If you've ever suffered from acne, you know it's never fun to deal with. In this day and age, it's surprising that acne isn't taken more seriously, considering the long-term psychological consequences it can cause.
We're constantly bombarded with new exotic treatment options, and the temptation to try all of them is so big that we're often impatient to stick to one regimen for a long period of time.
Not to mention, acne is a very complicated skin condition, and getting to the root cause of it isn't as straightforward as it might seem. Luckily, with the help of a good doctor and lots of patience and persistence, a cure for acne is well within reach.
But to get to the root cause of acne, we must examine the most common causes.
What Causes Acne?
Many different factors contribute to the appearance of acne.
Let's start by explaining the physical process behind a pimple. Acne happens when pores in the skin become clogged with oil, bacteria, or dead skin cells. During puberty, the oil glands attached to the hair follicles are triggered, which is why this condition often appears in teenagers. The released sebum travels up the hair and onto your skin.
A normal amount of sebum is necessary for keeping the skin soft and moisturized and preventing dry patches. But the trouble begins when the skin starts producing excess oil.
Other factors can also contribute to the overproduction of sebum, such as stress, hormonal changes, and comedogenic cosmetics.
Genetics plays a very important part in acne production. You are likely to get acne if your parents also have acne.
Types of Acne Medication
There are several treatment options for acne. Whether you're suffering from mild, moderate, or severe acne, there's something out there for you. Depending on your age and the severity of your acne, you can get prescribed either topical medication or oral medication. You may be prescribed both if you suffer from acute and not persistent acne.
You might be wondering what falls under the category of topical medication. The most common topical prescriptions include antibiotics, topical retinoids, benzoyl peroxide, and salicylic acid. Typically, they come in creams, cleansers, lotions, and gels. They work by treating the acne topically and by preventing future breakouts from occurring.
Now let's discuss the most common oral medication options and how they treat acne.
Oral Medication
Not all acne can be cleared up by topical medication only. If you've suffered from acne for a long period of time and milder treatments haven't worked, you're eligible for oral medication. However, oral medication is often left last for a reason – it has harsher side effects than topical treatments and takes longer to work.
Not to mention, many people are put off by taking pills daily and prefer to stick to topical treatments. However, oral acne medications can help with both acne lesions and acne scars.
Accutane (Isotretinoin/Roaccutane)
Anyone who's Googled acne at some point will have come across Accutane. That's because it's the single most powerful acne medication currently on the market for persistent acne breakouts. Those suffering from severe acne who haven't seen results from antibiotics and topical medications will likely be prescribed this.
Isotretinoin belongs to a group of retinoids (forms of vitamin A) that alter your DNA transcription. This makes the oil glands decrease in size. Since acne is often the cause of excessive sebum on the skin, pore size is one of the most crucial factors to consider when deciding between acne treatments.
Accutane shrinks the activity of the sebaceous glands, reducing the amount of sebum the skin produces. In addition, it also decreases bacteria in the oil glands, which makes the area less susceptible to comedones and breakouts.
Besides having a miraculous effect on acne and acne scarring, isotretinoin can also help with skin conditions such as psoriasis and others that are more severe, like lupus and lichen planus.
How Long Does it Take for Accutane to Work?
Every case of acne is different, so there isn't an exact estimate as to how long it would take for you to see results. Typically, you will start to see results around two weeks after starting treatment.
It's important to mention that, in many cases, treatment might worsen acne. This is because the acne medication forces your spots to come out. However, soon afterward, you'll notice an improvement, and it will continue to get better.
The treatment usually lasts from 15 to 20 weeks. During those weeks, your dermatologist will probably make a few appointments just to see your progress. Most patients who undergo an Accutane don't have an acne flare-up after treatment.
Dosage
Your dosage largely depends on your acne severity, age, weight, and family history.
The recommended daily dose is 0.5 to 1.0 mg/kg a day. Your doctor might start you on a small dose and increase your dose in a few weeks.
The pills should be taken with food or on a full stomach once or twice a day, depending on your doctor's instructions.
Most Common Side-Effects
A few less serious side effects can occur during Accutane therapy, such as:
- Dry skin, eyes, and lips
- Proneness to itchy and peeling skin
- Nosebleeds
- Hair loss
- Muscle and joint aches
- Increased sun sensitivity leading to more sunburns
- Increased triglyceride and cholesterol levels
Make sure to moisturize the skin on your face and body to avoid overly dry skin. If your mouth gets dry, you can suck on candy or chew gum. Make sure you stay hydrated so you can moisturize the skin from the inside out.
More Severe Side Effects
Even though these are less frequent, a few serious side effects can come with taking Accutane. You must take these into account before deciding whether or not to get the treatment.
