Pimples can be painful, both literally and figuratively (it's hard to feel confident with a face full of acne). Luckily, there is no shortage of over-the-counter and prescription products to treat skin issues. And acne sufferers will happily shell out cash to get a clear complexion: People spent more than $2 billion in the treatment of acne, including costs for prescription and over-the-counter products, according to a 2005 study. [American Academy of Dermatology]
That money is well spent; we know that oral acne medications work. They tackle the root of your acne problems—bacteria that's clogging skin follicles—internally so improvements will show up externally within four to six weeks, says Dr. Bobby Buka, section chief Mount Sinai School of Medicine, department of dermatology. But do these acne medications come with unwanted risks? Read on to learn more about the oral acne medications available and the risks you need to discuss with your doctor before deciding on a treatment plan.
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For moderate to severe acne, short-course oral antibiotics reduce bacteria and fight inflammation, says Dr. Sonia Badreshia-Bansal, UCSF clinical instructor. Doxycycline (brand names include: Doxy 100, Novaplus Doxy 100) has anti-inflammatory properties but can cause stomach upset, so patients often take it with food, says Dr. Buka. It also might result in some sun sensitivities. Minocycline (brand names include: Dynacin, Minocin) is less likely to cause stomach problems, says Dr. Buka. Because patients may develop antibiotic resistance, these treatments are typically used for a short time, usually no longer than three to four months [Mayo Clinic]. They may also decrease the effectiveness of oral contraceptives, so if you're taking these, be sure to let your doctor know!
For deep cysts, antibiotics may not be enough. Isotretinoin (brand names include: Absorica, Amnesteem, Claravis, Myorisan, Sotret) is a powerful medication available for scarring cystic acne or acne that doesn't respond to other treatments. Accutane was a common form of isotretinoin, but it was taken off the market in 2009, possibly due to controversy over mental health issues associated with the drug.
"We reserve isotretinoin for patients who have tried other medications and have not turned the corner," says Dr. Buka. He estimates about one out of every 20 patients needs this strong of a prescription. Most patients see improvement in their acne on one course of the prescription, after about four months, and then the acne stays away. Both dermatologists agree that this medication is very effective, but should be used with caution.
Because isotretinoin is associated with unpleased side effects from sun sensitivity to anxiety to severe birth defects, dermatologists carefully evaluate patients before writing a prescription. Doctors will also remain on alert for any unsettling symptoms and will likely do blood work once a month to make sure the med isn't hurting their patient's liver, says Dr. Buka.
Oral contraceptives, including a combination of norgestimate and ethinyl estradiol (Ortho Tri-Cyclen, Previfem, others), can prevent breakouts in women, especially if they occur around menstruation. The Pill's hormonal component shrinks glands that create sebum, the oily substance that causes acne. Women who have a distinct distribution of acne around their mouths are more likely to have acne that is hormonally driven, and birth control pills can help with that.
While oral contraceptives may cause other side effects—such as headaches, breast tenderness, nausea and depression—estrogen levels in many birth control pills are so low, Dr. Buka says his patients don't often report these symptoms anymore. You can also use oral contraceptives in conjunction with topical creams.
If you don't want to take a hormone like the birth control pill, spironolactone (brand name: Aldactone) has also been used to treat hormonal acne breakouts. This drug has an effect on the hair follicle and starves the bacteria that cause acne, says Dr. Buka. Possible side effect include raised potassium levels, decreased blood pressure, irregular menstrual cycles and breast tenderness. Because it is a diuretic, users should be careful when exercising in hot weather. Research shows it to be safe for long-term use, and Dr. Buka says very rarely a patient will say they're experiencing headaches from this medication.
Other Acne Treatment Options
But before you schedule your dermatology appointment, you might want to try taking a zinc supplement, says Dr. Buka. The mineral zinc plays a role in wound healing and reduces inflammation, which could help improve acne. Taking a zinc supplement with food may reduce side effects, including a bad taste in your mouth and nausea, but you can also add zinc to lotions or creams to reduce acne breakouts. It'll still take about four to six weeks to notice improvements in your skin but it'll save you money on prescription medications and doctors' office visits. [source: Mayo Clinic]
If you like the idea of trying to fix your acne problems without oral medication, a few minutes of sun exposure without protection each day may also help improve acne. "I would never recommend sun as a solution for acne, but for some people, 10 minutes a day without protection might help," says Dr. Buka. Ultraviolet light (found in the sun's rays) is a basis for many light-based acne treatments, like blue-light therapies. The FDA approved the acid and blue light combination in 1999 as a way to combat the pre-cancerous skin lesions, and University of Chicago researchers are continuing to explore light therapy methods on acne patients. [source: Medill Reports Chicago]