There is no doubt that acne is difficult to treat. If you've tried various topical medications without success or if you have severe acne, oral medications are usually the next step in your treatment. There are several options available, each with its own risks and benefits.
Oral medications for severe acne.
Not all acne will go away with topical medications (creams, lotions, and gels that are applied to the skin). Oral medications that are taken by mouth and sometimes called systemic medications improve skin conditions. Some medications are taken only once a day, while others are taken more frequently, ideally at the same time each day.
Persistent or severe cases of acne are difficult to control and oral medications are required in most cases. Severe acne (sometimes called cystic or nodular acne) causes large, deep, and inflamed rashes. Topical medications may not be deep enough to effectively treat such blemishes .
Another obstacle: acne often appears on other areas of the body, such as the back or shoulders. Getting to these sites for effective local treatment can be challenging. On the other hand, oral acne medications can work on deeply inflamed blemishes regardless of their location.
Even if your acne isn't necessarily severe, it can be stubborn. If you've tried topical treatments and your skin still isn't clearing up, oral medications can give your treatment the boost it needs so you can see real results.
Either way, if you have trouble controlling acne, see a dermatologist. All oral acne medications are available by prescription only. There is no over-the-counter alternative.
Oral antibiotics have been used to treat acne for many years. Like topical antibiotics, oral antibiotics reduce the amount of acne-causing propionibacteria (bacteria that cause acne breakouts). They also help reduce skin inflammation.
Most people start with a high dose and move to a lower dose as their acne improves. Oral antibiotics are used to treat moderate to severe acne or persistent acne.
The most common oral antibiotics prescribed to treat acne are:
Due to the increase in the number of resistant antibiotics According to the American Academy of Dermatology , oral antibiotics should only be used in combination with topical therapy to treat acne and should be prescribed for no more than three to six months. Monotherapy should be avoided.
Oral contraceptives for acne in women.
Oral contraceptives can be an ideal option for women with acne that comes and goes with their monthly cycle, and for those who need contraception anyway.
But you don't necessarily need these specific brands. Birth control pills have been prescribed off-label for many years to treat acne. Most doctors agree that almost any formulation will have the same effect.
You will also likely need a topical acne medication that can be used in conjunction with oral contraceptives .
Other Common Oral Acne Medications
In addition to the oral antibiotics mentioned above, the following oral acne medications are commonly prescribed.
Spironolactone (Aldactone) is another medication for adult women only. This is not an acne treatment, but in certain circumstances it can be used to treat hormonal fluctuations that contribute to the rash.
Spironolactone is not used very often and is not a first-line acne treatment, but for some women it is useful for treating acne that does not go away with more traditional treatments.
Isotretinoin , formerly marketed under the brand name Accutane , is a super potent acne medication. It works when all other acne treatments have failed and is considered the best treatment for severe acne .
Isotretinoin shrinks the sebaceous glands by reducing the amount of oil in the skin. This, in turn, reduces the number of comedones (or clogged pores) that form. No clogging your pores means less or no acne.
Isotretinoin is contraindicated during pregnancy due to the extremely high risk of birth defects and should not be used during breastfeeding. If you become pregnant while taking isotretinone, you should stop taking the medicine immediately.
If a treatment is prescribed, you will be enrolled in the iPledge program, an FDA-approved initiative to reduce isotretinoin-induced birth defects. Everyone must enroll, including men, although the requirements for men and women who cannot get pregnant are different from those for women who can get pregnant.
You will also be monitored for side effects during treatment. But the good news is that one or two courses are enough for most people before the acne is gone for good. Your dermatologist will help you decide if this option is right for you.
Get the word of drug information
Acne, no matter how bad, can be frustrating. If topical treatments alone won't clear up acne, or if acne is severe or widespread, oral treatment is the best option.
In some cases, you will only need to take oral medications for a short period of time to control acne and then support your skin with topical medications. However, in other cases, you may need to take them for longer periods of time.
If you are generally concerned about taking acne medications by mouth, or have questions or concerns about treatment, speak with your dermatologist.