I’m sorry to be the bearer of bad news. Natural supplements, over-the-counter creams, and cleansers don’t clear most forms of acne. I’ll discuss five valuable options in a prescription acne medication list.
Why is it important to treat acne?
I could not find any South African teenage acne statistics, but I am sure it is comparable to the USA at 85% of teens. 1 It is normal to have pimples in adolescence, but for most youngsters, it results in poor self-esteem. This can exacerbate anxiety and depression.
Severe acne results in permanent scarring.
There are many prescribed options, each with its pros and cons. Your doctor will help you decide which option is best for you, considering three factors:
- Your acne severity
- Previous treatments used
- Your medical history
Prescription Acne Medication List
| 1. Topical treatment (creams, gels and lotions) |
| -Retinoid, e.g., adapalene and tretinoin -Retinoid plus benzoyl peroxide -Antibiotic -Antibiotic plus retinoid -Antibiotic plus benzoyl peroxide |
| 2. Oral antibiotics |
| First-line -Doxycycline -Minocycline -Sarecycline (not registered in South Africa) -Lymecycline (not registered in the USA) Second-line -Trimethoprim/sulfamethoxazole Only exceptional circumstances -Azithromycin |
| 3. Combined oral contraceptives (COC)/The pill |
| -Cyproterone acetate 2mg, ethinylestradiol 0.035mg -Drospirenone 3mg, ethinylestradiol 0.02mg |
| 4. Spironolactone |
| 5. Isotretinoin |
1. Topical treatment
If your acne is mild, creams or gels are used first. They may fix the problem without the side effects of oral options.
We also piggyback them on oral antibiotics, birth control pills, and spironolactone for better results.
The following are examples of prescribed topical products:
- Retinoid, e.g., adapalene and tretinoin
- Retinoid plus benzoyl peroxide
- Antibiotic
- Antibiotic plus retinoid
- Antibiotic plus benzoyl peroxide
2. Oral antibiotics
Disclaimer: Do not fall pregnant while on acne antibiotic courses.
Antibiotics have treated acne successfully for over 50 years. 1 They target the bacterium Cutibacterium acnes.
Preserving antibiotics and preventing antibiotic resistance are hot topics these days. Doctors should only prescribe antibiotics if the infection warrants them, and this also applies to acne.
The following recommendations limit the possibility of antibiotic resistance:
- By restricting courses to three to four months. Six months at the longest.
- A topical treatment, e.g., retinoid plus benzyl peroxide, can be used simultaneously.
The class of choice is the tetracyclines. Others should only be used in specific situations. 1
Tetracyclines
For decades, tetracyclines have consistently had few side effects and good results. They also reduce inflammation.
No data shows that one tetracycline is better than another for acne treatment:
- Doxycycline
- Minocycline
- Sarecycline (not registered in South Africa)
- Lymecycline (not registered in the USA)
Sulphonamides
- Trimethoprim/sulfamethoxazole (TMP-SMX)
A last resort is TMP-SMX. It has a higher potential for resistance and is a high-risk drug for a rare, life-threatening rash called Steven-Johnson Syndrome. 1 It is not registered for acne treatment but works well to clear pimples.
3. Combined oral contraceptives (COC)/The pill
Being a lady gives you access to another option, the COC. You may know it as the pill or the birth control pill.
Read my post on the pill for reasons that you cannot take it (contraindications). The main concern is the increased risk of blood clots.
If you have no contraindications, I recommend you try COC before considering isotretinoin for two reasons.
- You should be on a contraceptive anyway when you start isotretinoin. You are not allowed to fall pregnant while on it.
- If the acne is hormonal or due to polycystic ovarian syndrome (PCOS), isotretinoin will not cure the acne.
Not all COC work well for acne. Only progesterones that block male-like hormones (anti-androgenic) are registered as treatment. They reduce sebum production and hyperkeratinisation of follicles.
The standard combinations for acne treatment are:
- Cyproterone acetate 2mg, ethinylestradiol 0.035mg
- Drospirenone 3mg, ethinylestradiol 0.02mg
4. Spironolactone
Disclaimer: Do not fall pregnant while on spironolactone.
This is another option for the ladies, sorry gents.
It is a helpful option for certain patients:
- Women who cannot or do not want to take the birth birth control pill.
- Patients who have completed an antibiotic course and have relapsed.
- Ladies who do not want to or who do not qualify to start isotretinoin.
This diuretic medication, or ‘water tablet,’ is usually prescribed for high blood pressure. Most patients will urinate more often.
Like the anti-androgenic COC, it works for hormonal acne by opposing male hormones. This is why men don’t tolerate it. They have feminizing side effects like enlarged breast tissue and sexual problems.
You need baseline kidney function and potassium blood tests. The dose should be increased slowly at regular follow-ups, as it might lower blood pressure.
5. Isotretinoin
Disclaimer: Do not fall pregnant while on isotretinoin.
Isotretinoin is last on the prescription acne medication list for a reason. It should be the last resort.
This is a miraculous, potentially life-changing medication, but it needs respect and consideration.
During pregnancy, it can cause congenital disabilities incompatible with life by interfering with fetal development.
Isotretinoin can have severe side effects:
- Dry nose and nose bleeds
- Dry eyes
- Dry, irritated skin and lips
- Sun-sensitive skin
- Liver damage
- Raised bad cholesterol (LDL)
- Tendon and joint pain
- Depression, anxiety, self-harm and suicide
Patients need blood tests before starting isotretinoin and at intervals during the course.
Untreated severe cystic acne causes scarring.
Isotretinoin is indicated for this type of acne.
Doctors prescribe it in two ways:
Cumulative or total dosing −This dosing course can cure acne. The doctor calculates the cumulative or total dose according to the patient’s weight. The medication is taken for 3 to 12 months, depending on the daily dose strength.
Pulse or intermittent dosing − This method suppresses acne while you are taking the medication, but flares are common when stopping. A low dose of isotretinoin is taken daily for a week of every month.
With many options available on the prescription acne medication list, most patients find a suitable treatment.
References
- Baldwin, H. (2020). Oral Antibiotic Treatment Options for Acne Vulgaris. The Journal of Clinical and Aesthetic Dermatology, 13(9), 26-32. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7577330/
- Renz, S., Chinnery, F., Stuart, B., Day, L., Muller, I., Soulsby, I., Nuttall, J., Thomas, K., Thomas, K. S., Sach, T., Stanton, L., Ridd, M. J., Francis, N., Little, P., Eminton, Z., Griffiths, G., Layton, A. M., & Santer, M. (2021). Spironolactone for adult female acne (SAFA): protocol for a double-blind, placebo-controlled, phase III randomised study of spironolactone as systemic therapy for acne in adult women. BMJ open, 11(8), e053876. https://doi.org/10.1136/bmjopen-2021-053876
