Top Prescription Acne Medications Reviewed
Prescription acne medication is a must for the most severe cases of acne. For mild to moderate common acne, however, other combinations of treatments sometimes get better results. And even if you need strong prescription acne medication to fight nodules, cysts, and joint disease caused by acne, you will need the same simple, common sense measures to keep acne from coming back.
This article will review the prescription acne medications from low-potency to high-potency, with suggestions on how to make each medication work optimally well.
- Always discuss options when you are offered prescription acne medication.
- Over-the-counter benzoyl peroxide may be easier to use and produce far fewer side effects that prescription benzoyl peroxide.
- In the United States, minocycline is the preferred antibiotic for acne. In Canada, clindamycin is offered to children, teens, and young adults to prevent staining of their teeth.
- Never pick out your own antibiotic for acne, even if antibiotics are available without a prescription in the country where you live. It is important to avoid getting a secondary infection that can be much worse than acne.
- Topical tretinoin can treat both acne and wrinkles.
Benzoyl peroxide, also known as BP, is the world’s most frequently prescribed acne treatment. Some of the prescription names it is sold under include Brevoxyl, Benzaclin, Benzac AC and Triaz. It is available in gel, cream and wash form. It works by bringing oxygen under the skin. Since it is not possible for bacteria to live where there is oxygen, 99.9% of the bacteria under the skin die instantaneously. This medication can often eradicate acne if used in the right dosage and in the right way.
The problem with prescription benzoyl peroxide usually is that it is too strong to use over the whole face. Most people experience stinging, burning, itching, flaking, peeling, and redness when they use benzoyl peroxide gels that contain more than 5% benzoyl peroxide, and doctors often start off their patients at 10% or more. Expect to see such side effects the first few weeks after starting treatment. This is normal and is known as the ‘hardening effect’ of Benzoyl Peroxide. However, 1% to 3% of individuals who use this product react allergically to it. This results in extreme crusting of the skin and inflammation. This is not similar to the ‘hardening effect’ of BP, so it should not to be confused with it.
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 effects that make you want to stop treatment. Save stronger benzoyl peroxide products for spot treatments—but be forewarned that a stronger produce may make a pimple even redder before it heals.
If you have Asian skin, use a vitamin E product in addition to benzoyl peroxide. The vitamin E will reduce the production of pigment that can discolor the skin even after acne heals.
Note: BP can cause beaching of the hair, skin and even clothes, towels and bedding. So use with care.
Azelaic acid is a natural acid that is derived from whole grain cereals and animal products. This acid helps the skin by stimulating the fast renewal of skin cells. This prevents cell build up. This reduces chances of the skin pores getting clogged hence, minimally reducing the chances of pimples and blackheads forming. This acid has anti-inflammatory properties and it kills bacteria that cause acne. You can find this in over the counter medications, but not in very strong concentrations. For it to kill the bacteria, it should be used in concentrations of 15% to 20%, which requires a prescription.
This product is popularly sold under the brand name Azelex. Azelex is a cream that has 20% azelaic acid. It should be applied twice a day.
1 to 5% of the people who use this cream will experience some side effects. This includes effects such as tingling, burning, itchiness and stinging. A few people have also reported that the cream caused skin lightening but these reports have not been substantiated since no research has yet been done on the effects of the cream on dark skinned people.
Azelaic acid can also be used to treat other conditions, such as rosacea. It is one of the top rated medications that is used to fight against acne.
Minocycline: In the United States, dermatologists usually treat acne with the tetracycline antibiotic minocycline. In Canada and Europe, dermatologists usually reserve minocycline for patients who are past the age of 22.
The reason to be careful with minocycline is that it can stain growing teeth, causing a condition known as “blue smile.” American dermatologists insist that if your teeth turn black or blue after you use their prescription, something else must be the problem, but European doctors—who in most cases can’t be sued—take the safer and more conservative route and treat acne with clindamycin ointments instead of minocycline. In Canada, doctors may also offer a clindamycin pill, but in Europe, doctors will offer clindamycin ointments because of a strain of bacteria known as Clostridium difficile in Europe that is more severe after treatment with oral clindamycin.
Tetracycline drugs are still used to treat acne, but they can cause stomach upset, and they are not safe for people who have kidney problems.
Erythromycin: Erythromycin is a macrolide antibiotic best used combined with Benzoyl Peroxide and sometimes helpful for cystic acne. However, don’t use other products on your skin when using Erythromycin since it can lead to irritation. Other side effects include burning, peeling, drying, itchiness, oiliness and redness. Some of the brand names it is sold under include Benzamycin, Erymax, Erygel, Akne-Mycin, Emgel, T-Stat, ETS, Theramycin Z, Ery-Sol, Erythra, A/T/S and Statisticin.
Oral antibiotics are taken in the form of pills at least once a day. They should not be used for more than 6 months. At least half of the people who use oral antibiotics get moderate results. Some of the side effects of oral pills include diarrhea, dizziness, vomiting, lightheadedness and vomiting. You may also experience recurrent vaginal yeast infections given that antibiotics also kill the good bacteria in the body. After some time, your body will get used to it and the side effects should go away or at least decrease. You may also experience an increased sensitivity to light and get rashes, redness or sunburns. In such cases, use sunscreen or wear long sleeved clothes. Taking low doses of antibiotic may still be effective while eliminating the risk of the acne bacteria becoming resistant to the antibiotic.
