There are dozens of prescription medications to treat moderate to severe acne. Some are topical (applied to the skin surface), others are taken as pills or injections. All require at least one visit to a professional dermatologist or physician. Fortunately, the majority fall into a few simple classes with pros and cons that are relatively easy to describe.

Isotretinoin (Accutane)

Accutane is one of the oldest, and among the most effective, prescription medications for the treatment of moderate to severe acne. It is used on cystic and other advanced forms and has been used safely by millions for that purpose. But it does have some potential side effects and risks.

Pregnant women are generally advised to avoid taking isotretinoin. Several studies have suggested that it can produce birth defects. It’s a synthetic molecule, a retinoid similar to Vitamin A, available in pill form. As such, it can be abused. Normal dosage is once or twice per day for 4-5 months.

It works to reduce oil production, unclog pores and kill the bacteria that contribute to acne. It can also cause headache, excessive skin dryness, diarrhea and other problems. However, like all side effects, everyone is affected differently. That’s one of the major reasons it’s important to see a professional regularly during the course of treatment.

Oral Antibiotics

Acne is caused, in part, by a bacteria (Propionibacterium acnes). So, the disease can be combated, in part, by taking antibiotics. Like all powerful antibiotics some care is necessary when using these.

Tetracycline (or its derivatives, doxycycline and minocycline) is one of the most commonly used. Both forms have been in use for many years and can substantially reduce inflammatory acne. Normal dosage is 5-10 grams per day at first, though it’s reduced as treatment progresses. Treatments may take several months. It, too, though carries some risk. Some patients’ skin becomes sensitive to the sun during treatment.

Erythromycin is another common treatment for acne. It’s a broad spectrum antibiotic and can kill Propionibacterium acnes effectively. Like any powerful antibiotic, though, it can sometimes cause gastrointestinal irritation. That’s a major reason it’s a prescription drug.

Topical Treatments

Some topical antibiotics can attack the Propionibacterium acnes bacteria directly through the surface of the skin. They’re typically used to treat less severe cases of acne. They may even be used in cases of acne vulgaris, a mild form.

A number of retinoids are sometimes prescribed. They may be the same compound used in over the counter medications, but in dosages high enough to warrant or require a prescription. Adapalene is a gel or cream that is usually effective within two or three months. It can cause minor skin dryness and irritation. It helps unclog pores. Tretinoin is a natural retinoid that has similar effects.

Anyone who has tried over the counter medications or treatments and not received satisfactory results has many other options. Nearly all acne can be successfully treated. Get a professional diagnosis to explore your options.

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