Acne Medications

Types and differences of acne medications

Many factors influence which type or combination of acne medications are prescribed. Dermatologists will consider the severity of the condition and the types of lesions present, as well as the patient’s age, skin type and lifestyle.

Acne medications available without a prescription include:

Prescription medications for acne include:

There are a wide variety of oral contraceptive pills that contain estrogen and/or progestin. Physicians will decide which type is most appropriate for use on an individual basis. These medications are often used in combination with other forms of acne treatment.

Conditions treated with acne medications

Different acne medications are used to treat different types and degrees of acne, including:

• Mild to moderate acne. Treated with over-the-counter medications, topical retinoids and azelaic acid.
• Moderate to severe acne. Topical retinoids and topical antibiotics may be used.
• Severe acne. Oral antibiotics may be used.
• Severe cystic acne that does not respond to other treatments. Isotretinoin is the standard treatment.
• Hormonal acne. Treatment includes antiandrogens and oral contraceptives.

Conditions of concern with acne medications

Acne medications are usually not recommended if patients are known to be sensitive to similar medications. In general, when using topical treatments patients are advised to avoid contact with the eyes, mouth, nostrils, mucous membranes, open wounds or red or raw skin. Other conditions of concern vary by medication, including:

• Benzoyl peroxide. Not recommended for patients with dermatitis or eczema.
• Salicylic acid. Not recommended for patients with blood vessel disease, influenza (flu), varicella (chickenpox), or kidney or liver disease. Use on inflamed, irritated or infected skin may cause severe irritation.
• Retinoids. Many retinoids (e.g., isotretinoin) should not be used in women of childbearing age who are or may become pregnant.
• Clindamycin. Caution is recommended for patients with asthma, impaired kidney or liver function, or a history of gastrointestinal disorders or diseases.
• Erythromycin. Not recommended for patients with porphyria or liver disorders or disease.
• Tetracyclines. Not recommended for patients with impaired kidney or liver function, pregnant women in the second or third trimester or children under the age of 8.
• Antiandrogens (e.g., spironolactone). Not recommended for pregnant women.

Potential side effects of acne medications

Side effects of acne medications vary depending on the type of medication. Common side effects of nonprescription acne medications include erythema (reddening), edema (swelling), dry skin, burning sensations, itching and peeling skin.

Topical retinoids may increase susceptibility to sunburn. It is recommended that patients use a sunscreen with a skin protection factor (SPF) of at least 15 and avoid unnecessary sun exposure. Other common side effects include skin irritation involving scaling, redness, dryness, erythema, burning sensations, itching and peeling skin.

Isotretinoin is associated with numerous side effects, including severe birth defects or miscarriages when used during pregnancy. Women of reproductive age are required to use two separate, effective forms of birth control for one month before treatment begins, during the entire course of treatment and for one month after treatment ends. Pregnancy tests are typically performed every month during treatment. Other side effects include:

• Dry skin and cheilitis (inflammation and redness of the lips). These are common, occurring in nearly all patients.
• Mood changes. Depression, sadness and irritability are very common during isotretinoin treatment. This drug has been linked to numerous suicide attempts. Physicians will monitor patients for depression.
• Vision impairment. Opacities of the cornea and poor night vision may occur during this treatment.

The following side effects may also occur:

• Fragile skin
• Nosebleeds
• Headaches
• Fatigue
• Nausea and vomiting
• Abdominal pain
• Lack of appetite
• Jaundice
• Dry eyes and mucous membranes
• Muscle and joint aches
• Liver damage
• Bone marrow suppression

Common side effects of topical antibiotics include skin irritation involving itching, burning or stinging sensations, dryness, erythema and redness. When antibiotics are taken orally, side effects may include headaches, dizziness, nausea, vomiting, vaginal yeast infections, abdominal pain, jaundice or diarrhea. Tetracyclines are not recommended for use in children under the age of 8. They may cause permanent discoloration and enamel defects in developing teeth and retard bone growth.

