In extreme cases when acne doesn’t respond to holistic treatments, medical intervention may be necessary. Oral prescription medications should be used as a last resort and for as short a time as possible. These treatments can be very effective but also have harsh side effects, so the sooner treatment is completed the better. Medical treatments are a good way to get the ball rolling in the healing process when holistic approaches are not effective or when acne becomes cystic and poses the threat of scarring. Below are the main medical interventions in which Dermatologists treat acne. Our list of top oral acne medications require a prescription and strict instructions to be followed for safe, effective treatment:

Oral Antibiotics

antibioticsOral antibiotics are one of the first lines of defense dermatologists use against acne. They work in two ways. The first and most obvious way is that they decrease the amount of p. acnes. bacteria on the skin, therefore lessening breakouts. A second, lesser known way that oral antibiotics work is by reducing systemic inflammation. Some medical experts think that this second property is actually more powerful in treating acne than the first.

Many Dermatologists choose to prescribe antibiotics for only a few weeks to a month because it is easy to develop a resistance to them and they cause stomach issues. This seems counterproductive because it takes up to three months for most oral antibiotics to become effective against acne. Other Dermatologists are not so conservative and will have no problem keeping a patient on oral antibiotics for years, realizing that even if resistance does occur, the anti-inflammatory properties of antibiotics alone are strong enough to keep acne at bay.

Types of Oral Antibiotics For Acne

Not just any type of antibiotic can be prescribed to treat acne, specific classes of the drug must be used that target the p acnes bacteria. The most commonly prescribed antibiotics for acne are tetracycline, doxycycline, minocycline, clindamycin, and erythromycin. Medication is usually taken once or twice a day. Calcium and Zinc can affect the absorption of tetracycline and so must be avoided during the time it is consumed.

Side Effects

One side effect of all oral antibiotics is antibiotic resistance (as mentioned above). This has become a huge problem in our world in creating “superbugs” and so many dermatologists choose not to prescribe antibiotics for acne at all.

Another concern is that Tetracycline, Doxycycline and Minocycline all have the potential to stain teeth and skin in children and young adults. Also, all of these antibiotics can potentially cause upset stomach, nausea and headache. Minocycline in particular may cause vertigo, diarrhea or in extremely rare cases, autoimmune diseases. All the aforementioned antibiotics cause skin sensitivity to the sun, so precautions should be taken such as broad spectrum SPF, protective hats and other protective clothing to prevent burns and sun damage.

Oral Isotretinoin (Accutane)

accutaneAccutane, otherwise known as isotretinoin, has the most serious side effects of all the acne treatments and is considered to be the most aggressive. Because of this it should only be used as a last resort to prevent cystic acne from worsening and leaving scars. It is mainly used for severe acne that is resistant to other treatments and currently comes with many requirements before obtaining a prescription. For women, they must agree to use two forms of birth control before obtaining a prescription because the drug causes severe birth defects in unborn children.

Accutane is a natural derivative of vitamin A and is taken orally. It builds up quickly in tissue so Vitamin A supplements must be avoided during treatment to avoid overdose. Accutane severely decreases the activity of the oil glands so that sebum production is reduced, follicle size is reduced and acne lesions heal and stop forming. It can take several weeks to begin working and full course of treatment (4 to 5 months) must be completed to achieve successful results.

Accutane is metabolized by the liver, so it is important to be careful when using this medication as it can cause liver damage. Many Dermatologists are so wary of the side effects of this drug that they won’t even prescribe it. Other dermatologists have no problem with it because it has been used successfully by millions of people. It is a very effective treatment despite the side effects. Some report that their acne is cured after one or two rounds of Accutane and that they never have to worry about breaking out again.

Since Accutane causes sensitivity to the sun, it is extremely important to use a broad spectrum SPF of 30 or higher when using Accutane. Failure to do so may result in severe skin damage.

Side Effects

Dry, flaking skin, nose bleeds, irritable bowel syndrome, liver intoxication, dry scalp, hair loss, birth defects, depression, suicidal thoughts, joint and muscle pain, headache chapped lips, night vision problems that may become permanent, stomach ache, and potentially Chron’s Disease, etc

Spironolactone

spironolactoneThis is an oral diuretic and heart medicine in pill form that also happens to treat hormonal acne in women. It works by lowering the amount of androgen hormones (otherwise known as DHT) on the skin. Since androgen hormones are a huge component in acne, this decrease is very effective at clearing hormonal skin problems in women. This is a powerful medication for women with adult acne and a first line of defense for hormonal acne. The only problem is that it takes a very long time to work. Results may not be seen for 3 months and full effects may not be achieved for 6 months.

Side Effects

Side effects are mild and include, frequent urination, menstrual irregularities, and stomach issues.

Oral Contraceptives

Oral contraceptives, oral contraceptivesotherwise known as birth-control pills, are often used to treat hormonal acne in women. After a few months of treatment, synthetic estrogens and progesterone in oral contraceptives regulate a woman’s hormones so that her cycle is regular and her androgen hormones decrease. Because of this, acne is improved. Usually at the start of treatment, acne worsens but begins to clear after a month or two. There are many side effects that come along with oral contraceptives, so think twice before using this method for acne treatment.

Side Effects

Some of the main side effects include: moodiness, skin discoloration, weight changes, increased risk of breast cancer in those who smoke or those who are over age 35, stomach aches, headaches, depression, and sun sensitivity.