How to Treat Acne Using Oral Medications
Popping a pill usually is not a cure for acne. The right medications used in the right way, however, can greatly accelerate progress in healing certain kinds of acne.
- Though antibiotics can be somewhat helpful in treating acne, they are by no means a miracle cure.
- Minocycline, doxycycline, tetracycline, erythromycin, and clindamycin are some of the most popular antibiotics used for acne treatment.
- The only oral retinoid medication used to treat acne is Accutane, and its use is very limited for safety reasons.
- Oral retinoids often come with a whole host of side effects that many people find uncomfortable or even intolerable.
The Problem with Oral Antibiotics for Acne
Oral antibiotics are sometimes used to treat acne, especially cystic acne. In theory, the antibiotic works by decreasing the number of acne-causing bacteria present on the skin, which in turn reduces the number of pimples and cysts that can form. However, in reality, this may not be the most effective treatment for the majority of people with acne.
The biggest issue with using oral antibiotics for acne is the fact that they contribute to a problem known as antibiotic resistance¹. This is when bacteria that have been exposed to certain antibiotics randomly mutate in ways that make them resistant to the antibiotic. Then, when they reproduce, those bacteria are resistant as well, and the process continues until there is a whole colony of bacteria that can’t be killed by the antibiotics traditionally used to kill them.
The second reason antibiotics aren’t the best treatment for most people is because they are a short-term solution, and acne is a long-lasting problem. To try and avoid the creation of antibiotic-resistant bacteria, doctors are supposed to prescribe antibiotics for a limited amount of time. While you’re taking the antibiotics, you may notice an improvement in your skin, but what about after you have to stop taking them? Sometimes a brief round of antibiotics is enough to reduce the colony of acne-causing bacteria to a more manageable size, but oftentimes, acne comes back just as bad as before.
Finally, antibiotics for acne aren’t an ideal treatment because research shows that they aren’t actually all that effective. According to one study involving 649 participants with acne, only half noted a moderate improvement in their acne after taking antibiotics for 18 weeks². This isn’t a bad result, but it also isn’t great, and may not be worth the risk of increasing antibiotic resistance, especially when you remember that antibiotics aren’t a permanent solution.
What Kind of Oral Antibiotic is Best for Acne?
Minocycline is the most commonly prescribed oral antibiotic for acne³. It has a specific action against the species of bacteria that causes acne, and it also reduces redness and oozing. Minocycline is in the group of antibiotics known as tetracyclines. Minocycline may trigger or unmask autoimmune liver disease, but it does not carry the potential for kidney damage4 unlike most medications in its class.
Doxycycline, sold under the trade names Bio-Tab, Doryx, Monodox, and Vibramycin, is another tetracycline antibiotic prescribed to treat acne. While doxycycline is only slightly less effective against acne bacteria than minocycline, it is more likely to trigger skin allergies5, and it is not effective for the staph infections that can cause pimple-like boils with round yellow centers.
Tetracycline is an older antibiotic sold under the trade names Actisite and Sumycin. It is more likely than newer related drugs to cause nausea, diarrhea, and easy sunburn. Like both minocycline and doxycycline, it can interfere with the development of the teeth. The gums can grow over the teeth, and the enamel can be permanently stained blue6.
Trimethoprim/sulfamethoxazole (termed co-trimoxazole in the UK and Australia), sold as Bactrim and Septra, is a “heavy duty” oral antibiotic for treating severe infection. It works by interfering with the enzymes acne bacteria need7 for making the B vitamin folic acid; they cannot absorb it from your body, so they have to make their own. In the elderly, this antibiotic can cause fatal kidney failure.
Some doctors prescribe oral erythromycin or clindamycin along with a benzoyl peroxide gel with good results. There is some reason to believe that the combination of an antiseptic gel and oral antibiotics reduces the risk of antibiotic resistance, ensuring that future acne patients will continue to get benefit from antibiotic treatment. Both of these antibiotics, however, commonly cause stomach upset.
