Severe acne produces deep cysts, pain and inflammation, and can result in skin damage and scars. Topical and oral treatments decrease oil production, reduce inflammation, eliminate bacteria, increase the shedding of dead skin cells that clog pores, or all four. Doctors commonly prescribe oral treatments for acne when topical therapy is not effective, to be used alone or in combination with topical solutions. Oral medications also can serve as a first-line therapy for severe acne.
Antibiotics
Oral antibiotics decrease bacteria populations, including Propionibacterium acnes (P. acnes) bacteria that cause acne. This also reduces inflammation. Physicians commonly prescribe tetracycline antibiotics such as doxycycline, minocycline and oxytetracycline for acne treatment. Therapy usually begins with a high dosage, as noted by the American Academy of Dermatology, and the patient reduces the dose as acne clears up. If the bacteria become resistant to the antibiotic over time, the patient can switch to a different medication. Noticeable improvement can take up to four weeks, and maximum results may not appear for several months, according to Standard Life Healthcare Limited. Patients should discontinue antibiotic therapy once the acne clears, and they can use topical solutions thereafter.
Oral Contraceptives
Oral contraceptives effectively decrease or eliminate acne in women by suppressing overactive sebaceous glands that produce excessive oil, as explained by the Mayo Clinic. These birth control pills contain forms of the hormones progesterone and estrogen in brands such as Ortho Tri-Cyclen. Women can use an oral contraceptive as long-term acne therapy as long as they don't smoke or have a blood-clotting disorder.
Spironolactone
Physicians sometimes prescribe a synthetic steroid and diuretic known as spironolactone (Aldactone) to treat acne in women. The patient can take spironolactone in combination with birth control pills or by itself. Spironolactone suppresses production of androgens (male hormones). Androgens stimulate oil glands, which can lead to acne.
Isotretinoin
Isotretinoin (Accutane), a synthetic retinoid (form of vitamin A), is another drug effective in treating severe acne. Isotretinoin is the only treatment that works on all four primary causes of acne, according to the American Academy of Dermatology. Unfortunately, isotretinoin also can cause serious side effects, including severe birth defects. Doctors usually only prescribe isotretinoin for severe cystic acne and for acne that has not responded to other medications.
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