Acne treatment involves medications that work in different ways to control excessive sebum production, prevent the growth of bacteria, or reduce inflammation, directly contributing to a reduction in the number of blackheads, whiteheads, and pimples.

Acne is a skin condition involving inflammation of clogged skin follicles and oil glands. It can be caused by excessive oil production, bacteria, or hormone imbalances.

Acne treatments include both oral and topical medications that are prescribed based on severity of the acne. These medications come with potential side effects and should therefore only be used under the supervision of your dermatologist or primary care provider.

woman smiling and applying topical acne treatment to her face

Acne treatments can involve both oral and topical medications, depending on the severity of the acne:

Oral medications

Oral medications for the treatment of acne may be prescribed in the form of pills or capsules. Common medications include:

1. Antibiotics

Antibiotics, such as tetracycline and minocycline, may be prescribed by a dermatologist or primary care provider for the treatment of moderate to severe acne. This type of treatment helps to eliminate bacteria on the skin and reduce redness and inflammation.

Antibiotics such as erythromycin or azithromycin are another option for people who cannot take tetracyclines, such as pregnant people and children under 8 years of age.

Antibiotics for acne treatment are carried in most pharmacies and drug stores and require a prescription for purchase.

Instructions: the dose and duration of antibiotic treatment will be determined by the prescribing provider and will vary based on the type of antibiotic used and the severity of the acne. Oral antibiotics should be used for the shortest time possible in order to prevent antibiotic resistance.

Side effects: serious side effects are rare with the use of antibiotics to treat acne. More common side effects include dizziness, nausea, vomiting, diarrhea, and skin rash. These medications can also increase sun sensitivity so it is important to use sun protection during treatment.

2. Isotretinoin

Isotretinoin, or retinoic acid, is one of the most effective treatments for severe acne with scarring and in cases in which acne does not improve with other treatments such as antibiotics, creams, and changes in skin care routine. Isotretinoin is sold under its generic name "isotretinoin" and is commonly known by its former brand name, Accutane.

Isotretinoin decreases sebum production, which helps reduce the growth of bacteria as well as skin inflammation. It is a prescription-only medication available at most pharmacies and drug stores.

Instructions: the typical starting dose for isotretinoin is 0.5 to 1 mg per kg of body weight per day and can be increased to up to 2 mg per kg of body weight per day. This medication should be taken after a meal and at the times specified by your doctor. Duration of treatment will vary depending on the daily dose and level of improvement over time, with complete resolution of acne typically occurring after 16 to 24 weeks of treatment.

Side effects: the most common side effects of isotretinoin include skin sensitivity, itchiness, dry skin, chapped lips, dry eye, muscle pain, and joint pain. Isotretinoin may also cause conjunctivitis and initial worsening of acne.

3. Oral contraceptives (birth control)

Acne treatment for women and adolescent girls may involve oral contraceptives, such as drospirenone, cyproterone, or combined estrogen and progesterone pills. These medications can help to control hormone imbalances and improve oily skin, leading to fewer breakouts.

Results may not be seen right away, so it is recommended to use other acne medications during the first few weeks of treatment.

Instructions: doses will vary on a case by case basis, but will involve taking 1 pill daily, at the same time every day, or as directed by your doctor or other healthcare provider.

Side effects: side effects will depend on the type of pill prescribed as well as the dosage. Common side effects include nausea, abdominal pain, breast tenderness, headache, weight gain, and changes in mood.

4. Spironolactone

Spironolactone is a diuretic typically indicated for the treatment of high blood pressure, however it also has antiandrogenic effects that can help in the treatment of acne related to polycystic ovarian syndrome.

This acne treatment acts to inhibit the production of sebum and the proliferation of sebocytes, helping to reduce the number of whiteheads, blackheads, and pimples.

Instructions: the starting dose of spironolactone for polycystic ovarian syndrome is typically 25 mg per day, which can be increased by a doctor to a maximum of 100 mg per day.

Side effects: may include irregular periods, breast sensitivity, decreased libido, dizziness, nausea, headache, increased urination, and fatigue.