Common side effects of hormonal therapies include irregular menstrual periods, breast tenderness, headache and fatigue.

Patients can lower their risk of side effects by using their medication exactly as directed by their dermatologist. Although many people believe that using their medication more frequently than prescribed will speed up the clearing of their skin, it may actually irritate the skin, delay clearing time, and increase their risk of side effects.

Drug or other interactions

Patients should consult their physician before taking any additional prescriptions, over-the-counter medications, nutritional supplements or herbal medications. Interactions of particular concern to individuals taking acne medications depend on the medication taken and may include:

• Benzoyl peroxide and tretinoin. These medications may neutralize each other.
• Topical retinoids. May cause a cumulative drying effect when used with medicated soaps and cleansers, topical peeling agents (including benzoyl peroxide) or alcohol–containing preparations.
• Isotretinoin and alcohol. Alcohol consumption while taking isotretinoin may increase levels of particular blood fats (triglycerides) and liver enzymes.
• Oral clindamycin and erythromycin. Erythromycin may reduce the effectiveness of clindamycin. Erythromycin may also increase the effectiveness of some anticoagulant medications, requiring reduced dosages.
• Tetracyclines. May increase the effectiveness of some anticoagulants, requiring reduced dosages. May reduce the effectiveness of oral contraceptives, causing breakthrough bleeding and an increased risk of pregnancy. Antacids may reduce the effects of tetracyclines.

Symptoms of acne medications overdose

Symptoms of overdose can be similar to the medication’s side effects, but are usually more severe. It is recommended that patients exhibiting severe burning, itching, swelling or excessive dryness while taking benzoyl peroxide contact their physician immediately. It is also recommended that patients using salicylic acid contact their physician immediately if they exhibit any of the following:

• Confusion
• Lightheadedness
• Diarrhea
• Dizziness
• Fast or deep breathing
• Severe or continuing headache
• Hearing loss
• Nausea or vomiting

Symptoms of overdose with topical antibiotics include severe skin irritation. Symptoms of overdose with oral antibiotics include nausea and vomiting, fever and gastrointestinal distress.

Pregnancy use issues with acne medications

Many acne medications should not be used by women who are or may become pregnant. This is particularly true of isotretinoin, an oral retinoid. Isotretinoin is absolutely not recommended for pregnant women because of a very high risk of miscarriage or severe birth defects. The Food and Drug Administration (FDA) strictly monitors isotretinoin and requires women to have two negative pregnancy tests prior to receiving a prescription.

Further, women must have monthly pregnancy tests throughout the course of isotretinoin treatment, as well as additional tests right after finishing the last dose of the drug and one month after finishing the last dose of the drug. It is not known if this medication passes into breast milk and breastfeeding is not recommended during therapy.

Topical retinoids are typically not recommended for women who are or may become pregnant, or those who are breastfeeding. It is currently unknown whether these drugs can have an adverse effect on developing fetuses or nursing children.

Most antibiotics are safe to use during pregnancy when monitored. However, these may enter breast milk and breastfeeding is typically not recommended while taking these medications. The use of tetracycline and its derivatives is not advised during pregnancy or breastfeeding. These drugs can inhibit bone growth and discolor permanent teeth in developing fetuses, as well as in children who are nursing.

Antiandrogens are also considered unsafe to use during pregnancy as they may cause birth defects. These drugs are also not recommended for women who are breastfeeding because it is unknown whether they can be passed through breast milk.

Child use issues with acne medications

Most acne medications do not have established dosages for children. Tetracyclines are not recommended for use in children until after they have all their permanent teeth because it can permanently discolor developing teeth. Care is advised when using salicylic acid on young children because they may be more likely to develop skin irritation. Children using clindamycin, an antibiotic, should be monitored closely, especially for diarrhea.

Elderly use issues with acne medications

Elderly use of acne medications typically poses no additional concerns aside from a slightly increased rate of side effects. However, it should be noted the elderly may not well tolerate certain side effects, such as the diarrhea common to certain antibiotic use. Because of this, elderly medication use often requires close monitoring.