Medical Treatments for Acne: Topical and Oral Options Explained

Topical prescription medicines - retinoids, benzoyl peroxide, and azelaic acid - treat acne by normalizing skin turnover, reducing bacteria, and lowering inflammation. Formulation choice (cream, gel, lotion) depends on skin type. Oral antibiotics (commonly doxycycline or minocycline) help with moderate to severe inflammatory acne but should be used short-term and combined with topical therapy to limit resistance. Hormonal treatments and isotretinoin are options for specific patients. Expect improvement over 6-12 weeks; consult a dermatologist for personalized care and safety guidance.

Overview

Several prescription medications help treat acne by normalizing skin cell turnover, lowering oil production, killing acne bacteria, or reducing inflammation. Common topical options include retinoids (adapalene, tretinoin, tazarotene), benzoyl peroxide, and azelaic acid. Oral options include antibiotics for inflammatory acne and other systemic therapies for more severe or persistent cases.

Topical prescription options

Topical prescription medicines come as creams, gels, lotions, and solutions. Your clinician will choose a vehicle based on your skin type. Lotions and creams add moisture and can be gentler for sensitive or dry skin. Alcohol-based gels and solutions tend to dry and may suit very oily skin or hot, humid climates.

Retinoids (adapalene, tretinoin, tazarotene) normalize follicular skin cell shedding and reduce comedones. Adapalene (brand: Differin) is available over the counter at low strength and as stronger prescription formulations. Azelaic acid (eg, Azelex) reduces bacteria and inflammation and can help with postinflammatory hyperpigmentation. Benzoyl peroxide kills Cutibacterium acnes and is available OTC and by prescription in higher concentrations; it can bleach fabrics.

Use small, pea-sized amounts of topical retinoids - usually at night. If you use benzoyl peroxide and a retinoid, separating morning and evening applications reduces the chance of irritation and avoids chemical interaction that can reduce retinoid effectiveness.

Expect some irritation and occasional temporary worsening as your skin adjusts. Noticeable improvement often takes 6-12 weeks.

Oral antibiotics and other systemic treatments

For moderate to severe inflammatory acne, dermatologists commonly prescribe oral antibiotics such as doxycycline or minocycline. These drugs reduce bacterial growth and inflammation. Because of antibiotic resistance risk, guidelines recommend using oral antibiotics only for as short a course as necessary (commonly 3 months or less) and combining them with a topical therapy such as benzoyl peroxide.

Other systemic options include hormonal therapies for women (combined oral contraceptives, spironolactone) and oral isotretinoin for severe, nodulocystic, or treatment-resistant acne. A dermatologist will discuss benefits, monitoring, and risks for each.

Safety and side effects

Tetracycline-class antibiotics (doxycycline, minocycline) can cause photosensitivity and gastrointestinal upset and are contraindicated in pregnancy. They are also avoided in young children because of the risk of tooth discoloration (generally avoided under age 8). Common side effects of topical treatments include dryness, redness, and peeling.

Broad claims that common oral antibiotics reduce the effectiveness of hormonal birth control are not supported by strong evidence except for certain drugs like rifampin. Discuss contraception with your provider if you have concerns.

Practical tips

• Follow your clinician's instructions for how often and where to apply topical medicines.

• Use a gentle cleanser and noncomedogenic moisturizer to manage irritation.

• Expect gradual improvement; don't stop treatment early if you don't see immediate results.

• See a dermatologist for persistent, widespread, or severe acne to review options such as hormonal therapy or isotretinoin and to get a personalized plan.