If you are seeing a dermatologist for your acne, you'll likely leave the office with topical products, or at least prescriptions for them. Such agents, which can consist of antibiotics, retinoids or other chemicals, generally work well on moderate cases of acne. But if your case is moderate or worse, you might also receive a prescription for an oral medication. To achieve long-term clearance of acne, dermatologists often have patients use a combination of both types of therapies along with other steps, such as a special cleansing regimen.
Isotretinoin
Isotretinoin, which goes by several names, including Roaccutane and Isotane, is for severe treatment-resistant cases. The American Academy of Dermatology calls this oral retinoid "the most effective acne treatment available." But it can cause side effects, including: headache; bone and joint pain; diarrhea or rectal bleeding; thinning hair; and, if taken by a pregnant woman, severe birth defects in a developing fetus. Isotretinoin is typically taken once or twice a day for 16 to 20 weeks. It attacks acne by reducing excess oil production, clogged pores, the acne-causing P. acnes bacteria and inflammation.
Oral Contraceptives
Oral contraceptives, also known as birth control pills, can be highly effective in treating acne in women, according to Dr. Hilary Baldwin, an associate professor in the Department of Dermatology at State University of New York-Brooklyn. They work by suppressing sebaceous glands. Any contraceptive pill that contains both estrogen and a progestin can be effective; these are known as combination pills. Side effects tend to be mild and can include weight change, breast tenderness, breakthrough bleeding and mood changes.
Erythromycin
Oral antibiotics such as erythromycin work by controlling the population of P. acnes. Doctors generally prescribe this treatment for persistent cases of moderate to severe acne. The course of erythromycin typically runs no more than six months. A common side effect of erythromycin is an irritated gastrointestinal tract.
Tetracycline
Tetracycline is another antibiotic used to treat P. acnes and tends to reduce the inflammatory lesions--papules and pustules--of acne, according to the American Academy of Dermatology. To clear up moderate or severe acne, doctors typically prescribe 500 to 1000 milligrams a day. Once your case has improved, you might take low doses over the long term to prevent further breakouts. Children younger than 8 should not take tetracycline for acne, because it can stain the teeth and adversely affect growth. Women who are pregnant--particularly the last half of breastfeeding--or breastfeeding also should not take it, because it can, according to the Mayo Clinic, slow the growth of teeth and bones.
Tetracycline Derivatives
Two synthetic tetracycline derivatives, called doxycycline and minocycline, are also available for acne treatment. Doxycycline is a top choice for inflammatory acne in particular, but can cause some patients to be sensitive to the sun, meaning they have to stay out of the sun or cover up well in order to avoid sunburn. Doctors often look to minocyline when other oral antibiotics have not worked. Minocycline also may be less likely than other drugs to lead to antibiotic resistance, according to the American Academy of Dermatology.
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