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Top Prescription Acne Medications Reviewed

The best acne medication differs from person to person based on their skin care needs. For some, a gentle over-the-counter option is the best way to reduce acne, while for others, stronger prescription medication is necessary. Regardless of your acne needs, there is an acne medication available for you. The best way to find the right acne treatment is with patience, and sometimes with the assistance of a dermatologist. This guide will cover the basics of acne medication, from benzoyl peroxide to Accutane.

Prescription Acne Medication
Always review your options before taking a prescription medication to treat acne.

Summary:

  • Always discuss your options when you are offered prescription acne medication.
  • Over-the-counter acne medications work for most people with acne, but for those with severe or cystic acne, prescription acne medications are usually the best option.
  • Benzoyl peroxide, salicylic acid, and azelaic acid are common over-the-counter options.
  • Antibiotics used to be a popular acne prescription, but growing awareness about antibiotic resistance has led most dermatologists to try other options.
  • Retinoids are a diverse group of acne medications ranging from over-the-counter options like Differin to intense prescription medications like Accutane
  • Combined oral contraceptives and other hormonal prescription options can also treat acne for some people.

The Best Over-the-Counter Acne Treatment Options

The best acne medication differs from person to person, but because acne is caused by so many different factors, the best solution for most people is an acne treatment that includes multiple key ingredients. For the vast majority of people with acne, the best medicine for acne is a gentle, over-the-counter option that treats the causes of acne without irritation the skin. Below, we’ve included three of our favorite over-the-counter acne treatment options.

Exposed Skin CareExposed Skin Care products include benzoyl peroxide, salicylic acid, and azelaic acid (see below for more details), all at low concentrations that are safe for all skin types. Plus they also incorporate powerful natural ingredients, like tea tree oil, vitamin E, and green tea extract. Before jumping straight to the strongest (and harshest) prescription treatment available, we highly recommend giving this gentle but effective brand a try for a few weeks. If it doesn’t work, you can always send your empty product bottles back to the company and they will reimburse you in full.

The Body Shop Tea Tree Oil Products: Even though it’s not made in a lab, tea tree oil has been studied and proven to be a powerful anti-acne agent. The Body Shop takes advantage of this ingredient with their full line of tea tree oil products, from pure oil to face wipes to a clay mask, all containing tea tree oil. These products are best for oily skin, pimples, and cystic acne.

PanOxyl Acne Foaming Wash: This product is marketed for facial acne, but we recommend using on pesky body acne instead. PanOxyl uses benzoyl peroxide, a highly effective acne-fighting ingredient that we’ll describe more just below, but at a concentration that is much too high to be used on your face. Most PanOxyl products contain 10% benzoyl peroxide, which will likely cause peeling and burning on your face, but could be the perfect solution for back or butt acne.

Benzoyl Peroxide

Benzoyl peroxide is one of the most popular acne medications available, and it works especially well for pimples because it kills the bacteria that causes them. It works by bringing oxygen under the skin, killing the particular type of bacteria associated with acne, known as p. acnes. P. acnes are anaerobic, meaning they can’t live where there is oxygen, so benzoyl peroxide is a great way to kill bacteria under the skin instantaneously1. This medication can often eradicate acne if used in the right dosage and in the right way.

For some, the right dosage can be found over-the-counter in concentrations as low as 2.5 percent or up to 10 percent, but for others, a prescription dosage is needed to see the best results. Prescription doses rarely go over 10 percent, as benzoyl peroxide is known to cause stinging, burning, itching, flaking, peeling, and redness2 when used in concentrations over 5 percent, but they may combine the benzoyl peroxide with other acne medications.

Ask your doctor about starting with a milder formula of benzoyl peroxide, as low as 2 to 2.5%. These products are much less likely to cause side effects³ that make you want to stop treatment. Save stronger benzoyl peroxide products for spot treatments—but be forewarned that a stronger product may make a pimple even redder before it heals.

Note: BP can cause bleaching of clothes, towels and bedding, so use with care. Some research suggests it may also cause discoloration (bleaching or dark spots) in people of color, so be sure to consult a dermatologist before using benzoyl peroxide.

