When Over-the-Counter Acne Treatments Aren't Enough: What a Dermatologist May Prescribe

Adult acne is common. Dermatologists tailor treatment based on acne type and may prescribe stronger topical retinoids, topical benzoyl peroxide/antibiotic combinations, oral antibiotics (short courses), hormonal therapies (combined birth control or spironolactone for people assigned female at birth), or isotretinoin for severe cases. Expect several weeks to months for improvement and routine monitoring for side effects and risks.

Adult acne is common

Many people expect acne to end with adolescence, but adult-onset acne - or recurrence in your twenties and beyond - is common. Breakouts can be frustrating and, when severe, can lead to scarring. A dermatologist can evaluate your skin and suggest prescription options when over-the-counter (OTC) products don't help.

How dermatologists decide on treatment

At a visit your dermatologist will examine your skin, review medical history, ask about birth control or pregnancy plans, and discuss past treatments. The plan depends on acne type (inflammatory papules and pustules, nodules/cysts, comedonal acne), severity, and your health goals.

Topical prescription treatments

Topical prescription medications include retinoids (tretinoin, tazarotene, higher-strength adapalene) and topical antibiotics often combined with benzoyl peroxide. Prescription retinoids unclog pores and reduce inflammation; they are stronger than most OTC options. Benzoyl peroxide kills acne bacteria and is commonly paired with topical antibiotics to limit resistance. Expect dryness and sensitivity early in treatment.

How long until they work?

Most topical prescriptions need several weeks to show improvement; many patients see clearer skin after 6-12 weeks.

Oral antibiotics and resistance concerns

For moderate inflammatory acne, dermatologists may prescribe oral antibiotics such as doxycycline or minocycline. These reduce bacteria and inflammation but are generally recommended for the shortest effective course to limit antibiotic resistance. Providers usually combine oral antibiotics with topical therapies.

Hormonal options for people assigned female at birth

Hormonal therapies can help acne linked to androgens. Combined oral contraceptives (estrogen+progestin) that are approved for acne can improve breakouts over months. Spironolactone, an anti-androgen used off-label for acne, can be effective for many adult women but requires monitoring for side effects.

Isotretinoin for severe or scarring acne

Isotretinoin (oral retinoid) is reserved for severe nodulocystic acne or acne that causes scarring and doesn't respond to other treatments. It can produce long-term remission but carries significant side effects and is highly teratogenic; strict pregnancy-prevention measures and regular follow-up are required.

What to expect and when to see a dermatologist

Prescription acne treatments usually take weeks to months. Side effects commonly include skin dryness, irritation, and increased sun sensitivity; oral agents have additional risks that your dermatologist will review. Early evaluation can reduce scarring and shorten time to clear skin, so see a board-certified dermatologist if OTC options fail or acne is severe.