Acne is a common skin condition that can vary in severity from a few pimples to large, inflamed cysts. Several oral medications are available through prescription to help treat acne. The most effective depends on a person’s circumstances, such as age, health, and severity of the condition.
Globally, acne affects more than 8 in 10 people aged 12–25 years. People may develop acne during hormonal fluctuation, including puberty, pregnancy, or menopause. In addition, factors such as stress, diet, and certain cosmetics can contribute to the development of acne.
Many different oral medications are available to treat acne, including antibiotics, anti-androgens, birth control pills, or a vitamin A drug called isotretinoin. A dermatologist can assess a person’s skin and inform them about the best medication on an individual basis.
This article explores the best oral medications for acne, including the risks and benefits of each drug type.
A note about sex and gender
Sex and gender exist on spectrums. This article will use the terms “male,” “female,” or both to refer to sex assigned at birth. Click here to learn more.
Acne is a skin condition that occurs when the hair follicles
Sebum helps to keep the skin lubricated and soft. However, when there is excess sebum, it can mix with dead skin cells and form a plug in the follicle. This plug then traps bacteria under the skin, leading to inflammation and forming pimples, blackheads, or whiteheads.
Acne can occur on the face, neck, chest, back, or shoulders. It most often affects teenagers and young adults, but it can happen at any age.
Many oral medications are available should a person wish to treat acne. However, a doctor’s recommendations may depend on the severity of acne and any other health conditions a person has.
Oral antibiotics are a mainstay for treating moderate to severe inflammatory acne. They work by killing bacteria, such as Cutibacterium acnes, that contribute to acne formation. Antibiotics may also ease inflammation.
Some examples of antibiotics that may help to treat acne
Doctors may recommend antibiotics when people have tried topical agents and other alternatives that have not helped ease symptoms. Some examples of topical agents for acne might include benzoyl peroxide or adapalene.
Due to the potential for antibiotic resistance, doctors may only prescribe oral antibiotics for a limited course — for example, 3–4 months. They should then reevaluate the person.
Long-term oral antibiotics have various associated risks,
- hypersensitivity reactions
- increased intracranial pressure
- liver damage
- heart issues
Additionally, minocycline may increase the risk of developing systemic lupus erythematosus (SLE) and autoimmune hepatitis generally after 1 year of use.
Once oral antibiotics ease symptoms, dermatologists may recommend that the person continues using topical agents, such as clindamycin, sodium sulfacetamide, or azelaic acid, to maintain their results.
Oral birth control can
Androgens are a group of hormones, including testosterone, that stimulate the skin to produce sebum. Usually, the ovaries and female adrenal glands produce low levels of androgens. But if levels are higher, it can lead to excess sebum that triggers acne.
Females with acne along their jawline and lower face often have good results using oral contraceptives.
Three oral birth control pills for acne have
- Ortho Tri-Cyclen, a combination of norgestimate and ethinyl estradiol
- Estrostep, a combination of norethindrone acetate and ethinyl estradiol
- Yaz, a combination of drospirenone and ethinyl estradiol
The side effects of oral contraceptives are usually mild and disappear with continued use. However, they
- abdominal cramping
- breast tenderness
- decreased libido
In a small number of cases, they can also cause more serious side effects, including:
Anti-androgens are another class of hormone medications. They block androgen receptors, preventing androgens from stimulating the sebaceous glands.
The group includes spironolactone (Aldactone), which doctors also use to treat high blood pressure and fluid retention. In addition, dermatologists use it to treat acne and excess hair growth in females.
If other acne treatments do not work, it is an option for deep-seated acne on the lower face, jawline, or neck.
- decreased libido
- gynecomastia, or swelling of the breast
Isotretinoin (Amnesteem, Claravis, Absorica, Zenatane) is a vitamin A derivative. This medication is sometimes called Accutane.
Doctors may prescribe it for people with severe cystic acne, severe acne, or stubborn acne that does not respond well to other treatments. A course can last 4 or 5 months. It often results in prolonged acne clearance, which can be permanent for some people.
It is not an option for pregnant people as it can cause serious birth abnormalities and pregnancy loss.
Isotretinoin can also cause serious side effects, including:
- dry skin
- dry eyes
- sun sensitivity
- thinning hair
- difficulty seeing at night
- stomach issues
Due to the potential for serious side effects, dermatologists inform people about the benefits and risks associated with this drug. They may provide educational leaflets to help people decide if they would like to undergo isotretinoin therapy.
People on the drug should expect close medical supervision while taking isotretinoin and frequent visits to their dermatologist. This may require taking extra precautions — for example, blood tests and pregnancy tests, where relevant.
The best or most effective medication for acne may depend on the person’s circumstances. There is no one specific treatment that is the most effective overall.
Factors that can influence the decision include:
- severity of acne
- any other health conditions
- pregnancy status
- other medications a person is taking
- potential side effects of the medication
Doctors may consider the following oral medications for specific types of acne:
- Hormonal acne: Doctors may recommend treatment with antibiotics or oral contraceptives, depending on the person’s gender.
- Cystic acne: Severe acne that does not ease with antibiotics may require isotretinoin.
- Fungal acne: Also known as pityrosporum folliculitis, this condition develops when fungus on the skin grows out of control. Antifungals, such as itraconazole and fluconazole, are the
treatments of choicefor this acne type.
Acne can develop in people of any age but is common in teenagers and pregnant individuals. These populations may require different treatment regimes.
Dermatologists may recommend topical treatments such as benzoyl peroxide and retinoids for teenagers before suggesting oral medications.
Oral medications, such as isotretinoin, are not always an option in pregnant people due to the potential risk to fetuses. Oral birth control and anti-androgens are also not an option during pregnancy. Some antibiotics may be suitable, or a doctor may recommend topical treatments only.
Doctors may recommend various oral medications to help treat acne. Usually, they reserve these options for when topical treatments are ineffective.
Oral medications include antibiotics, oral contraceptives, isotretinoin, and anti-androgens. The best oral medication for acne depends on the type of acne someone has, their age, pregnancy status, overall health, and other factors. There is no one oral medication that works best for everyone.
Oral medications carry the risk of side effects which can range from nausea to serious birth abnormalities. For this reason, anyone considering oral medications for acne must discuss their situation with a doctor or dermatologist.