Health Conditions

Oral Antibiotics

As discussed earlier, bacteria may reside in acne lesions. Oral antibiotics (tetracycline, minocycline, doxycycline, erythromycin, clindamycin, and cotrimoxazole) are often used in combination with topical acne products for moderately severe acne. Tetracycline is the most commonly prescribed antibiotic for treating acne, but it may cause sun sensitivity and predispose a woman to vaginal yeast infections. Minocycline and doxycycline are commonly used in people whose acne does not respond to tetracycline. Minocycline may cause skin discoloration. Clindamycin is not as widely used as the other oral antibiotics due to a side effect of diarrhea. Erythromycin is similarly effective to tetracycline and may have fewer side effects. Cotrimoxazole may be as effective as tetracycline but it is generally reserved for acne that doesn't respond to tetracycline or other antibiotics. The reason for this is to minimize the potential for resistance to develop (meaning that the bacteria that cause acne can become resistant to cotrimoxazole's effects). Though these medications are very effective in the treatment of acne, many people find it difficult to take them as prescribed since they require dosing between two and four times daily. The effectiveness of these products is decreased when they are not taken exactly as prescribed. A new product containing extended release minocycline, which is taken once daily, has recently become available and may make it easier for patients to take their medications correctly. Improvement in acne can generally be seen in 6 to 12 weeks when using oral antibiotic medications.

Oral Contraceptives

Excess sebum (oil) production in the skin is typically triggered by an increase in androgen hormones ("masculine hormones"). In recent years, some oral contraceptives like Ortho TriCyclen and Estrostep have gained FDA-approval for the treatment of acne in females. They work to treat acne by decreasing androgen ("masculine") hormone levels and thus decreasing sebum production. Oral contraceptives may be an effective treatment option for women with moderate acne, but it takes three to six months to see their full effect.

Spironolactone

Spironolactone also decreases androgen hormone levels and thus decreases production of sebum. If oral contraceptive therapy is not effective, spironolactone can be added for additional benefit. Some side effects associated with spironolactone include dizziness, breast tenderness, and painful menstruation in women. It is recommended to get blood pressure and potassium levels checked periodically while on this medication.

Isotretinoin

Isotretinoin (Accutane) is used to treat severe, cystic acne that has not improved with other therapies. Some dermatologists use isotretinoin in mild to moderate acne that has not responded well to 6 months of standard therapies. Treatment with this drug usually continues until there is a 70% reduction in the number of cysts, and usually this can be seen in 15 to 20 weeks. A 6-month course of isotretinoin is sufficient for most patients. While extremely effective for treating acne, isotretinoin is associated with some potentially bothersome side effects including extreme drying of the mouth, nose, and eyes (approximately 90% of patients taking isotretinoin experience these side effects); inflammation and peeling of facial skin, joint aches, muscle stiffness, and sun sensitivity. Isotretinoin can also cause birth defects if used during pregnancy, so contraception (some type of effective birth control) is required in females taking isotretinoin. Contraception should begin one month before starting isotretinoin and continued for three months after stopping isotretinoin. Isotretinoin now has a mandatory registry that was put in place by the FDA, which is known as IPLEDGE. IPLEDGE was primarily put in place to prevent unwanted or potentially dangerous adverse effects.

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Note: The above information is intended to supplement, not substitute for, the expertise and judgment of your physician, pharmacist, or other healthcare professional. It is not intended to diagnose a health condition, but it can be used as a guide to help you decide if you should seek professional treatment or to help you learn more about your condition once it has been diagnosed.