Tell your doctor immediately if you experience any of the following:
- Increased risk of mental health issues such as depression, suicide attempts, and psychosis. Even though these are rarer than the others, your doctor must consider your history with mental health before prescribing Accutane. Those who've noticed these symptoms report they disappear after going off Accutane.
- Elevated liver enzymes, which can be monitored by doing blood work regularly.
- Persistent headaches that may cause you to vomit.
- Accutane can also cause an infection. The most common symptoms of infection are usually a fever, sore throat, and difficulty swallowing.
- Visions changes or hearing loss
- Dizziness
- Allergic reactions. If you have any medicinal or food allergies, inform your doctor about them. Otherwise, you risk getting an allergic reaction due to the treatment. Common symptoms are a rash, itching, swelling, dizziness, and difficulty breathing.
- Accutane and other retinoid drugs can potentially cause severe birth defects like face, heart, and brain abnormalities if taken while pregnant. This is why women are tested for pregnancy at the beginning of the treatment and continue to be tested throughout. Doctors typically recommend using two birth control methods during the treatment.
According to statistics, around 25.6% - 35% of Accutane cases result in neonatal defects. Some defects include intellectual disabilities, eye and ear abnormalities, heart defects, hydrocephaly, microcephaly, and central nervous system malformations.
Women who have taken Accutane right before their pregnancy should not breastfeed their children.
Can I Wax While I’m on Accutane?
It's not recommended to wax during therapy and six months after your treatment because your skin is highly sensitive and has a higher risk of scarring. On top of scarring, you also risk injury and trauma to the skin during waxing.
After you've come off the medication, you should wait at least six months before waxing or trying other treatments, such as dermaplaning, dermabrasions, peels, and lasers. This also includes tattoos, piercings, and any surgical procedures.
Can I drink alcohol while on Accutane?
The general answer is that you shouldn't drink while on Accutane because it can damage the liver and increase liver toxicity, especially if you drink large amounts of alcohol. In addition, Accutane can alter the lipid levels in your bloodstream, which can be extremely dangerous.
Depending on your doctor, you might be told that small amounts of alcohol like wine are safe. Their suggestions will largely depend on your age, the dosage of Accutane, whether or not you're taking any additional medication, and your medical history.
If you combine alcohol with Accutane and your liver gets damaged, you might experience additional side effects like skin redness and tingling, vomiting and nausea, and an increased heart rate.
Always be honest with your doctor. You're undergoing serious treatment, and you should always be upfront about what substances you take, including any food supplements and vitamins.
Consult your doctor about the possible side effects of combining alcohol and Accutane.
How to Make your Accutane Experience Easier
In addition to the tips your doctor will give you, here are a few things that can help you make the experience easier.
- Always take the pills when your doctor tells you to, usually around meal times. For better absorption, include healthy fats in each meal, like flaxseeds, walnuts, and chia seeds.
- Keep a healthy diet and a regular exercise routine throughout your treatment. This will make you feel better and keep your skin hydrated. The endorphins will help with your mental health and help minimize any annoying side effects.
- Keep your skincare routine as natural and simple as possible. Your acne-prone skin is more sensitive than usual when you're on Accutane. It can become irritated and red. To avoid this, avoid any harsh exfoliants, toners containing alcohol, heavy creams, and spot treatments.
- Always use sunscreen and minimize sun exposure. Accutane makes your skin more sensitive, so if you live in a warm climate, avoid exposing your skin directly to the sun during the hottest hours of the day – from 10 am to 4 pm.
- Moisturize your skin and lips regularly to avoid excessive dryness. Use a moisturizer that's good for sensitive skin, but not too heavy or abrasive. We recommend the Wrinkle-Free All Day Moisturizer.
Is There a Chance of Relapsing After Going on Accutane?
Even though post-Accutane acne relapse is relatively rare, recent clinical experience shows that relapse might be more common than initially thought. However, it depends on a few things.
Relapse rates vary from 10% to 60%, depending on the Accutane dose and the treatment duration. There are a few factors that play a role in these percentages.
First, we need to define what counts as relapse. No Accutane patient is immune to getting a few pimples here and there. After all, lifestyle and diet can play a major role in acne. So if you've finished taking Accutane and you're still experiencing occasional pimples, don't panic.
Another factor that influences relapse rates is age. The younger the patient, the higher the chances of relapsing. This is because younger patients experience greater fluctuations in their hormone levels as opposed to older patients. The upside of taking Accutane while younger is that you minimize the chances of scarring, which can be equally hard to deal with.
Similarly, there is a higher relapse rate in women suffering from hormonal acne. If the root cause isn't treated, the acne will probably appear again at some time. So female patients that suffer from polycystic ovarian syndrome and similar conditions should treat the cause directly before considering a second dose of Accutane.
