Medically reviewed by Dr. Nancy Shannon, MD, PhD on September 19, 2021
Prescription acne treatments are some of the most important and powerful tools at your disposal in the fight against acne. While it may seem like you should leave sorting through prescriptions to your dermatologist and focus on natural treatments, there’s good reason to be informed about what your options are. The more you know, the better equipped you’ll be to discern which will work best for you. Here’s what you need to know:
Retinoids are a group of Vitamin A derivatives that, when applied topically, increase the rate of skin cell turnover. By causing older, dead skin cells to dissipate and get replaced with younger, healthier cells, retinoids prevent pores from becoming blocked and discourage acne development.
Retinoids are available in different forms such as lotions, gels, foams, or creams. Some retinoids, such as adapalene, are even available over-the-counter, but these formulations are generally weaker than the ones available through prescription. For this reason, some dermatologists like to start out their patients on over-the-counter retinoids (to allow a patient’s skin to adjust to retinoids) before moving them to prescription retinoids.
Isotretinoin, commonly known by the brand name Accutane, is a particularly powerful oral retinoid and is one of the most powerful treatments for severe acne out there. It works by shrinking the oil-producing sebaceous glands found in the pores. The oily material produced by these glands, known as sebum, can cause acne breakouts if too much is produced. By limiting the productivity of the sebaceous glands, isotretinoin can permanently make acne formation much less likely.
Because isotretinoin is meant for severe acne or acne that has not responded to other prescription treatments, it can have a particularly strong drying effect on the skin, and people with especially sensitive skin but severe acne will usually be prescribed a lower dose to limit drying side effects. Most dermatologists will try several different treatments before opting for isotretinoin.
When your pores get clogged, the bacteria trapped inside begin to feed on the sebum and multiply rapidly. This leads to the development of inflammatory papules and pustules. Antibiotics help limit the growth of those bacterial populations, reducing the overall severity of your acne.
There are a number of different topical and oral antibiotics available for treating acne such as doxycycline (oral), erythromycin (topical and oral), and clindamycin (topical). To limit the risk for antibiotic resistance, most antibiotics are used short-term (a few months, especially for oral antibiotics) or are used in conjunction with benzoyl peroxide (an over-the-counter topical antibiotic).
- Combination Topicals
Combination topicals are just what they sound like: formulae that combine two or more acne-fighting ingredients into a single product. The most common topicals of this type are a mix of some kind of retinoid with benzoyl peroxide or salicylic acid. While not all combination topicals require a prescription, the more effective ones likely will due to the strength of their ingredients.
- Birth Control
One of the leading causes of acne among women is hormonal fluctuation. The body’s natural balance of sex hormones changes drastically over the course of a typical menstrual cycle, leading to breakouts of menstrual acne as a result.
Birth control can help prevent this by leveling out the body’s level of sex hormones. In order to prevent pregnancy, birth control keeps hormone levels relatively high and stable. This means that the dips and spikes associated with periods will no longer be as severe or even occur at all, meaning fewer hormonal breakouts in the long run.
Androgens are sex hormones, so most anti-androgen products have been used historically for treating sex and reproduction-related conditions. Spironolactone is an oral anti-androgen that is used “off-label” for women with hormonal acne (related to their menstrual cycle). Anti-androgens work by limiting sebum production, which in turn limits the extent to which pores get clogged leading to acne. In August of 2020, however, the FDA approved a new topical anti-androgen cream (clascoterone 1%) for acne treatment. When applied to the skin, anti-androgen creams limit sebum production and act as anti-inflammatories as well, keeping acne severity to a minimum. While topical anti-androgen acne treatments may not yet be the norm for acne, the development of more treatments in the future could make it an invaluable part of the fight to keep your skin clear.
Sorting through all of the different treatments available for acne — prescription or otherwise — is no small task. If you’re feeling overwhelmed, get in touch with a member of our team of experts today to learn more about what your options look like.