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Prescription Treatments for Acne

Antibiotics. Antibiotics may be used on top of the skin (topical) or taken orally (systemic). Antibiotics work by clearing the skin of acne-causing bacteria and reducing inflammation. There are several topical products available in creams, gels, solutions, pads, and lotions. Topical antibiotics are limited in their ability to penetrate the skin and clear more deep-seated acne, whereas systemic antibiotics circulate throughout the body and into sebaceous glands. However, systemic antibiotics often cause more side effects than topicals, but they can be used for more severe kinds of acne. Usually, topical antibiotics aren't recommended alone as an acne treatment, as they can increase the risk for antibiotic resistance in skin bacteria. However, using benzoyl peroxide with a topical antibiotic may reduce the chances of developing antibiotic resistance.

Topical erythromycin and clindamycin are antibiotics that are also anti-inflammatory drugs and are effective against a number of bacteria. They should always be combined with benzoyl peroxide or a topical retinoid and applied directly to the skin. Oral erythromycin is also available, but you may become resistant to its effects, limiting its usefulness.

Other oral antibiotics often used are tetracycline, minocycline, and doxycycline, all of which are quite effective in many cases of acne.

Antibiotics do not address the other causative factors in acne and may take several weeks or months to clear it up. Antibiotics are often used in combination with other drugs that "unclog" follicles. Many oral antibiotics for acne should not be used during pregnancy. 

Retinoids or vitamin A derivatives. These drugs are available as topical or oral drugs. Topical retinoids clear up moderate-to-severe acne by normalizing the way the skin grows and sheds. They can be used in combination with other acne products, such as benzoyl peroxide and oral antibiotics. Topical retinoids don't have the severe side effects of oral retinoids; however, they aren't recommended for pregnant or nursing women. Side effects of topical retinoids include redness, dryness, and itchy skin.

For severe cystic acne, isotretinoin is the most effective therapy. This drug is the only drug that intervenes in all of the causes of acne. It can often even clear severe acne that hasn't responded to other treatments. However, the product can have side effects. It can cause severe birth defects and must NEVER be taken by a woman who is pregnant or who is not using contraception. In addition, it can't be taken by a woman who is nursing. Some studies suggest its use has been associated with an increased risk of depression, suicide, and inflammatory bowel disease. Talk to your doctor about the potential risks of this drug. 

Other side effects are dry skin and lips, muscle and joint pain, headache, elevated triglyceride levels (a type of cholesterol), and, rarely, thinning hair. For most people taking these drugs, side effects are tolerable and not a reason to discontinue therapy before the acne clears up.

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