People with moderate to severe inflammatory acne may be treated with prescription topical or oral medicines, alone or in combination.

Prescription Topical Medicines

Several types of prescription topical medicines are used to treat acne. They include:

• Antibiotics – help stop or slow the growth of bacteria and reduce inflammation.

• Vitamin A derivatives (retinoids) – unplug existing comedones (plural of comedo), allowing other topical medicines, such as antibiotics, to enter the follicles. Some may also help decrease the formation of comedones. The drugs contain an altered form of vitamin A. Some examples are tretinoin (Retin-A2), adapalene (Differin), and tazarotene (Tazorac).

• Others – may destroy P.acnes and reduce oil production or help stop or slow the growth of bacteria and reduce inflammation. Some examples are prescription strength Benzoyl peroxide, sodium sulfacetamide/ sulfur-containing products or Azelaic acid (Azelex).

Like OTC topical medicines, prescription medicines come as creams, lotions, solution, gels or pads. Your doctor will consider your skin type when prescribing a product. Creams and lotions provide moisture and tend to be good choices for people with sensitive skin. If you have very oily skin or live in a hot, humid climate, you may prefer an alcohol-based get or solution, which tends to dry the skin. Your doctor will tell you how to apply the medicine and how often to use it.

For some people, prescription topical medicines cause minor side effects, including stinging, burning, redness, peeling, scaling or discoloration of the skin. With some medicines, such as tretinoin, these side effects usually decrease or go away after the medicine is used for a period of time. If side effects are severe or don’t go away, notify your doctor.

As with OTC medicines, the benefits of prescription topical medicines are not immediate. Your skin may seem worse before it gets better. It may take from 4 to 8 weeks to notice improvement.

Prescription Oral Medicines

For patients with moderate to severe acne, doctors often prescribe antibiotics. Oral antibiotics are thought to help control acne by curbing the growth of bacteria and reducing inflammation. Prescription oral and topical medicines may be combined. Common antibiotics used to treat acne are tetracycline (achromycin V), minocycline (Dynacin, Minocin), and doxycycline (Adoxa, Doryx and Monodox).

Other oral medicines less commonly used are clindamycin (Cleocin), erythromycin or sulfonamides (Bactrim). Some people taking these antibiotics have side effects, such as an upset stomach, dizziness or lightheadedness, changes in skin color and increased tendency to sunburn. Because tetracyclines may affect tooth and bone formation in fetuses and young children, these drugs are not given to pregnant women or children under age 14. There is some concern, although it has not been proven, the tetracycline and minocycline may decrease the effectiveness of birth control pills. Therefore, a backup or another form of birth control may be needed. Prolonged treatment with oral antibiotics may be necessary to achieve the desired results.

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