10 Acne Medications: How They Work, Usage, Side Effects and More

• Acne medications include over-the counter and prescription topical products, and prescription oral medications 
• Key factors when determining the best acne medications include type, severity and cause 
• Potential side effects of acne medications must be considered when choosing treatment 

Due to the variations in the underlying causes and severity of acne, it can sometimes be challenging to treat. To meet that challenge, a wide variety of acne medications are available to address specific symptoms and causes, based on an individual’s situation.

Acne occurs when the sebaceous glands in hair follicles, or pores, produce too much sebum (oil). This buildup of sebum combines with dead skin cells and bacteria, clogging the follicles and forming comedones (blackheads, whiteheads and pimples). In severe acne, affected follicles become inflamed, resulting in pus-filled, painful cysts or nodules that extend deep into the skin. 

How Do Acne Medications Work?

Acne medications target one or more of the individual causes of acne – namely, the overproduction of sebum (oil), the buildup of dead skin cells and infection due to bacteria.

Changes in hormones that cause the overproduction of sebum are also addressed by specific acne medications. 

Controlling hormones

During puberty, pregnancy and menopause, natural increases in androgens (male hormones) occur that cause overproduction of oil. Some acne medications work by bringing hormones to normal levels.  

Exfoliating skin

Getting rid of dead skin cells that combine with excess oil and other debris to block follicles is key for preventing the formation of blackheads, whiteheads and other blemishes.

Killing bacteria

Acne can be exacerbated by Propionibacterium acnes, a bacteria that is normally present on the skin. When bacteria become trapped within blocked pores, infection occurs and results in pimples, cysts and nodules that are pus-filled and inflamed. Certain antibiotics as well as topical medication can kill bacteria and reduce the severity or eliminate blemishes altogether.

Reducing sebum buildup

One cause of acne is the overproduction of sebum by oil glands in the skin. An important aspect of acne treatment is drying up excess oil and controlling oil production. 

Topical Acne Medications

Topical medications for acne include creams, gels, ointments and cleansers. They’re considered first-line treatment for mild to moderate acne as they offer high success rates by eliminating excess oil, helping to slough off dead skin cells and kill bacteria. 

Topical acne medications are available over the counter (OTC) as well as in prescription strength. Topical antibiotics, Dapsone gel and retinoid creams and gels are available only by prescription.  

The most common side effects of topical medications are limited to the areas of skin treated and range from temporary stinging when applied to redness, dryness, and peeling with prolonged use. 

Antibiotics

When applied directly to blemishes or acne-prone areas, topical antibiotics destroy the bacteria associated with inflammatory acne. Two topical antibiotics are used: erythromycin 2% and clindamycin 1%. 

As is the case with oral antibiotics, topical formulations are thought to play a role in bacterial resistance. Therefore, they are rarely used alone but prescribed with another medication, such as benzoyl peroxide or a retinoid. There are also combination medications available: Benzamycin (benzoyl peroxide and erythromycin) and BenzaClin (benzoyl peroxide and clindamycin).

Topical antibiotics are applied directly to skin twice a day. One exception is a foam formulation of clindamycin 1% that is used once per day. 

On their own, antibiotics rarely cause side effects. However, because they contain benzoyl peroxide, Benzamycin and BenzaClin may cause itching, redness and burning. 

Azelaic acid

Azelaic acid is an acid found in certain grains. It kills the bacteria that contribute to acne and helps exfoliate dead skin cells. It’s most effective for treating mild to moderate acne. It is available OTC as a gel or cream in a 10–15% strength and in a 15–20% strength by prescription.

Your dermatologist will give you instructions on use based on the severity of your acne and any other treatments you may be using. Most often, it’s applied once or twice a day to clean dry skin.

You may notice mild side effects at the beginning. The most common are tingling, burning or stinging. With continued use you may notice your skin is dryer and more sensitive. 

Benzoyl peroxide

Benzoyl peroxide removes dead skin cells, dries up excess oil and kills bacteria. It’s most effective for mild to moderate acne. It is available as a body wash or cleanser for twice-daily use and as a lotion, cream or gel that can be dabbed directly onto individual blemishes or areas of breakouts. Prescription-strength formulas are also available.

The most common side effects of benzoyl peroxide include a sensation of warmth, tingling or stinging upon application, and redness, dryness and peeling of skin with continued use.

Dapsone

Dapsone, a prescription medication available under the brand name Aczone, has both anti-inflammatory and antibacterial properties. It has been found to be highly effective for treating moderate inflammatory and noninflammatory acne after 12 weeks of use.

This potent medication is used sparingly; a pea-sized amount is applied in a thin layer to affected areas once a day. Side effects include dryness, redness, burning, peeling and oiliness. Rarely, it can have serious systemic side effects.

Retinoids and retinols

These medications are derived from retinoic acid (vitamin A). They exfoliate dead skin cells and promote the growth of new cells, which in turn push oil and debris out of clogged pores. They’re highly effective for treating moderate to severe acne. Retin-A is one example of this type of medication.

Topical retinoids are available by prescription only. One exception is a retinoid-like medication called adapalene, which is available OTC as Differin, as well as by prescription in a stronger concentration. 

Retinols aren’t as strong as retinoids and are therefore available without a prescription. They are most effective for mild to moderate acne. 

At first use, retinoids and retinols can be highly irritating. Common side effects include burning or stinging, redness, itching, dryness and peeling. These tend to be more severe with retinoids.  

