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List of Acne Medications and Side Effects

By Tiffany Moore

A variety of acne medications are used today to clear acne in the United States. The kind of prescription acne drugs for the patient is based on the severity and type of acne. Topical (applied to the skin) or oral medications may be prescribed for mild to severe acne. Although systemic (works internally) therapy is mainly used for treatment of severe acne, it may be needed for moderate cases.

Acne Medications Possible Side Effects

Interlesional Corticosteroid Injection

When an acne cyst becomes severely inflamed, there is a high chance that it will rupture and cause scarring. To treat these severely inflamed cysts and prevent scarring, dermatologists may treat such cysts with interlesional corticosteroid injection, also commonly known as steroid shot, cortisone injection, or cyst injection. An interlesional corticosteroid injection helps treat acne by melting the cyst over 3-5 days. If too much cortisone, or too strong a dilution is used, the fat around the injection site can atrophy. Possible side effects are depressions, or pitting, of the skin in the area.

Isotretinoin

Isotretinoin (a derivative of vitamin A) is a very potent oral drug used to treat very severe cyctic acne and severe acne. It can help prevent scarring. Isotretinoin reduces the size of the sebaceous glands thus preventing the excess secretion of oil, decreasing the growth of bacteria. It has been estimated that up to 90% of patients treatment with isotretinoin result in complete or almost complete recovery from cystic acne. One of the most serious side effects when used during pregnancy is the potential to cause severe birth defects. Other possible severe side effects may include severe pain in the chest or abdomen, trouble swallowing or painful swallowing, severe headache, blurred vision or dizziness, bone and joint pain, nausea or vomiting, diarrhea or rectal bleeding, depression, dryness of the skin, eyes and nose, and/or thinning hair.

Oral Antibiotics

Tetracycline and erythromycin have been a mainstay of therapy for years to treat moderate to severe inflammatory acne. Tetracycline reduces inflammatory lesions of acne but is contraindicated in children less than 8 years as they can affect growth and stain teeth. These oral antibiotics should also not to be taken during pregnancy and breast feeding as tetracyclines can affect the development of the child’s bones and teeth, leading to skeletal defects. Erythromycin is effective against a broad spectrum of bacteria, including P. acnes. The most common side effect is irritation of the gastrointestinal tract.

Doxycycline and minocycline, the synthetic derivatives of tetracycline, are also used to treat acne. Doxycycline proves especially effective in treating inflammatory acne. However, it can cause sun sensitivity in some patients. Minocyline is often effective in treating acne that has not responded to other oral antibiotics and seems to produce fewer incidents of antibiotic resistance.

Treatment with oral antibiotics usually begins with a higher dosage, which is reduced as acne resolves. Generally, antibiotics are prescribed for six months or less.

Oral Contraceptives

Oral contraceptives have been shown to effectively clear acne in women by inhibiting the over-activity of sebaceous glands (oil glands). Some of these oral contraceptives include ethynodiol, norgestimate, norethindrone and norethindrone acetate. However, women who smoke, have a blood-clotting disorder, above 35 or have a history of migraine headaches should not be prescribed oral contraceptives without the advice of a gynecologist.

Topical Antimicrobials

Azelaic acid, benzoyl peroxide, clindamycin, erythromycin, and sodium sulfacetamide are the prescription topical antimicrobials used to treat acne vulgaris in the United States.

Azelaic acid is a naturally occurring acid that has bacteriostatic and keratolytic properties. It is used to treat mild to moderate inflammatory and non-inflammatory acne. Azaleic acid is well tolerated by most people and can be safely used for years. Side effects may include skin dryness and lightening of the skin where applied.

Benzoyl peroxide is inexpensive and works by killing P. acnes. When used in combination with antibiotics (erythromycin, clindamycin), benzoyl peroxide increases efficacy and reduces antibiotic resistance. It is available in a wide range of strengths and can be found as a gel, lotion, cleanser, cream and wash. The most common side effects are skin irritation, the potential to bleach hair and fabrics as well as possible allergic reaction.

Clindamycin is a safe and well tolerated semi-synthetic antibiotic that acts by reducing P. acnes and decreasing inflammation. Topical erythromycin is an antimicrobial and anti-inflammatory agent but may cause skin dryness and possible irritation.

Sodium sulfacetamide products are effective in treating inflammatory acne and mostly contain sulfur. It is used in patients who cannot tolerate other topical antimicrobials.

Topical Retinoids

Retinoids work to unclog pores and prevent whiteheads and blackheads from forming. Topical retinoids prescribed in the United states include adapalene, tazarotene, and tretinoin.

Adapalene is applied as a gel or cream. It unclogs pores and has anti-inflammatory properties. Side effects include minor skin irritation and dryness.

Tazarotene helps treat acne by stopping the development of new comedones. It should not be used during pregnancy as the medication has produced birth defects in animals. Skin irritation is a possible side effect.

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