Dr Justine Kluk - Consultant Dermatologist London

Prescriptions for acne

Evidence-based Medical treatments

Skincare products on their own might not be enough to bring acne under control, so spending time and money trying to switch up your routine again and again may only be delaying effective medical treatment.

Prescription therapy for acne comes in several different forms. There are topical agents (creams and gels), such as retinoids, and oral treatments, such as the combined oral contraceptive pill, antibiotics and specialised options, such as isotretinoin (Roaccutane) and spironolactone.

Some medical treatments for acne:

1. Retinoids

Topical retinoids work by unclogging pores. They are the treatment of choice for blackheads and closed comedones, the small, stubborn skin-coloured bumps that often appear on the forehead and sides of the cheeks or jawline.

Topical retinoids also have direct anti-inflammatory effects and can be combined with other treatments, such as oral antibiotics, the pill or spironolactone for treating more inflamed spots and maintaining results afterwards.

 Side effects include include redness, dryness, itching and stinging. Your Dermatologist will give you tips on how to introduce these and which skincare products to combine them with to improve tolerability.

Image of retinoids

2. Benzoyl Peroxide

Benzoyl peroxide works by killing the bacteria that causes acne. It can be applied regularly to help control ongoing breakouts and on an ad hoc basis to reduce flare-ups.

The main downside of benzoyl peroxide is that it can cause skin irritation so you only need to apply a small amount to affected areas, or redness and peeling are likely. It can also bleach your towels, clothing and bedsheets so be careful when and how you apply it and consider wearing an old T-shirt to bed if you are applying it to your back or chest.

Benzoyl Peroxide

3. Antibiotics

Your doctor may recommend a course of antibiotic tablets or lotion. These are usually taken in combination with topical treatments, such as retinoids, benzoyl peroxide or azelaic acid.

Antibiotics need to be taken for at least two months, and are usually continued until there is no further improvement. Typical courses last three to six months.

Some antibiotic tablets should not be taken at the same time as food or can make your skin more sensitive to the sun or laser, so read the instructions carefully. It is also essential to let your doctor know if you are planning a pregnancy as certain antibiotics cannot be taken if you are pregnant.

Topical antibiotics

4. Isotretinoin

Isotretinoin is an oral retinoid and the treatment of choice for severe or persistent acne associated with nodules or cysts, scarring or psychological distress and when first-line treatments have failed.

It works by suppressing sebaceous gland activity, helps us to shed our dead skin cells more effectively to prevent blocked pores and also reduces inflammation and the growth of Cutibacterium acnes, the bacteria implicated in acne development.

Isotretinoin is very effective at controlling acne, but it does have some potential side effects and monitoring requirements so may not be suitable for everyone. Females must take careful steps to prevent pregnancy during treatment and close supervision by a dermatologist experienced in prescribing the drug is mandatory. Your dermatologist will give you a skincare plan to follow during your course of treatment to make life easier for you.

Isotretinoin

5. Spironolactone

A medicine called spironolactone may also be helpful in some women by reducing the effects of testosterone on the skin. Prescription of this needs to be decided on a case by case basis by a consultant dermatologist as it is licensed for the treatment of Polycystic Ovarian Syndrome (PCOS), not acne per se.

Spironolactone is often taken alongside the contraceptive pill as it can make periods irregular in some women, and it cannot be taken if you are planning a pregnancy in the near future.

Spironolactone helps control spots in a third of people, reduces them in another third and has no effect on the final third.

5. Light and laser treatments

Although limited data has shown that laser or light treatments may improve acne in certain individuals, these are not recommended routinely as there is much less evidence of their benefits compared to prescription therapy when used for the wider population.

We are experts in assessing patients with acne and finding the right treatment fit for you. If we believe you would benefit from a light or laser treatment alongside medical therapy, we have a network of expert procedural dermatologist and plastic surgery colleagues we work closely with who can step in when needed.

Have you been round the block with acne treatment and ended up back at square one?

We’d love to help. We have years of experience in recommending prescriptions and skincare plans for patients who haven’t responded to first line options as well as people seeking help for the very first time.

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