Also, no matter how successful your Accutane treatment is, it's important to remember that we're all different, and there's no universal reason why you might suffer from acne. It's a complicated matter, and various factors contribute to the appearance of acne.
Like with other treatments, there's no guarantee that the acne won't come back afterward. However, even if a relapse does occur, it will be less severe than the initial state.
Even if this treatment doesn't work for you the first time, there are other acne medications and treatments to try.
Birth Control for Acne
The birth control pill is often used to treat acne in female patients.
How it Works
Usually, birth control pills contain synthetic forms of estrogen and progesterone – the female hormones. The ratio depends on the type of hormonal birth control and varies often.
These hormones work by stopping the ovaries from releasing an egg and changing the lining of the uterus to prevent implantation.
How the Birth Control Pill Affects Acne
You might be wondering how this hormonal treatment plays a role in regulating acne. The pill directly affects androgens (often called male hormones), and it decreases the production of sebum, which is very beneficial for making acne go away.
It's important to note that the pills should contain both estrogen and progestin to be considered acne medication. Since the mini pill only has a synthetic form of progesterone, it isn't as effective in improving acne.
What Does Science Say?
Studies show that combined pills have the best chance of improving acne. They also prove that pills containing drospirenone or synthetic progestogen are more effective than others.
All in all, there is enough evidence to conclude that the pill can improve your skin and treat acne vulgaris, whether you're suffering from severe or moderate acne.
Types of Birth Control
The FDA has officially approved four types of birth control, all of which are a combination of both estrogen and progesterone. The following pills are prescribed most often:
- Ortho Tri-Cyclen - These contain a combination of norgestimate – a synthetic progestin form of progesterone, and Ethinyl estradiol.
- Beyaz - This is a combination of drospirenone – a synthetic form of progestin, levomefolate calcium, and ethiny alcohol.
- Yaz - This pill has both drospirenone and ethinyl alcohol.
- Estrostep Fe - Combining norethindrone acetate, ferrous fumarate, and ethinyl estradiol, it is available in several versions with different estrogen ratios.
It's important to note that the FDA has stated that pills that contain drospirenone may increase the risk of blood clots as opposed to pills that contain other progestins.
Benefits of Taking Birth Control
Birth control has multiple benefits, most of which aren't directly related to skin issues.
It's said to improve periods, make them lighter and less painful, and minimize cramps. Some scientific claims state it can reduce the risk of certain cancers, such as ovarian, colon, and uterine cancer.
Finally, there is enough anecdotal and scientific evidence to support the claim that it reduces the amount of acne in most individuals.
Side-Effects of Taking Birth Control
A few side effects can appear while you're on birth control. The less serious side effects are:
- Nausea
- Weight gain and bloating
- Stomach cramps and digestive issues
- Weight loss
- Changes in your period
- Vomiting
- Headaches
- Increased breast sensitivity
- Dizziness
- Fainting
Some serious side effects of birth control include deep vein thrombosis (DVT), stroke, and heart attacks. Even though these are rare, your doctor will ask you to provide a detailed family history to see if you qualify for birth control pills. Patients more susceptible to these serious side effects are those who smoke, have a history of cardiovascular problems, and are older than 35.
Keep in Mind
Some pills that the FDA hasn't approved have shown a positive effect on acne in clinical studies. If you're taking oral contraceptives that haven't improved your acne, you might want to consider switching brands.
Remember, everybody is different and reacts differently to birth control. Some people swear by it as an acne treatment, while others claim it has worsened their acne. If you're new to birth control, the safest way to go is by taking those that are FDA approved for treating acne.
On average, you should start seeing results after a couple of months. Similarly to Accutane, your skin might break out initially before getting better. Be patient and trust the process. If you want to take birth control solely for its effect on acne, see a dermatologist. This will give you an overall varied treatment containing topical medications and antibiotics.
Spironolactone for Acne
Often prescribed for patients suffering from polycystic ovarian syndrome, spironolactone works by blocking the effects of excess male hormones, which can have a negative effect on hormonal acne. When the hormone profile of a female patient is dominated mostly by male hormones, the sebaceous glands can overproduce oil which increases the likelihood of acne breakouts.
It affects testosterone, which can increase sebum production in the body. By blocking the actions of testosterone, it minimizes the chances of excess oil and clogged pores.
Even though it's not FDA-approved for treating acne specifically, dermatologists are allowed to prescribe it for women who are suffering from hormonal acne.
Spironolactone comes as 25 mg, 50 mg, or 100 mg oral tablets. Your dosage will depend on your medical history and why you're taking it. Just like Accutane, it can make your acne worse before it gets better. It's best to be prepared and expect some breakouts when starting the treatment. Don't worry; they should be gone in a short time. Expect to see results after a few months of treatment.
