Topical Prescription Acne Treatments

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It would be great if acne could always be taken care of with over-the-counter (OTC) products. But, as you may well have experienced, that's not always the case.

To get results, you'll likely need to turn to your physician or dermatologist for a prescription acne treatment. The good news is there are plenty of topical medications that are effective in treating acne. So, if OTC acne products just aren't helping, it's time to move on to prescription options.

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.

According to published studies, azelaic acid should be used with caution in patients with sensitive skin due to side effects that include redness, burning, and irritation. It should also be used with caution in patients with with Fitzpatrick skin types IV or greater. Also, the safety of this medicine during pregnancy is not known.

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. 

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3 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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