Topical Prescription Acne Treatments

These prescriptions may be more effective than over-the-counter acne products

Topical acne treatments available as over-the-counter (OTC) products may work to clear up acne in some cases, but some people will require prescription acne treatment.

These products are available through your dermatologist or other healthcare provider. Retinoids, antibiotics such as erythromycin, and topical drug combinations available by prescription can be quite effective in treating acne.

This article looks at how these prescription acne medications are used, as well as some specific concerns such as topical acne treatment for sensitive skin or its use during pregnancy.

Woman applying acne cream to her her
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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.

It 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.

Azelaic Acid and Sensitive Skin

Azelaic acid should be used with caution in people with sensitive skin due to side effects that include redness, burning, and irritation, as well as for those with sun sensitivity measured as Fitzpatrick skin types IV or greater.

Topical Retinoids

Topical retinoids are extremely popular and effective acne treatments. Topical retinoids are a group of medications derived from synthetic vitamin A. 

The topical retinoids that are used to treat acne include tretinoin and tazarotene. Adapalene is more accurately described as a retinoid-like compound, but because it works in just the same way it's often included in the topical retinoid group.

Topical retinoids 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.

Topical retinoids, especially the topical retinoid tretinoin, has another advantage—they're effective anti-aging treatments. They are often used to reduce the look of fine lines and wrinkles, making retinoids a popular treatment choice for adult-onset acne sufferers.

A common side effect during the first few weeks of topical retinoid treatment is a flare-up of acne. This should, however, clear as the patient continues with the treatment.

The most common topical retinoids used to treat acne are:

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.

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 antibiotics are generally prescribed for moderate to severe acne. The most common topical antibiotics used to treat acne are clindamycin and erythromycin.

Topical Combination Medications

Topical combination medications, as the name suggests, include medications 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.

An important feature of topical combination therapy is the fact that less antibiotic is often needed to kill bacteria compared to using topical antibiotics alone. Additionally, studies have shown that using a combination therapy increases adherence to treatment and may therefore increase effectiveness.

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)

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. Within just a few weeks, you may start noticing improvement. 

Frequently Asked Questions

  • Does vitamin C help with acne?

    Yes, research suggests that anti-inflammatory properties of topical vitamin C can help to improve acne and reduce oil production in the skin. Talk to your healthcare provider about using vitamin C for acne before you begin.

  • Can benzoyl peroxide make acne worse?

    Benzoyl peroxide has several side effects, including skin dryness, slight redness, itching, flaking skin, and minor peeling. It also may not be the best treatment option for people with sensitive skin. However, it is an effective treatment for acne and is unlikely to make it worse.

  • Can I use a topical acne treatment while pregnant?

    You'll need to talk about acne treatment with your healthcare provider during pregnancy. It's unclear if medications such as Epiduo are safe to use when pregnant. That's true of other topical acne treatments that contain retinoids as well as azelaic acid.

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6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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