Doctor-Prescribed Options

Prescription treatments for more severe acne

Cystic acne is the most severe form of acne. It consists of blemishes, or cysts, that are fluid-filled lumps located under the skin's surface. They can become large and painful. Because cysts begin deep within the skin, this type of acne must be treated by a dermatologist. Over-the-counter medications are generally not powerful enough. Experts recommend early intervention to reduce instances of scarring, which is much more likely in cystic acne cases. Common treatments include oral antibiotics, topical antibiotics, oral contraception, retinoids and Accutane.

Because of the risk of creating drug-resistant bacteria, oral antibiotics (doxycycline, tetracycline and erythromycin) should be taken with extreme caution and under a doctor's advice. Experts agree that these drugs should only be used when all other topical treatments have failed to produce results.

Topical antibiotics (clindamycin and erythromycin) warrant great caution as well. A 2005 study in Archives of Dermatology found that acne patients participating in antibiotic treatment were twice as likely to suffer from upper-respiratory tract infections as those who were not involved in this type of treatment. What's more, a 2005 British study found that over-the-counter benzoyl peroxide was more effective at treating blemishes than either type of antibiotic or combination of them.

Most doctors would agree that Accutane is the most effective treatment for severe acne. In 2001, the FDA said, "Considered the biggest breakthrough in acne drug treatment over the last 20 years, Accutane is the only drug that has the potential to clear severe acne permanently after one course of treatment." It can, however, cause harsh side effects. Severe birth defects occur in 90 percent of babies born to women who become pregnant during the course of treatment.

For this reason, the FDA introduced the iPLEDGE program in March of 2006. The program tries to protect against pregnancy by requiring Accutane patients to submit to periodic pregnancy tests before and throughout treatment. Patients are also required to agree to the use of two forms of effective birth control while using the drug. They must do the same for an entire month prior to beginning treatment and for one month after it ends.

Other common side effects of Accutane use include dry skin and lips, hair loss and headaches. Some, though less commonly, have reported changes in mood, depression and thoughts of suicide. Because the side effects are potentially serious, we chose not to include Accutane in our ConsumerSearch Fast Answers section. It is, however, a viable, physician-supervised option for those who have had no success with other acne treatments.

Retinoids, on the other hand, are very effective with relatively few side effects. According to Paula Begoun, "?retinoids are backed by mounds of solid research supporting their mechanism of action, efficacy, and tolerability." They are helpful for all types of acne, from mild to severe and are even more so when used in combination with hormonal, antibiotic or benzoyl peroxide treatments.

There are basically three types of retinoids available: tretinoin (Retin-A, Renova), tazarotene (Tazorac) and adapalene (Differin). Studies show that all are equally effective but that Retin-A and Tazorac tend to have more bothersome and harsh side effects than Differin. These side effects include burning, peeling and redness of the skin -- effects which tend to diminish with continued use. Physicians generally prescribe various retinoids based on individual acne cases and may switch prescriptions as needed.

As with over-the-counter medications, it may take some experimentation to find the right prescription-strength treatment.