Because of the side effects, it’s important to use retinoids and retinols sparingly at first to allow your skin to adjust. A typical regimen is to start with a pea-sized amount smoothed in a thin layer on affected areas every third night for a week, increasing the frequency of use gradually.

Both medications increase sensitivity to ultraviolet (UV) rays and so it’s vital to limit sun exposure as much as possible and to use a broad-spectrum SPF sunscreen daily.                                                                                                 

Salicylic acid

Salicylic acid is a beta hydroxy acid that encourages dead skin cells to slough off to prevent them from clogging pores. It is available OTC in cleansers, toners, creams and gels, typically in concentrations of .05–5%. These products are best for mild comedonal acne.

Stronger concentrations of salicylic acid are prescribed to treat more severe acne. It is also used in chemical peels. 

OTC salicylic acid products such as cleansers and toners typically are used twice a day, morning and night. Creams and gels can be used as a spot treatment or to areas of breakouts. 

The side effects of salicylic acid are the same as for most medications that encourage exfoliation of dead skin cells – stinging, irritation, dryness and peeling.                                         

Oral Acne Medications

When topical acne medications are ineffective in managing acne or their side effects can’t be tolerated, prescription-strength oral medications may be the next step. However, for some people, a combination of benzoyl peroxide and a topical antibiotic is equally effective.

Antibiotics

Oral antibiotics help treat inflammatory acne by destroying the bacteria that causes inflammation. Side effects of oral antibiotics vary among the selection: doxycycline, erythromycin, minocycline, sarecycline, tetracycline and trimethoprim/sulfamethoxazole.

Your doctor will provide you with specific instructions. In general, antibiotics can cause nausea, diarrhea or vomiting, so typically it’s recommended they be taken with food. Other potential side effects are headaches, dizziness and increased sensitivity to the sun. 

Hormonal contraceptives

Birth control pills that contain both estrogen and progestin, known as combination oral contraceptives, are prescribed to treat hormonal acne. They help minimize sebum production by decreasing the levels of male hormones called androgens that cause overproduction of sebum.

The three oral contraceptives approved by the Food and Drug Administration (FDA) for acne are YAZ, Ortho Tri-Cyclen and Estrostep. Each is taken once a day and may have side effects that include nausea and vomiting, abdominal cramps, bloating and weight gain.

Isotretinoin

Isotretinoin is an oral retinoid, derived from vitamin A, and works by shrinking sebaceous glands to prevent excess oil production. It is prescribed to treat severe nodular acne.

Isotretinoin is available in strengths of 0.5–1.0 mg. It’s typically prescribed to be taken twice per day in strengths up to 2 mg in total.   

The most common side effects of isotretinoin are related to the reduced oil production it induces  including dry skin, peeling, chapped lips, dry eyes, nose and mouth, and nosebleeds.                                                                                                                                

Spironolactone

Spironolactone is an anti-androgen, which means it works much like oral contraceptives to lower levels of the hormones that trigger excess oil production. It’s prescribed off-label to treat persistent acne in females caused by hormonal imbalances that hasn’t been improved by other treatments.

The brand name for spironolactone is Aldactone. Most dermatologists will prescribe 25 mg once per day to start, increasing to between 50 mg and 100 mg over several weeks, if necessary.

The most common side effects include irregular menstrual periods, breast tenderness and increased urination; less often, thirst, nausea, headache and dizziness.                                                           

Best Acne Medications for Adults

Adults develop acne for the same reasons as younger individuals – due to pores becoming blocked with oil and debris. However, their acne may be exacerbated by factors such as smoking, cosmetics and sweat. Women also develop it due to periods of hormonal fluctuations such as pregnancy and menopause, or as a result of a condition called polycystic ovarian syndrome (PCOS).

The best acne medications for adults are those that are tailored to address the cause and severity of their acne. Adults who have mild and intermittent breakouts may be able to clear and prevent them with OTC products containing salicylic acid, benzoyl peroxide or low-strength retinols.

Acne that develops due to hormonal fluctuations will best respond to oral prescription medications that stabilize levels such as spironolactone and oral contraceptives. 

Acne Medication and Pregnancy

Pregnancy poses a special challenge as some medications are not safe for developing fetuses and so must be avoided during pregnancy, or if you are thinking of becoming pregnant. 

Most notable is isotretinoin, which has been found to cause severe birth defects. Other acne medications that should be avoided during pregnancy include antibiotics doxycycline, minocycline, sarecycline, tetracycline and trimethoprim/sulfamethoxazole; and the anti-androgen medication, spironolactone.

Takeaway

Noninflammatory acne can range from mild pimples and blackheads to large tender nodules and cysts representative of inflammatory acne. There are many underlying causes of acne, notably fluctuating hormones, but also such factors such as smoking, cosmetics and sweat.

There is a wide range of OTC or prescription-strength acne medications available in both oral and topical formulations. These medications effectively clear pores of harmful bacteria and debris, regulate oil production and slough off dead skin cells. These actions also help prevent new lesions from forming. 

Based on your medical history and an examination of your skin, your dermatologist will determine which medication or combination of medications are best for your skin.

It is important to begin treatment as soon as possible in order to treat active lesions and prevent future breakouts. Taking action quickly can also prevent worsening symptoms and resulting scars. Whichever route you take, if you stay faithful to your skin care regime, you should see improvements in your skin in the weeks ahead.