Medications Used to Treat Acne
Medication | Adverse Effects | Comments |
|---|---|---|
Topical antibacterials | ||
Dry skin Possible bleaching of clothing and hair Allergic reactions (rarely) | Comedolytic and antibacterial with very low to no development of resistance Should be used in all patients if tolerated Gel product usually preferred | |
Dry skin Possible bleaching of clothing and hair Allergic reactions (rarely) | One combination product mentioned in the American Academy of Dermatology 2024 guidelines of care for the management of acne vulgaris | |
Dry skin Possible bleaching of clothing and hair Allergic reactions (rarely) | Some forms must be kept refrigerated | |
Diarrhea (rarely) | Should be avoided in patients with inflammatory bowel disease | |
Very rarely causes methemoglobinemia | ||
Local irritation (rarely) | Well-tolerated, but frequent development of bacterial resistance | |
Irritation, dry skin, redness | Foam propellant is flammable. Avoid fire/flame and smoking immediately after application. | |
Topical comedolytics and exfoliants | ||
Some redness, burning, and increased sun sensitivity | Requires use of protective clothing and sunscreen | |
Possible lightening of skin | Minimally irritating Should be used cautiously in people with darker skin because of skin-lightening effects | |
Glycolic acid 5–10% | Stinging Mild irritation | Over-the-counter product in cream, lotion, or solution; adjunct therapy but no longer commonly used |
Skin irritation Increased sun sensitivity | Requires use of protective clothing and sunscreen Should be avoided during pregnancy | |
Skin irritation (with dryness, erythema, and scaling) Increased sun sensitivity | Initiate treatment at a low strength (eg, 0.025% cream) and increase if ineffective; if irritation occurs, strength, frequency, or both should be reduced Requires use of protective clothing and sunscreen Should be avoided during pregnancy | |
Dryness, erythema, and scaling of the skin Increased sun sensitivity | Requires use of protective clothing and sunscreen | |
Oral antibiotics | ||
Stomach upset | Frequent development of bacterial resistance | |
Increased sun sensitivity | Good first-line medication in terms of efficacy and cost Requires use of protective clothing and sunscreen | |
Stomach upset | Frequent development of bacterial resistance | |
Headache Dizziness Skin discoloration | Sometimes considered a more effective antibiotic, but this is not clear and it can be expensive (6) | |
Narrow spectrum of activity targeting acne-specific bacteria | ||
Increased sun sensitivity | Inexpensive and safe, but must be taken on an empty stomach Requires use of protective clothing and sunscreen | |
Rare adverse drug reactions | Development of bacterial resistance | |
Oral retinoid | ||
Possible harm to a developing fetus (contraindicated during pregnancy) Possible effect on blood cells, the liver, and fat (triglyceride and cholesterol) levels Dry eyes, chapped lips, drying of mucous membranes Pain or stiffness of large joints and lower back with high dosages Associated with depression, suicidal thoughts, attempted suicide, and (rarely) completed suicide Unclear whether associated with new or worsened inflammatory bowel disease (Crohn disease and ulcerative colitis) | Requires periodic complete blood count, liver tests, fasting glucose, and lipid profile | |
Antiandrogens | ||
Redness, scaling or dryness, and itching | For treatment of acne in patients 12 years of age and older | |
Combined (estrogen plus a progestin) oral contraceptives | Hypertension, thromboembolic events Weight gain Nausea Breakthrough bleeding Headache | For treatment of acne in females |
Light-headedness Increased urination Breast tenderness Nausea | For treatment of acne in females | |