Doctor-Prescribed Options

Prescription treatments for moderate to severe acne

Cystic acne is the most severe form of acne. It consists of fluid-filled blemishes or cysts, which 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 isotretinoin (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 say 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 the 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 the antibiotics.

Most doctors would agree that isotretinoin, the active ingredient found in Accutane, is the most effective treatment for severe acne. In 2001, the Food and Drug Administration (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." In June 2009, Huffman-La Roche announced that it would discontinue production and distribution of Accutane due to competition from generic brands. Isotretinoin is still available in generic form. This potent drug 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 requires women taking isotretinoin to submit to periodic pregnancy tests before and throughout treatment. Patients are also required to agree to use 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 isotretinoin use include dry skin and lips, hair loss and headaches. Less common side effects include changes in mood, depression and thoughts of suicide. Because the side effects are potentially serious, we chose not to include isotretinoin in our ConsumerSearch Best Reviewed 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. They are effective on all types of acne, from mild to severe, and are even more effective 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 that tend to diminish with continued use. Physicians generally prescribe various retinoids based on individual acne cases and may switch prescriptions as needed. All brands get good reviews from users at MakeupAlley.com.

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