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.
- Minocycline is the most often prescribed oral medication for acne. American doctors tend to be insensitive to its side effects for patients under the age of 22.
- Tetracycline can cause dangerous side effects in some adult users.
- The only oral retinoid medication used to treat acne is Accutane, and its use is very limited for safety reasons.
Oral Antibiotics for Mild to Moderate Acne
Fifty years ago a trip to the family doctor for acne treatment almost always resulted in a prescription for oral antibiotics. As antibiotic resistance becomes an increasingly greater problem, however, fewer and fewer doctors prescribe oral antibiotics for mild to moderate common acne1, and antibiotics are almost never the first line of treatment.
Minocycline is the most commonly prescribed oral antibiotic for acne2. It has a specific action against the species of bacteria that causes acne, and it also reduces redness and oozing. Although this antibiotic is most commonly sold under the trade names Dynacin and Minocin, an extended release version of the drug is most commonly prescribed for acne.
Minocycline is in the group of antibiotics known as tetracyclines. Other antibiotics in this group usually have to be dosed four times a day, while it is possible to take just one pill a day of minocycline for acceptable results. Minocycline may trigger or unmask autoimmune liver disease, but it does not carry potential for kidney damage3 unlike most medications in its class.
The body’s absorption of minocycline is impaired if it is taken with calcium or iron supplements4. Between 50% and 70% of women who take this antibiotic will develop ringing in the ears (tinnitus), dizziness, or vertigo. And if you are a man or a woman who fair skin from a British, Russian, or Scandinavian heritage, there is a real risk that taking minocycline can give your face a permanent gray-slate cast5.
That’s why most British doctors will prescribe one of the the related antibiotics doxycycline, lymecycline, or oxytetracycline before trying minocycline. American doctors, however, are likely to try minocycline first.
Doxycycline, sold under the trade names Bio-Tab, Doryx, Monodox, and Vibramycin, is another tetracycline antibiotic prescribed to treat pimples. While doxycycline is only slightly less effective against acne bacteria than minocycline, it is more likely to trigger skin allergies6, 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 blue7.
In Europe, doctors are reluctant to prescribe these antibiotics to anyone under the age of 22. Taken between the ages of 15 and 22, they can permanently stain the teeth at the gum line, and taken before the age of 15, they can turn the entire teeth blue. In the United States, however, doctors will usually risk some dental disfigurement by prescribing the medications to patients older than the age of eight.
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 need8 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.
In Canada, doctors typically try to treat acne with the least expensive antibiotics available. Some Canadian 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. They shrink sebum glands9 and stimulate the growth of the skin so that it opens up over cysts and nodules without need for lancing or surgery.
The downside to treatment with oral retinoids is that they carry many side effects10. 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 only oral retinoid drug for acne used in most of the world is isotretinoin, also known as Accutane. It would be fair to describe Accutane as “vitamin A on steroids.” It stimulates the growth of the skin, causing it to grow so fast that it opens up over nodules and cysts.
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.
The problem with Accutane is that it also stimulates rapid growth of other tissues in the body, and that can be a bad thing. Its effect in pregnancy can be devastating11, especially if it is taken during the first two weeks of pregnancy, before a woman knows she is pregnant. Although many unborn children who are exposed to Accutane suffer no ill effects, about 40% of babies exposed to Accutane who survive through the pregnancy while in the womb develop abnormalities of the face, heart, ears, or brain. About 50% of embryos exposed to this medication in the womb are aborted or stillborn.
Women who do not get pregnant and men can suffer other issues with the drug. It can cause12 liver failure, suicidal depression, or a kind of diabetes called LADA (latent autoimmune diabetes of adulthood).
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
And many users note a particularly disconcerting side effect. Accutane cures nodules and cysts, but causes whiteheads, blackheads, and pimples!
If you are prescribed oral Accutane, chance 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.
- Leyden JJ, Del Rosso JQ. Oral antibiotic therapy for acne vulgaris: pharmacokinetic and pharmacodynamic perspectives. J Clin Aesthet Dermatol. 2011;4(2):40–47.
- 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.
- Leyden JJ. Absorption of minocycline hydrochloride and tetracycline hydrochloride. Effect of food, milk, and iron. J Am Acad Dermatol. 1985 Feb;12(2 Pt 1):308-12.
- La Placa M, Infusino SD, Balestri R, Vincenzi C. Minocycline-Induced Blue-Gray Discoloration. Skin Appendage Disord. 2017;3(3):161–162.
- 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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