Azelaic Acid

Azelaic acid is a natural acid that is derived from various grains like wheat and barley. It helps reduce acne by preventing skin cell buildup, killing p. acnes bacteria, and reducing inflammation4. This means it can help reduce all kinds of acne, from blackheads to pimples. Blackheads and whiteheads form when dead skin cells combine with sebum, the oil our skin naturally produces and get clogged in a pore. To get rid of this kind of acne, it helps to regulate your skin cell production and exfoliate your skin to remove excess dead skin cells. Azelaic acid is a great way to do both of these things, while also decreasing inflammation and killing bacteria. When the skin is inflamed, it swells slightly, causing the pores to constrict. This traps dead skin cells and sebum inside, leading to blackheads and whiteheads, and if bacteria get trapped as well, then pimples can also form.

You can find azelaic acid in over the counter medications in mild concentrations. These gentle products are perfect for those who primarily deal with blackheads and whiteheads rather than pimples. In order to kill bacteria and get rid of pimples, you’ll need a concentration of 15 to 20 percent, which typically requires a prescription.

Like benzoyl peroxide, azelaic acid for acne hasn’t been tested sufficiently in people of color and may cause skin lightening or discoloration. It’s important to start with low concentrations or consult a dermatologist before starting any new acne treatment if you have skin of color.

Salicylic Acid

Salicylic acid is an ideal over-the-counter acne medication for treating blackheads and whiteheads. This is because it is a beta-hydroxy acid and when it is applied to the skin, even in low concentrations, it exfoliates the skin, removing excess sebum, dead skin cells, and other debris that might clog our pores.

Low concentrations of salicylic acid, like 0.5 percent, are perfect for people who have both acne and sensitive skin. If you have sensitive skin, you know that most of the “best” acne medications just don’t work for you because they are too strong. Products that are too strong for you can cause increased inflammation, which can actually lead to more acne rather than less. Because of this, salicylic acid is our number one recommendation for sensitive skin.

However, salicylic acid isn’t just for those of us with sensitive skin. It can also help those of you with tougher skin, through higher concentrations. Over-the-counter, you can find salicylic acid in concentrations up to 2 percent, but if you want something even more intense, many spas and dermatology offices offer salicylic acid chemical peels with 20-30 percent salicylic acid. Beware, these peels will likely leave your face very photosensitive for a few days, but they have been known to significantly reduce sebum for a few weeks at a time.

Unlike benzoyl peroxide and azelaic acid, salicylic acid has been studied in some people of color and has demonstrated effective and safe results. According to one study published in the Journal of Cutaneous and Aesthetic Surgery, salicylic acid is a safe and effective treatment in Asian skin5, and may even help reduce post-acne hyperpigmentation.

Sodium Sulfacetamide-Sulfur

Sodium sulfacetamide-sulfur is another acne medications often found in over-the-counter treatments, and it works especially well for those with mild-moderate acne that is largely made up of pimples. This is because it effectively dries out excess sebum without drying out the skin, and some studies suggest that this combination of sodium sulfacetamide and sulfur has antibacterial properties. According to one study published in The Journal of Clinical and Aesthetic Dermatology, sodium sulfacetamide 10 percent-sulfur 5 percent can significantly reduce the size of p. acnes colonies when used as an emollient foam6. This treatment option is also available as a facewash, topical gel, and topical cream, and can be found at most drugstores.

Due to these antibacterial properties, sodium sulfacetamide-sulfur was quite popular before antibiotics such as penicillin were introduced, but now that doctors are cutting back on antibiotic usage, it could make a comeback in the world of acne treatment.

Antibiotics for Acne

Antibiotics for acne, both topical and oral, used to be the top prescriptions for getting clear skin, but research has revealed that they aren’t the best option for most people today due to something called antibacterial resistance. This is where bacteria mutate, become immune to certain antibiotics, then reproduce offspring that are also immune, creating entire colonies of bacteria that can’t be killed by certain antibiotics.

When it comes to acne, this means that the p. acnes bacteria that cause pimples and cysts can become more powerful, usually leading to more acne, not less. But the real problem goes far beyond acne. This resistance can spread from one type of bacteria to another, creating all kinds of colonies of antibacterial-resistant bacteria.

Most doctors are now recommending that all antibiotics be prescribed only when necessary. Although acne can have a significant psychological impact and severe cystic acne may present a serious case of infection, there are other, better ways to treat acne besides antibiotics. So why are antibiotics still prescribed for people with acne?

