Oral Medications for Treating Acne

Oral Medication Options for Treating Stubborn or Severe Acne

oral antibiotics
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Acne can be tough to treat. If you've tried several topical acne medications without much improvement, or if your acne is severe, oral acne medications are the next treatment step.

Are oral acne medications the right treatment choice for you?

Oral Medications May Be Your Best Acne Treatment Options

Not all acne clears up with topical medications (the creams, lotions, and gels that you apply to your skin).  Oral medications, also called systemic medications, work internally to improve the skin. You take them by mouth.  Some medications you'll take just once a day, others you'll take more often, ideally at the same time every day. 

Persistent or severe cases of acne are difficult to control, and in the majority of cases requires oral medications. Severe acne (sometimes called cystic acne or nodular acne) creates large, deep, inflamed breakouts. Topical medications can't get deep enough to effectively treat these types of blemishes.

Another obstacle: Acne often occurs on other areas of the body, like your back or shoulders. It can be tough to reach those areas to effectively apply topical treatments. Oral acne medications, on the other hand, can work on deeply inflamed blemishes and you don't have to be a contortionist to get the medication where you need it.

Even if your acne isn't necessarily severe, it might simply be stubborn. If you've tried topical treatments and your skin still isn't clearing up, oral medications can give your treatment the boost it needs so you can see actual results.

In any case, if you're having trouble getting your acne under control, see a dermatologist. All oral acne medications are prescription only. There are no over-the-counter alternatives. 

Oral Antibiotics

Oral antibiotics have been used to treat acne for many years. Like topical antibiotics, oral antibiotics work by reducing Propionibacteria acnes (the bacteria responsible for acne breakouts). They also help decrease inflammation of the skin.

Most people are started on a high dosage and moved to lower dosages as acne improves. Oral antibiotics are used to treat moderate to severe acne, or persistent acne.

The most common oral antibiotics prescribed for acne treatments are:

Oral antibiotics work best when paired with topical acne treatments, so expect to be prescribed topical retinoids, benzoyl peroxide, or another topical treatment to use as well.

Oral Contraceptives

Oral contraceptives, also known as birth control pills, can be used to treat acne in women. Oral contraceptives work to reduce oil gland secretions by suppressing androgen hormones.

They are a good choice for women with acne that comes and goes along with their monthly cycle, and for ladies with acne who need a form of birth control anyway.

Most likely, you'll also need a topical medications to use along with your oral contraceptives.

Just a handful of birth control pills have been approved as acne treatments by the FDA, like Ortho Tri-Cyclen, Beyaz, and Yaz. But you don't necessarily need these specific brands.

Birth control pills have been prescribed off-label to treat acne for many years. Most doctors agree nearly any formulation will give the same effect.

Aldactone (Spironolactone)

Aldactone (spironolactone) is another medication that is just for adult women only. It's not specifically an acne treatment, but it can be used in certain circumstances to treat hormonal fluctuations that contribute to breakouts.

Aldactone isn't very commonly used, and it's not a first-line acne treatment choice, but for some women it is helpful in treating acne that isn't getting better with more conventional treatments.

Isotretinoin

Isotretinoin, formerly sold under the brand name Accutane, is a super powerful acne medication. It works when all other acne treatments have failed, and it's considered the best treatment for severe acne.  

Isotretinoin works by shrinking the sebaceous glands, reducing the amount of oil found on the skin. This, in turn, reduces the amount of comedones (or pore blockages) produced. No pore blockages equals no pimples.

But this medication isn't for everyone. For example, pregnant women can't use this drug because it can cause serious birth defects.

While using this medication, you will enroll in the iPledge program. This program is designed to help reduce the number of birth defects caused by isotretinoin use during pregnancy. Everyone has to enroll, even men, although the requirements for men and women who can't get pregnant are different than requirements for women who can get pregnant.

You will also be monitored for side effects during the course of your treatment. But, the good news is most people only need one or two courses before acne is gone for good. Your dermatologist will help you decide if this is the right option for you.

A Word from Verywell

If topical treatments alone aren't improving your acne, or if your acne is quite severe or widespread, an oral medication is really the best option. In some cases you'll only need to take oral medications short term, to get acne under control, and then maintain your skin with topical medications. Other times, though, you may need to take them for longer periods of time.

If you're at all worried about taking an oral acne medication, or if you have questions or concerns about your treatment, by all means let your dermatologist know. Getting acne under control can be frustrating, but the long term results are worth it.

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