Side Effects
The most common side-effects are:
- Vomiting, nausea and digestive problems
- Dizziness and headaches
- Irregular periods
- Increased hair growth
- Dry mouth and increased thirst
More severe side-effects include:
- Numbness and tingling
- Muscle pain and weakness
- Arrhythmia
- Allergic reactions
- Problems with breathing and swallowing
- Flu-like symptoms
Spironolactone Precautions
It shouldn't be taken with potassium-supplementing drugs because it can lead to hyperkalemia and arrhythmia. If you have any history of cardiovascular, kidney, and liver problems, tell your doctor.
Typically, spironolactone isn't recommended for pregnant or breastfeeding women.
Antibiotics
You're probably used to taking oral antibiotics to treat bacterial infections or even applying topical antibiotics for fungal infections, but did you know they can also help with acne?
Antibiotics kill the bacteria on the skin that contributes to acne and reduce redness. In most cases, they treat inflammatory acne, such as pustules.
Even though topical and oral antibiotics have been used as an acne treatment for decades, there are still concerns within the dermatological community about the possibility of patients developing antibiotic resistance. This is why they're often combined with a benzoyl peroxide topical treatment so the patient doesn't become resistant.
Usually, it takes 6-12 weeks for patients to see a noticeable difference in the appearance of their skin. The dosage is different for every patient and depends on the acne they're suffering from. Talk to your doctor for precise instructions and whether you should take them with food.
Types of Antibiotics
Tetracycline
This is the most common oral antibiotic which is prescribed for treating acne. It's important to remember that it should always be taken on an empty stomach and that children under nine and pregnant women shouldn't take it.
When it comes to the dosage, usually, the starting dose is 500 mg twice a day.
Minocycline
Minocycline is a popular antibiotic used to treat acne. It's a derivative of tetracycline, but the dosage is smaller – it ranges from 50 to 100 mg twice a day, and you should take it with a meal. This kind of antibiotic is most effective for pustules.
Doxycycline
This type has the same dosage as minocycline; you should also take it with food. It's not usually the first choice, but it's used for patients that don't respond to other types. With doxycycline, your skin is more likely to be sensitive to the sun and cause sunburns.
Erythromycin
Arguably the most successful antibiotic for acne, erythromycin, other than its basic function to kill the bacteria on the skin, also has the ability to reduce redness due to the anti-inflammatory properties it contains. The dosage is from 250 to 500 mg a day, taken with food. This one is reported as safe for pregnant women.
There are a few things every patient on oral or topical antibiotics should remember.
Some types of oral and topical antibiotics can increase sun sensitivity, so it's advised to wear sunscreen at all times and avoid direct exposure to the sun. Avoid going out in the middle of the day, between 10 AM and 4 PM. You should also wear protective clothing such as hats or shirts when going to the beach.
Patients have reported gut-related issues while they're on their oral antibiotics course. This is due to the pills killing even the good, protective bacteria in the gut, which can lead to a few digestive issues. Talk to your doctor about taking oral probiotics known to help with digestion in cases like this.
Side Effects
- Nausea, vomiting and digestive issues
- Antibiotics can lessen the effect of birth control pills, which is why it’s recommended to use an additional birth control method.
- Headaches
- Fever, rash, joint pain and swelling
- Yeast infections in women
- Allergic reactions, most common with minocycline
Make sure to speak to your doctor about these potential side-effects.
Other Treatment Options
If you suffer from mild acne or are under a lower dose of acne medication, your dermatologist might suggest other treatment options in conjunction with the orthodox treatment. These include laser therapies, chemical peels, steroid injections, and dermabrasion. Benzoyl peroxide is also often used to treat mild or moderate acne vulgaris.
Final Thoughts
Acne is an extremely painful skin condition, both physically and psychologically. It can make you feel utterly helpless and damage your mental health. However, there are many different prescription medication types to target acne, from oral antibiotics and topical antibiotics to birth control.
Even though the side effects of the medication mentioned can seem daunting, these are some of the most successful acne treatment options available, with millions of testimonies in favor of their effectiveness.
The right treatment for you is out there; you just have to be persistent enough to find it. Never stop searching for a solution! The most important thing is to consult a dermatologist you trust and listen to their instructions.
A healthy and clean complexion will come sooner than you think.
References
Use of oral contraceptives for management of acne vulgaris
Acne Relapse Rate and Predictors of Relapse Following Treatment with Oral Isotretinoin
Pregnancy and isotretinoin therapy
Disclaimer
All information, content, and material of this website is for informational purposes only and are not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of a qualified physician or healthcare provider.