The idea behind using antibiotics for acne is that they can help reduce the number of p. acnes on the skin and relieve an acute case of severe acne. After the person stops taking the antibiotics, the hope is that the reduced numbers of p. acnes will prevent the pimples or cysts from getting out of hand again. However, in reality, most people simply end up taking the antibiotics much longer than they should, and the acne almost always comes back. That’s because, according to The Lancet: Infectious Diseases, over 50 percent of p. acnes strains are resistant to antibiotics7. If your doctor tries to prescribe you antibiotics for your acne, we recommend asking about other courses of action.

Retinol vs. Retinoids vs. Tretinoin

If you’re a skin care veteran, odds are high that you’ve heard of retinol, retinoids, or tretinoin. The question is, what is the difference between them, and is one of them better for acne than the others?

Retinol: Retinol is simply another word for vitamin A, sort of like how we call vitamin B7 “biotin.” It’s important that our bodies get systemic vitamin A through our diet for good vision, a strong immune system, and general organ function, but some research suggests that vitamin A could have a positive impact on the skin when applied to it directly. The problem is, regular retinol doesn’t actually do much for acne. That’s because the retinoic acid found in retinol isn’t always activated when left to its own devices. We typically have to activate the retinoic acid synthetically through the creation of various medications.

Retinoids: Retinoids are substances that are derived from vitamin A, which includes retinol, but also includes synthetic versions of retinol with activated retinoic acid which tends to be more effective in treating acne. Retinoic acid has been shown to reduce sebum production8 and regulate skin cell production9, which together can greatly reduce acne. These synthetic retinoids include adapalene, tretinoin, isotretinoin, and others. Although these synthetic options are more reliably effective, they also tend to have more side effects, like burning, itching, and dryness. Unlike retinol, which is available over-the-counter, nearly all synthetic retinoids are prescription-only. One of the main exceptions is Differin, which is a brand that sells a topical gel containing adapalene, a mild synthetic retinoid, over-the-counter.

Tretinoin: As we said above, tretinoin (common brand name: Retin-A) is a synthetic retinoid, but it is stronger than some of the other options, and its cousin, isotretinoin, is even stronger. Isotretinoin, better known as Accutane, is an oral synthetic retinoid typically only prescribed for very severe cases of cystic acne because it can cause intense side effects and is a powerful teratogen, meaning it causes birth defects. However, after taking isotretinoin for several months, many people never need to do any serious acne treatment again, so for some, it is well worth the side effects.

Dapsone

Dapsone is a topical gel medicine sold under the brand name Aczone for treating severe acne, and it’s perfect for people who want a low-maintenance acne treatment plan. Unlike many of the best acne medications, dapsone only needs to be applied once daily, and it is the only medications most people will need, though it’s always good to include a face wash and moisturizer in your skin care routine if possible. Dapsone can function on its own because it is both antibacterial and anti-inflammatory10, effectively taking care of two of the biggest causes of acne.

However, unlike the previously discussed treatment options, gender plays a role in how effective dapsone will be. Research has shown11 that female patients who use it get a much better response than male patients. It’s also a slow-working treatment. Studies among adolescents have shown that it is very effective, but it may take up to 12 weeks for improvements to show up, with more improvements taking place with continued use.

Some of the side effects of Daspone include rashes, dryness and burning, which may get so severe that treatment must be discontinued, especially if you have sensitive skin.

Combined Oral Contraceptives

Combined oral contraceptive pills contain progesterone and estrogen and help to balance out the levels of testosterone in the body12 One obvious effect of this is birth control, but dermatologists have also found it very useful for treating hormonal acne. Testosterone doesn’t directly cause acne, but when hormone levels fluctuate and testosterone increases above its baseline level, it can lead to increased acne for some. This is because increases in testosterone and other androgens leads to an increase in sebum production, which can cause more clogged pores and more p. acnes bacteria, leading to blackheads, whiteheads, pimples, or even cysts.

There are all kinds of birth control out there, but it’s important that you look for the combined oral contraceptives specifically if you’re looking to prevent acne. Progestin-only forms of birth control lack the estrogen necessary to balance out the testosterone, and therefore are unlikely to help your skin much.

