Prescription Topical Acne Treatments

While over-the-counter (OTC) acne products can be effective, prescription topical acne treatment may be recommended if you have stubborn acne and/or moderate-to-severe breakouts. These medications include azelaic acid, retinoid, antibiotic, and combination creams and gels.

These work in different ways—reducing inflammation, killing acne-causing bacteria, and encouraging the shedding of dead skin cells, for example. Whether or not you need a prescription topical acne treatment, and which one may be best for you, depends on the severity of your acne.

This article looks at how these topical acne treatments are used, as well as some specific concerns regarding use on sensitive skin.

Azelaic Acid

Azelaic acid is a prescription cream or gel for mild to moderate acne. It is also sold under the brand names Azelex and Finacea.

This topical acne treatment is believed that azelaic acid works by reducing Propionibacterium acnes, the bacteria most responsible for acne breakouts. It also helps normalize the shedding of dead skin cells and decreases inflammation.

Azelaic acid has the added benefit of improving post-inflammatory hyperpigmentation, the discoloration left after an acne lesion has healed.

Topical Retinoids

Topical retinoids are a group of medications derived from synthetic vitamin A. They promote skin cell turnover, keeping your pores unclogged and preventing comedones. They're used to treat mild to moderate breakouts, as well as severe acne.

They are also effective anti-aging treatments. Topical retinoids are often used to reduce the look of fine lines and wrinkles, making them a popular treatment choice for people with adult-onset acne would like this additional benefit.

Topical retinoids are extremely popular and effective. The most common topical retinoids used to treat acne are:

• Retin-A (tretinoin)
• Retin-A Micro (tretinoin)
• Avage (tazarotene)
• Tazorac (tazarotene)
• Differin (adapalene)*

*Adapalene is more accurately described as a retinoid-like compound, but it's often included in the topical retinoid group because it works in the same way.

A flare-up of acne is common during the first few weeks of topical retinoid treatment. Your skin should clear with continued used of the product.

Topical Antibiotics

Topical antibiotics improve acne by stopping the growth of acne-causing bacteria, Propionibacterium acnes. They can also help reduce inflammation and might decrease the amount of blocked pores.

These topical acne treatments are generally prescribed for moderate to severe acne. The most common topical antibiotics used for this purpose are:

• Clindamycin
• Erythromycin

Topical antibiotics aren't used as often today as they were in years past because they can contribute to antibiotic-resistant bacteria and some users may experience side effects.

To counteract this problem, topical antibiotics should be used along with another acne treatment medication, like a topical retinoid or benzoyl peroxide.

Monotherapy with topical antibiotics are used for only a short time period (12 weeks).

Topical Combination Medications

Topical combination medications are those that contain two acne-fighting ingredients. You get the benefits of both medications with just one application.

These medications can kill acne-causing bacteria, normalize the shedding of dead skin cells, keep pores clear, and reduce the number of comedones, depending on the combination acne medication that your dermatologist prescribes.

There are plenty of topical combination medication options, including:

• Acanya (clindamycin and benzoyl peroxide)
• Benzamycin (benzoyl peroxide and erythromycin)
• BenzaClin (benzoyl peroxide and clindamycin)
• Duac (benzoyl peroxide and clindamycin)
• Epiduo (adapalene and benzoyl peroxide)
• Onexton (clindamycin and benzoyl peroxide)
• Ziana (clindamycin and tretinoin)

Combination medications that include a topical antibiotic offer a key benefit: Often, less of the antibiotic is needed to kill acne-causing bacteria than if the treatment were used alone.

Additionally, studies have shown that using a combination therapy increases adherence to treatment and may, therefore, increase effectiveness.

A Word From Verywell

There are many prescription medication options available to treat acne. Talk to your dermatologist about which one(s) will work the best for your breakouts. Prescription medications can work quickly. You may start noticing improvement in just a few weeks.