Other antibiotics are used to treat acne and other infections occurring simultaneously, but the fluoroquinolone antibiotics used for combination treatments, such as Cipro, can’t be used if you eat certain citrus fruits.
Don’t choose antibiotics on your own, even if you live in a country where antibiotics are available without a prescription. Using the right antibiotic for the right period is essential for killing acne bacteria and to cure acne without increasing the risk of another infection.
Dapsone is a medicine sold under the brand name Aczone for treating severe acne. It is a topical gel that has anti-inflammatory properties. It is an antibacterial agent and an antioxidant, as well. It is applied on the affected area two times a day. It helps to reduce acne lesion count by 30% to 45%. Research has shown that female patients who use it get a much better response than male patients. Studies among adolescents has also shown that marked improvement is noticed after 12 weeks of treatment, with more improvements taking place with continued use.
Some of the side effects of Daspone include rashes, dryness and burning. The side effects experienced are not as severe as those experienced when the drug is orally taken to treat leprosy, though.
Ideally, Daspone should not be the first thing that your doctor prescribes to you for treating acne. It is best prescribed after other acne treatment medications, such as Benzoyl Peroxide, Salicylic acid and retinoids have already been tried or are not available. Combining Daspone with retinoid Tazorac will give you better results than using Daspone alone.
The way tretinoin works is by locking into receptors on the surface of a special class of skin cells known as keratinocytes. These are the cells that create baby skin cells that mature as they travel from the basal layers of skin to the surface. Increasing the production of these cells causes the skin to stretch and grow around pores, opening them without any need of deep-cleaning cleansers or, in the case of nodules and cysts, lancing or surgery. Retin-A is also anti-inflammatory and encourages the growth of white blood cells that fight infection, while it shrinks the glands that make sebum.
The problem with oral Retin-A is that it can cause problems in the liver and central nervous system. It can also overstimulate growth in the human embryo, and cause birth defects if taken during the first month or pregnancy. And a significant problem with Retin-A is that it can stimulate so much growth in the skin that new skin blemishes occur.
The best way to use Retin-A is as a gel applied directly to the skin. Products for this purpose are labeled as “topical tretinoin.” You don’t have to get a prescription, and the product is much less expensive over-the-counter than from the pharmacy. Results can be very fast, and you can control the amount of tretinoin you apply to your skin to limit irritation. Using both benzoyl peroxide and topical tretinoin, at different times of day, can prevent new infections as the skin opens up around pores.
Often used for hormonal acne, birth control pills contain progesterone and estrogen and help to decrease the levels of testosterone in the body. This reduces the severity of acne in females. Total lesion count reduces by 30 to 60 %. Smoking while taking oral contraceptive pills increases risk of heart disease, therefore it is not advisable. The Food AND Drug Administration (FDA) approved the use of oral contraceptive pills for the treatment of acne. This includes brand names, such as Ortho Tri-Cyclen, YAZ and Estrostep.
This drug is topically applied on the skin. It was quite popular before antibiotics such as Penicillin were introduced. It has antibacterial properties and stops the growth of bacteria. It is also an anti-inflammatory. Some of the side effects that are normally experienced by less than 2% of its users include irritation, burning and stinging. More severe reactions have led to some of its users dying, though this rarely happens.
This medication is available in tablet form. It is a potassium sparing diuretic used to treat acne in women and particularly useful for non-hormonal acne. It’s available in a wide range of doses and often combined with other treatments. In many cases spironolactone can dramatically reduce sebum production, leading to less acne formation. Some of the side effects of using it include loss of appetite, weakness, cramping, pain, bleeding and bruising.
Accutane, Tazorac, and Differin
Accutane, Tazorac, and Differin are medications that work in much the same way as Retin-A, but they have very different side effects.
- Accutane (isotretinoin) takes about 5 hours to enter the bloodstream and lasts about 24 hours. It is a strong stimulant to skin growth that can cause significant side effects. In the United States, doctors will require all women of reproductive age to use not just one, but two forms of birth control to prevent genetic damage to unborn babies. It is usually prescribed for people who have severe nodular acne that doesn’t respond to other treatments. A complete dosage taken in 15 to 20 weeks has been shown to completely clear acne, with no future remissions.
- Tazorac (tazarotene, also sold under the trade name Avage) is derived from vitamin A and used as a cream, gel, or lotion applied to the skin. It’s normally found in concentrations of .05% to .1%. The gel form is the best for acne. Applied once a day, it begins working immediately and lasts about 36 hours, with very little absorption into the bloodstream. Creams and lotions can clog pores and cause whiteheads and blackheads, however. It cannot be used by people who have eczema, it should not be used after a sunburn, and it should not be used for more than 10 days at a time. Some people who use this drug are more sensitive to sun after they eat celery or celeriac or after they take St. John’s wort. Up to 30% of people who use this experience side effects including peeling, dryness, redness, itchiness and burning.
- Differin (adapalene) is also used as a cream, gel, or lotion applied to the skin that has anti-inflammatory properties. As with Tazorac, the gel form is best for acne. Sometimes Differin is combined with benzoyl peroxide to prevent infection of surrounding skin as cysts and nodules open. The product works by keeping pores from being covered with new skin, and is best for people who need to keep cyst-prone skin clear.
There are many other medical treatments for acne—most of which have severe side effects or very specialized applications. For the best non-prescription clear skin maintenance system, consider Exposed Skin Care.
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