Oral Retinoids for Acne
The other class of oral medications commonly prescribed for acne is a group of medications known as the retinoids. These drugs are chemically related to vitamin A, only much more potent. Their exact mechanism isn’t fully understood yet, but so far, research has revealed that they shrink sebum glands and reduce sebum production8 and they have been found to be particularly effective in treating cystic acne.
The only oral retinoid drug for acne used in most of the world is isotretinoin, also known as Accutane. Accutane also prevents the growth of skin over pores, so new cysts and nodules do not form. It shrinks sebum glands by slowing down the rate at which naturally occurring adult stem cells transform themselves into oil glands in the skin.
If you are prescribed oral Accutane, chances are that you have severe acne problems and this is the one drug that can help. Even if you take Accutane, however, you will still need to follow a healthy skin care routine to prevent the condition from coming back. A complete acne treatment system like Exposed Skin Care may help.
Accutane Side Effects
The downside to treatment with oral retinoids is that they carry many side effects9. For people who have had to deal with the pain and disfigurement of cysts or nodules for many years, oral retinoids can be little short of a miracle cure, but doctors reserve them for the most severe skin problems.
The problem with Accutane is that its effect in pregnancy can be devastating10, especially if it is taken during the first two weeks of pregnancy. Although many unborn children who are exposed to Accutane suffer no ill effects, about 40% of babies exposed to Accutane develop abnormalities of the face, heart, ears, or brain. About 50% of embryos exposed to this medication in the womb are aborted or stillborn.
Men and women who do not get pregnant can also suffer other issues with the drug. It can cause liver failure, suicidal depression, or a kind of diabetes called LADA (latent autoimmune diabetes of adulthood)11.
There can also be:
- Dry skin
- Dry mouth
- Joint pain
- Itchy skin
- Dry skin and pain at the corners of the mouth
- Hair loss, sometimes permanent
- Blood abnormalities
- Loss of appetite
- Excessive appetite
- Kern D. All Activity. Antibiotic resistance in acne treatment. Acne.org. 2019.
- Ozolines M., et al. Randomised controlled multiple treatment comparison to provide a cost-effectiveness rationale for the selection of antimicrobial therapy in acne. Health Technology Assessment. 2005;9(1):iii-212.
- Garner SE, Eady EA, Popescu C, Newton J, Li WA. Minocycline for acne vulgaris: efficacy and safety. Cochrane Database Syst Rev. 2003;(1):CD002086. Review. Update in: Cochrane Database Syst Rev. 2012;8:CD002086.
- Garrido-Mesa N, Zarzuelo A, Gálvez J. Minocycline: far beyond an antibiotic. Br J Pharmacol. 2013;169(2):337–352.
- Bryant SG, Fisher S, Kluge RM. Increased frequency of doxycycline side effects. Pharmacotherapy. 1987;7(4):125-9.
- Vennila V, Madhu V, Rajesh R, Ealla KK, Velidandla SR, Santoshi S. Tetracycline-induced discoloration of deciduous teeth: case series. J Int Oral Health. 2014;6(3):115–119.
- Estrada A, Wright DL, Anderson AC. Antibacterial Antifolates: From Development through Resistance to the Next Generation. Cold Spring Harb Perspect Med. 2016;6(8):a028324. Published 2016 Aug 1.
- Orfanos CE, Zouboulis CC. Oral retinoids in the treatment of seborrhoea and acne. Dermatology. 1998;196(1):140-7.
- David M, Hodak E, Lowe NJ. Adverse effects of retinoids. Med Toxicol Adverse Drug Exp. 1988 Jul-Aug;3(4):273-88.
- Malvasi A, Tinelli A, Buia A, De Luca GF. Possible long-term teratogenic effect of isotretinoin in pregnancy. Eur Rev Med Pharmacol Sci. 2009 Sep-Oct;13(5):393-6.
- WebMD.com. Accutane Oral: Uses, Side Effects, Interactions, Pictures, Warning & Dosing. Retrieved from https://www.webmd.com/drugs/2/drug-6661/accutane-oral/details
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