Anti-Acne Prescription Medications

Patient Expert

I keep reading about lots of different types of acne medications but I'm not sure what I'm supposed to use or ask my doctor about. What's the difference between something like Benzaclin and Differin?

Acne medications are varied, but most work to do at least one of three things: Kill acne bacteria, decrease oil production, and increase the rate of cell turnover. For most people with light to moderate cases of acne, over-the-counter products are usually strong enough to help reduce breakouts.

For others with heavy to severe cases of acne, it may require prescription strength medications. Although prescribing an anti-acne regimen falls under your dermatologist's discretion, you can still inform yourself of the basics before speaking with your doctor.

Here's a list of different types of commonly prescribed acne medications and how they work to prevent and reduce acne:

Topical anti-bacterial ointments

Benzoyl Peroxide - While this is a common drugstore ingredient, your doctor may be able to prescribe a more concentrated benzoyl peroxide ointment for severe acne. In addition, this ingredient is found in many anti-acne formulas because it tends to increase the effectiveness of other anti-bacterial treatments. Benzoyl peroxide does not cause resistance in P. acnes, the bacteria that lives on skin and causes acne, and can reduce the ability of P. acnes to develop resistance to other antibiotics.

Clindamycin - Often found in formulas alongside benzoyl peroxide under the brand names of Cleocin, Duac, and Benzaclin, this antibiotic works well to kill P. acnes bacteria while also reducing inflammation in the skin. It's safe for topical use when following prescription guidelines, but it can cause skin irritation in a small percentage of patients.

Azelaic Acid - While this is primarily prescribed to fight acne, azelaic acid is occasionally prescribed to lighten hyperpigmented spots on people with darker skin. More commonly found under the brand names of Azelex and Finacea, azelaic acid is produced naturally by a yeast that lives on human skin. In addition to its antimicrobial properties, it helps keep pores clear by decreasing the rate at which skin cells shed into hair follicles. Some people may experience lightening of the skin after continued use.

Topical retinoids

Adapalene - Differin is the most commonly known version of adapalene. As with all retinoids, adapalene is a derivative of vitamin A and works to unclog pores. When used in combination, adapalene has been shown to increase the skin's absorption of clindamycin. Since adapalene (and most other retinoids) can cause photosensitivity, it's important to wear sunscreen while using this and similar products.

Tazarotene - Known most commonly as Tazorac, this ingredient also improves the appearance of acne but can dry the skin excessively during the first few weeks of use. Tazarotene can also reduce sun damage to the skin and benefit those who suffer from psoriasis, but it can also increase skin irritation. Doctors tend to prescribe a skin moisturizer alongside tazarotene in order to alleviate flaky skin.

Tretinoin - Renova and Retin-A are among the most widely known topical retinoids. In addition to alleviating acne by reducing sebum production, tretinoin has also demonstrated some success in improving the appearance of stretch marks by increasing the production of collagen in the skin. Since retinoids are known to cause birth defects, women who are pregnant should not use these ingredients and birth control must be used while on this medication.

Oral medications

Isotretinoin - Widely referred to by the brand name Accutane, this oral retinoid is reserved for patients who have severe cases of cystic acne that remain unaffected by other kinds of medication. Like topical tretinoin, this drug has been shown to cause birth defects and doctors require women to take oral contraceptives while taking this medication.

Tetracycline - While tetracycline antibiotics have a wide variety of uses, they are mainly used to treat acne and rosacea due to their ability to reduce inflammation. Tetracycline can cause discoloration of teeth and women who are pregnant or breastfeeding should avoid this course since tetracycline can affect the skeletal development of children.

Oral Contraceptives - Since overproduction of sebum is one of the root causes of acne, women have the added option of decreasing acne by regulating hormones. While most oral contraceptives are safe for long-term use, you should speak to a gynecologist as well as a dermatologist about the best options for decreasing acne.