Pharmaceutical Medications and Acne Vulgaris

Acne is a complicated disease and there are many treatment options. There is no one-size-fits-all solution for acne. However, most acne can be healed with the proper course of treatment. Pharmaceutical medications can be very effective for improving acne symptoms.

Effective acne treatments are as diverse as the people who suffer from acne. Keep track of the medications you’ve tried, and don’t be afraid to ask your doctor about others. Don’t settle for the first treatment if it is not working well. Schedule follow-ups with your health care provider, be persistent and get informed!

The Basics

There are four major types of pharmaceutical medications that are used to treat to acne vulgaris: Keratolytics, Antibiotics, Retinoids and Hormonal Treatments. Each class of medications is has a unique complement of advantages and disadvantages. Dermatologists often prefer to use combinations of medications, especially for the treatment of moderate to severe acne vulgaris (Acne Types: 3-4).

Keratolytics and Exfoliants

Keratolytics and exfoliants help improve acne symptoms by preventing the formation of “clogged pores”. They work by helping to soften, loosen and remove the outermost layer of the skin. Keratolytics and exfoliants can also helpful for improving mild acne scars and small areas of uneven skin. Many of these medications are available in “OTC products” (Over The Counter).

Keratolytics and exfoliants are primarily used for the treatment of mild acne vulgaris (Acne Types: 1-2). These medications are often not effective for the treatment of moderate to severe acne symptoms (Acne Types: 3-4).

Popular Anti-Acne Keratolytics and Exfoliants: Benzoyl Peroxide (eg. Clearasil and Persa-Gel), Salicylic Acid (eg. OXY Pads), Azelaic Acid (Skinoren), Glycolic Acid, Alpha-Hydroxy Acids (AHAs), Resorcinol and Urea.

Antibiotics

Antibiotics kill bacteria. Bacteria (primarily Propionibacterium acnes bacteria) contribute to acne. Decreasing the growth of bacteria in the skin can help improve acne symptoms.

Antibiotic resistant bacteria are growing problem worldwide, but especially in North America and Europe. The presence of antibiotic resistant bacteria has caused some antibiotics to become less effective for the treatment of acne vulgaris. However, there are many different types of antibiotics which can be effective acne treatments.

Topical antibiotics are medications that are applied directly to the skin. Topical antibiotics are one of the most common treatments for acne vulgaris, and are used to treat all types of acne (Acne Types: 1-4). Oral antibiotics are medications that are ingested and affect the whole body. Oral antibiotics can be very effective acne treatments, but they have a higher risk of side effects than topical antibiotics. Oral antibiotics are usually used to treat moderate to severe acne (Acne Types: 2-4).

Popular Topical Antibiotics for Acne: Erythromycin (eg. Eryacne), Clindamycin (eg. Cleocin), Fusidic Acid (Fucidin), Retapamulin (Altabax), Dapsone (Aczone) and Sulfacetamide (Clenia).

Popular Oral Antibiotics for Acne: Doxycycline (Vibramycin), Minocycline (Solodyn), Tetracycline (Sumycin), Co-Trimoxazole (Bactrim), Amoxicillin (Amoxil), Cephalexin (Keflex) and Azithromycin (Zithromax).

Retinoids

Retinoids decrease the production of sebum (oil) in the skin. Sebum is a food source for the bacteria that grow inside of hair follicles. Retinoids can decrease the growth of bacteria in the skin and the formation of hyper-keratinized plugs. Retinoids also increase cell turnover and are a common treatment for mild scars and fine lines.

Topical retinoids are applied directly to the skin and are common treatments for acne vulgaris. Topical retinoids are most effective for the treatment of mild to moderate acne vulgaris (Acne Types: 1-3). Topical retinoids are often combined with a complementary medication, such as an antibiotic.

Oral retinoids are ingested and affect the entire body. Oral retinoids are reserved for the treatment of moderate to severe acne (Acne Types: 3-4). Oral retinoids are usually reserved for acne patients who have not responded to other treatments. Oral retinoidscan be very effective but they also have a high risk of serious side effects.

Popular Topical Retinoids: Tretinoin (Retin-A), Adapalene (Differin), Tazarotene (Tazorac) and Isotretinoin (Isotrexin).

Popular Oral Retinoids: Isotretinoin (Accutane).

Hormonal Treatments

Hormones contribute to acne. Androgen hormones (eg. testosterone) can stimulate the growth of sebaceous glands and increase the production of sebum (oily skin). Overactive sebaceous glands and excess sebum can contribute to the growth of acne-causing bacteria, and can lead to hyper-keratinized follicles (clogged pores). Treatments that suppress the activity of androgen hormones are helpful for many acne patients. Depending on the specific medication, hormonal treatments are used to treat all types of acne (Acne Types: 1-4).

Hormonal birth control pills (“The Pill”) are the most common hormonal treatment in the world. Birth control pills contain synthetic estrogens and progesterones (female hormones). In some individuals, hormonal birth control can suppress the action of androgen hormones. Androgen Inhibitors are a class of medications that directly block the action of androgen hormones. They do this by preventing the body from recognizing and/or processing androgen hormones. Corticosteroid injections are used for the temporary relief of inflammation associated with severe inflammatory acne (Acne Type: 4).

Popular Hormonal Treatments: Hormonal Birth Control (“The Pill”), Spironolactone (Aldactone), Cyproterone (Androcur), Finasteride (Propecia), Dutasteride (Avodart), Flutamide (Eulexin), Bicalutamide (Casodex) and Corticosteroid Injections.

Important Note: The information provided on this site is intended for informational purposes only and is not intended to diagnose or treat any diseases. The Science of Acne strongly encourages you to consult a qualified medical professional before making any treatment decisions. For the complete disclaimer, click here.

References and Sources

Books

PDR Staff Writers. 2011. 2011 Physicians’ Desk Reference (PDR)
Habif. 2009. Clinical Dermatology
Goodheart. 2006. Acne For Dummies

Online Resources

Acne Vulgaris @ Wikipedia
Acne Vulgaris @ eMedicine
Acne Treatment Reviews @ WebMD
Acne Treatment Reviews @ Acne.org

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