Topical medications

Topical acne treatments are usually prescribed in the form of a gel, solution, or cream. It is important to use sun protection while being treated with these medications.

1. Azelaic acid

Azelaic acid is a compound with antibacterial, anti-inflammatory, and antioxidant properties that prevents breakouts by inhibiting the growth of the bacteria Propionibacterium acnes.

This medication can be found at most pharmacies and drug stores and requires a prescription for purchase.

Instructions: before applying, it is important to wash your hands and the affected area well, using a soap indicated for acne prone skin. The gel or cream will contain 150 to 200 mg/g of azelaic acid and should be applied twice a day to all areas with acne. Due to its antibacterial properties, azelaic acid should not be used for more than 6 weeks in a row.

2. Glycolic acid

Glycolic acid is an anti-inflammatory and antimicrobial acne treatment that helps exfoliate the skin. It is used for skin peels and should only be applied by a dermatologist.

Instructions: the concentration of glycolic acid in skin peels is between 5 and 10%. Treatments should be applied by a dermatologist at an interval of no less than 15 days.

3. Salicylic acid

Salicylic acid is an anti-inflammatory and antibacterial exfoliant used as a complementary therapy in the treatment of acne, as it helps control oily skin and prevent contamination by fungi and bacteria.

Instructions: salicylic acid can be applied as part of skin peels done by a dermatologist or as a daily cream or gel. It should only be used under the supervision of a dermatologist or primary care provider. It is important to wash your hands and the affected area prior to applying salicylic acid, making sure to use an appropriate soap indicated for acne prone skin.

4. Benzoyl peroxide

Benzoyl peroxide is a powerful bactericide and anti-inflammatory medication that helps in the treatment of mild to moderate acne by eliminating bacteria.

Instructions: benzoyl peroxide comes in the form of creams or a gel that should be applied twice a day for a period of 8 to 12 weeks, or as directed by your doctor. It is recommended to use a cream or gel containing between 2.5 and 10% benzoyl peroxide. Before applying, make sure to wash your hands and the affected area well.

5. Clindamycin

Clindamycin is a topical antibiotic that is usually recommended in combination with benzoyl peroxide or retinoids.

This acne treatment inhibits the action of bacteria on the skin, helping to control outbreaks and decrease inflammation.

Instructions: clindamycin comes in the form of solutions or gels and should be applied twice a day for a maximum of 6 weeks.

6. Retinoids

Retinoids, such as adapalene and tretinoin, are vitamin A derivatives that can also be used for the treatment of acne.

Retinoids are anti-inflammatories that act on the sebaceous glands to decrease the production of sebum and stimulate cellular regeneration, helping to improve healing and prevent scarring.

Instructions: wash your hands and the affected area with soap and water and pat dry. Apply the retinoid cream or gel over the entire affected area at bedtime, or as directed by your doctor.

Side effects

The most common side effects of topical acne medications are dry skin, skin irritation, sun sensitivity, redness of the skin, and a burning sensation like a sunburn. It is important to always use sun protection to prevent skin damage while undergoing treatments with topical acne medications.

Treatments during pregnancy

Some medications should not be used during pregnancy, including clindamycin and retinoids such as tretinoin and isotretinoin. Retinoids are contraindicated in pregnancy because of the risk for fetal malformations. They are also contraindicated during lactation as retinoids have been shown to pass through the breast milk.

Azelaic acid is one acne treatment that may be used during pregnancy, however it is important to consult a dermatologist and your OBGYN before using any acne treatment during pregnancy. This is because certain acne medications, like retinoids, can be harmful to the fetus.

Home remedies

In addition to conventional treatments, certain home remedies may be useful in the treatment of acne, such as sodium bicarbonate (baking soda) and even mint tea.

It is important to drink at least 2 to 2.5 liters (68 to 84 oz) of water per day to keep the skin well hydrated while undergoing acne treatments. It is also important to maintain a well-balanced diet of whole grains and fresh fruits and vegetables to help decrease skin inflammation.

Acne can leave marks on the skin that may take a long time to go away. Treatments such as face masks made from clay or yogurt can help reduce the appearance of these marks on the skin.