Acne Medications Explained
Acne is the most common skin condition in the United States, affecting approximately 50 million individuals each year across all ethnic backgrounds. While it is often associated with adolescence, acne impacts people throughout life. The most prevalent form of this condition is known as acne vulgaris, which includes blackheads, whiteheads, papules, pustules, and deeper cystic lesions.
Acne develops when pores become clogged by oil, dead skin cells, and bacteria such as Cutibacterium acnes, resulting in inflammation and lesions that may scar and cause emotional distress.
Acne’s impact on emotional and psychological well-being can be significant. Studies have shown that severe acne can negatively affect self-esteem, mood, and overall quality of life. The condition may be temporary, but one of its most serious complications—scarring—can be permanent. Acne scarring results from inflammation that damages the skin’s deeper layers, and for some patients, it can cause long-term distress.
Because of its potential to affect both skin health and mental health, early and appropriate treatment is essential. At Palo Alto Dermatology Institute, we specialize in identifying the type and severity of acne and offering evidence-based therapies that reduce active breakouts and help prevent scarring. Our goal is not only to clear the skin but also to support the overall well-being of each patient we treat.
We offer a comprehensive array of prescribed treatments. These range from topical agents to oral medications, hormone therapies and specialized treatments for more severe and treatment- resistant cases.
Topical treatments are typically the first line of defense in managing mild to moderate acne. Among the most effective options are topical retinoids, which help unclog pores and normalize skin cell turnover.
1. Retinoids
- Tretinoin (Retin A and generics) is a widely used retinoid that reduces acne lesions and post-inflammatory hyperpigmentation. It may cause initial redness and peeling, but these side effects often subside with continued use. It is effective as long-term maintenance.
- Adapalene (Differin, OTC and prescription), is a gentler retinoid with similar effectiveness. Side effects tend to be milder and subside with use.
- Tazarotene is a stronger alternative that may be used for more resistant cases, though it tends to cause more irritation and is contraindicated during pregnancy.
2. Benzoyl peroxide
Benzoyl peroxide is another common topical treatment. It works by killing acne-causing bacteria and reducing inflammation. It is often used in combination with other agents such as retinoids or antibiotics to enhance results and minimize the development of bacterial resistance. Patients should be aware that benzoyl peroxide can bleach clothing and may cause dryness or redness during initial use.
3. Topical antibiotics
Topical antibiotics like clindamycin and erythromycin help reduce bacterial overgrowth and inflammation. These are usually prescribed in combination with benzoyl peroxide to prevent antibiotic resistance. One newer option is a triple-combination topical medication that includes adapalene, benzoyl peroxide, and clindamycin, offering multiple mechanisms of action in a single application.
4. Clascoterone
Clascoterone (brand name Winlevi®) is a topical anti-androgen medication approved for acne treatment. It works by blocking androgen receptors in the skin, which helps reduce oil production and inflammation. Clascoterone is suitable for both male and female patients aged 12 and older, with minimal systemic absorption and a favorable safety profile.
1. Antibiotics
For moderate to severe acne, oral medications may be necessary. Oral antibiotics, including doxycycline and minocycline, are frequently used to reduce inflammation and bacterial activity. They are typically prescribed for a limited time and always in combination with a topical treatment like benzoyl peroxide to reduce the risk of antibiotic resistance. Erythromycin or azithromycin may be used in patients who cannot take tetracyclines.
2. Oral Hormone Therapies
Hormonal therapies are another option for patients whose acne is influenced by hormonal fluctuations. These include combination oral contraceptives, which regulate hormone levels and reduce oil production, and spironolactone, an anti-androgen that blocks hormone receptors in the skin. These treatments are most commonly used in women and require ongoing monitoring for side effects.
3. Oral Isotretinoin
For patients with severe cystic acne or those who have not responded to other treatments. Isotretinoin is a powerful medication that targets all major factors contributing to acne: excess oil production, clogged pores, bacteria, and inflammation. It is usually taken over the course of several months and can result in long-term remission for many patients. However, isotretinoin requires close monitoring due to potential side effects, including dry skin, joint pain, changes in mood, and serious risks to pregnancy. Patients of childbearing potential must participate in the FDA’s iPLEDGE program, which requires strict pregnancy prevention during and after treatment.
4. Combination Therapies
The American Academy of Dermatology emphasizes the importance of combination therapy to address the different causes of acne simultaneously. For example, a regimen may include a topical retinoid to prevent clogged pores, benzoyl peroxide to eliminate bacteria, and an oral antibiotic to reduce inflammation. The goal is not only to clear active breakouts but also to prevent scarring and maintain long-term control.
The TheraClearX laser is a cutting-edge dermatological device designed specifically for the treatment of acne. It uses a combination of broad-spectrum light and gentle suction to address acne at its source. The light therapy eliminates acne-causing bacteria while reducing inflammation, and the vacuum technology removes oil, debris, and dead skin cells from clogged pores. This dual-action approach makes the TheraClearX an effective solution for patients seeking a non-invasive treatment option for acne-prone skin.
Facials, chemical peels and skin healing techniques are a safe and effective options for acne patients including patients with post-acne skin darkening or hyperpigmentation. Often these treatments are paired with medical and surgical acne therapies.
Managing side effects is an essential part of treatment. Patients using retinoids or benzoyl peroxide may experience dryness or irritation which can resolve within weeks of starting therapy. Side effects can be managed with moisturizers, sunscreen, and adjustments to application frequency.
Oral antibiotics may cause gastrointestinal upset or sun sensitivity, while hormonal medications may lead to menstrual changes or breast tenderness. Isotretinoin can affect liver function and cholesterol levels, requiring periodic blood tests and follow-up visits.
The dermatologists at Palo Alto Dermatology Institute use a patient-centered approach to select the most effective treatment plan, tailored to the individual’s skin type, acne severity, and overall health. Patients are monitored regularly, and treatment regimens are adjusted as needed to ensure optimal outcomes.
Acne is a complex condition that often requires a combination of therapies to achieve lasting results. With access to the most advanced topical and oral medications available today, patients at Palo Alto Dermatology Institute receive evidence-based, compassionate care aimed at restoring clear, healthy skin. If you or your child is struggling with acne, scheduling a consultation with a board-certified dermatologist is the first step toward an effective treatment plan.