Although combined oral contraceptives are a more popular treatment with women, men can use them as well, as they may also experience hormonal fluctuations. The only downside is that birth control pills tend to produce feminizing features in the person taking them, such as reduced hair growth or enlarged breast tissue. To get a prescription for a combined oral contraceptive, you can talk to your family doctor, a dermatologist, or an OB/GYN, or visit your local Planned Parenthood.

Spironolactone

If you’re looking for a hormonal solution to your acne but don’t want to take a combined oral contraceptive, spironolactone may be the answer. This oral medication is a potassium-sparing diuretic originally designed to treat high blood pressure, but is now also used to treat acne. It mainly functions by reducing sebum production, leading to less acne formation13. If you are able to get pregnant, you don’t necessarily need to take a combined oral contraceptive, but you will want to use some form of birth control since spironolactone, like Accutane, is a well-known teratogen and is known for causing birth defects.

Spironolactone has relatively minor side effects, like low appetite, weakness, or cramping, but there’s one major exception: spironolactone comes with a black box warning about its cancer-causing effects. The FDA is required to include this label based on a study conducted in the 1950s that found carcinogenic properties in the spironolactone given to rats in an experiment. However, the dose of spironolactone used in this study was nearly 500 times higher than the dose currently prescribed, and no studies since have found anything carcinogenic about spironolactone. Because of this, most dermatologists feel comfortable prescribing spironolactone for acne. Still, it’s something to be aware of before you take it. Additionally, those with low blood pressure or kidney conditions are likely not good candidates for spironolactone and may want to explore other acne treatment options.

Accutane and Pregnancy

 

References:

  1. Del Rosso J. What is the role of benzoyl peroxide cleansers in acne management?: do they decrease propionibacterium acnes counts? do they reduce acne lesions? Journal of Clinical and Aesthetic Dermatology. 2008. 1(4):48–51.
  2. Benzoyl peroxide gel side effects. WebMD.com.
  3. Sagransky M., Yentzer B., Feldman S. Benzoyl peroxide: a review of its current use in the treatment of acne vulgaris. Expert Opinion on Pharmacotherapy. 2009. 10(15):2555-62.
  4. Nazzaro-Porro M., Passi S., et al. Azelaic acid in the treatment of acne. Italian Journal of Dermatology and Venereology. 1989. 124(4):175-84.
  5. Goh C., Noppakun N., et al. Meeting the challenges of acne treatment in Asian patients: a review of the role of dermocosmetics as adjunctive therapy. Journal of Cutaneous and Aesthetic Surgery. 2016. 9(2):85-92.
  6. Del Rosso J. The use of sodium sulfacetamide 10%-sulfur 5% emollient foam in the treatment of acne vulgaris. The Journal of Clinical and Aesthetic Dermatology. 2009. 2(8):26-29.
  7. Walsh T., Efthimiou J., Dréno B. Systematic review of antibiotic resistance in acne: an increasing topical and oral threat. The Lancet: Infectious Diseases. 2016. 16(3):23-33.
  8. Pan J., Wang Q., Tu P. A topical medication of all-trans retinoic acid reduces sebum excretion rate in patients with forehead acne. American Journal of Therapeutics. 2017. 24(2):207-212.
  9. Bielli A., Scioli M., et al. Cellular retinoic acid binding protein-II expression and its potential role in skin aging. Aging. 2019. 11(6):1619-1632.
  10. Wozel G., Blasum C. Dapsone in dermatology and beyond. Archives of Dermatological Research. 2013. 306(2):103–124.
  11. Tanghetti E., Harper J., Oefelein M. The efficacy and tolerability of dapsone 5% gel in female vs male patients with facial acne vulgaris: gender as a clinically relevant outcome variable. Journal of Drugs in Dermatology. 2012. 11(12):1417-21.
  12. Słopień R., Milewska E., et al. Use of oral contraceptives for management of acne vulgaris and hirsutism in women of reproductive and late reproductive age. Menopause Review. 2018. 17(1):1–4.
  13. Layton M., Eady E., et al. Oral Spironolactone for Acne Vulgaris in Adult Females: A Hybrid Systematic Review. American Journal of Clinical Dermatology. 2017. 18(2):169–191.
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