills

Common side effects of using oral birth control for acne include (Zaenglein, 2018):

• Weight gain

• Breast tenderness

• Breakthrough bleeding

• Headaches

• Mood changes

Heavy smokers (≥ 15 cigarettes per day) over the age of 35 should not use combined birth control pills because of the increased risk of blood clots, heart attacks, and strokes (Zaenglein, 2016).  

Spironolactone

Spironolactone is a form of hormonal acne treatment that is only prescribed to women because it can lead to breast development in men. It is also contraindicated in pregnant people due to its potential for feminizing a male fetus. Common side effects of spironolactone include (Zaenglein, 2016):

• Urinating more frequently

• Irregular periods

• Breast tenderness

• Breast enlargement

• Fatigue

• Headache

• Dizziness

If you don’t want to use prescription medications to treat your acne, you have other options, including over-the-counter treatments, procedures, and natural remedies. 

Over-the-counter treatments

These include popular OTC remedies like (Zaenglein, 2016):

• Benzoyl peroxide

• OTC retinoids like retinol, adapalene, etc. 

• Azelaic acid (less than 15%)

• Salicylic acid

Procedures

For some with moderate to severe acne, especially those with nodular or cystic acne, your dermatologist may recommend a procedure to help improve the acne, including (Zaenglein, 2016):

• Chemical peels

• Steroid injections

• Extractions

• Laser/light therapy (Zaenglein, 2018)

Natural remedies

Many natural acne remedies exist, but they have limited scientific data backing them up. Some involve lifestyle changes, like decreasing stress, staying hydrated to keep your skin healthy, and using sunscreen to avoid sun damage. Other potential treatments that need more research include:

• Decreasing your intake of foods that cause your blood sugars to spike (high glycemic index), like fatty foods, processed carbohydrates, etc. (Dall’Oglio, 2021)

• Decreasing dairy intake (Juhl, 2018)

• Taking supplements like tea tree oil, zinc supplements, probiotics, and fish oil (Zaenglein, 2016)

Acne treatments are not one-size-fits-all. A therapy that helps one person may not give you the results you want, and you may have to try different remedies. Allow yourself time to find the best treatment options for your skin. 

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Current version

May 26, 2022

Written by

Chimene Richa, MD

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.