There are so many types of acne medications available, it can be hard to know where to start. Acne medication is a prescription you receive from your doctor or dermatologist that is specifically designed to treat acne. These prescriptions help clear skin by fighting one or more of the three main causes of acne: inflammation, bacteria, and oil production.
What Causes Acne?
You may know that oil buildup can cause breakouts but did you know that bacteria and inflammation play a role in acne formation as well? Dermatologists used to believe that bacteria were the main cause of acne, but recent research has shown that inflammation is actually the trigger for most acne.
The skin is inflamed by a variety of triggers, from stress to irritation. When the skin becomes inflamed, the pores close and trap any oil, bacteria, and dead skin cells that were on the surface of the skin. Trapped in the pore, these are the perfect ingredients for acne. Oil and dead skin cells can form clogs to create blackheads and whiteheads, and bacteria can multiply quickly under the skin to form pimples and cysts.
Bacteria aren’t all bad. The bacteria primarily associated with acne are called p. acnes, and without inflammation, they generally don’t cause any issues. P. acnes consume the oil our skin naturally produces as their food source, so if left alone on the surface of the skin, bacteria can prevent too much oil buildup. However, once the skin is inflamed, the bacteria get trapped in a pore and multiply rapidly. They create a small infection which leads to inflammation and pus, which is what creates a pimple.
Excess oil production can also cause acne because it easily clogs pores. Combined with dead skin cells, oil can get stuck in the pores and cause blackheads and whiteheads. Excess oil contributes to pimple formation as well, because it provides extra food for p. acnes bacteria, helping them grow and create an infection.
The best acne medications address at least one of these issues, and our favorites address two or even all three.
The 5 Best Acne Medications
Out of the hundreds of acne medications out there, the best are:
- Benzoyl Peroxide
- Salicylic Acid
- Hormone Regulators
We recommend these as the 5 best acne medications because there is significant research and clinical trials that prove they work. However, research also shows that most people do not need prescription-strength acne treatment. Cystic and nodular acne usually need medication intervention, but less severe forms of acne can almost always be treated with a gentle, consistent skincare regimen.
If typical 3-step systems haven’t worked for you in the past, you probably don’t need a stronger solution, but a milder one. Many acne products are far too harsh, and can actually cause more acne by drying out the skin. Dry skin is more easily irritated, and when skin is irritated, it becomes inflamed and traps oil, dead skin cells, and bacteria beneath the surface, where they turn into whiteheads, pimples, and even cysts.
At Exposed Skin Care, we understand that dry skin is just as bad for acne as oily skin, so our products are gentle enough to take care of your skin, and tough enough to take care of acne. We offer three kits, in Basic, Expanded, and Ultimate options, that contain all the acne treatment products most people could ever need.
Acne medication should never be the first line of treatment, but for some, it is necessary. If you decide to try a prescription-strength acne treatment, w recommend benzoyl peroxide, salicylic acid, a retinoid product, antibiotics, or a hormonal regulation medication. The best acne medication for you depends on your skin type and what kind of acne you usually have.
Benzoyl peroxide is the most commonly prescribed acne medication because it can effectively kill 99% of p. acnes bacteria. It is a topical medication that carries oxygen beneath the surface of the skin, which kills p. acnes because they are anaerobic, meaning they can’t survive long in the presence of oxygen.
A prescription for benzoyl peroxide is available in concentrations ranging from 2.5% to 10%, and some of the lower concentrations are also available over-the-counter. Many popular acne brands offer products that contain benzoyl peroxide, but they typically use a much higher concentration than necessary. Although some acne requires prescription-strength benzoyl peroxide, most people will see clearer skin using 2.5% – 5%. One side effect of benzoyl peroxide is dry and irritated skin, and the higher the concentration, the more likely this is. To prevent this, at Exposed Skin Care we use 3.5% benzoyl peroxide in our Acne Treatment Serum. It is strong enough to beat acne, but gentle enough not to cause even more.
If your acne is primarily pimples, rather than blackheads or whiteheads, benzoyl peroxide is a good choice for you. Its antibacterial properties can help treat and prevent pimples. Although bacteria play a major role in cystic acne as well, benzoyl peroxide is typically not strong enough to clear cystic acne on its own. It is often combined with other popular acne medications, like retinoids or antibiotics to treat cystic acne.
Instead of targeting p. acnes bacteria, salicylic acid breaks up the oil and dead skin cells clogging pores and exfoliates the skin. This helps get rid of blackheads, but used consistently, it can also prevent all types of acne. The buildup of oil and dead skin causes blackheads and whiteheads, and it contributes to pimples as well. Keeping the skin clear of excess oil is generally a good acne management technique.
However, if you have dry skin, this may not be the best option for you. Acne on dry skin is usually caused by irritation rather than oil buildup, so salicylic acid is typically less helpful. To avoid this, try using a product with a low concentration of salicylic acid. Concentrations from 0.5% to 2% are available over-the-counter, including many of our products at Exposed Skin Care. Our Facial Cleanser, Clearing Tonic, and Clear Pore Serum all use salicylic acid at a low concentration that will get rid of acne without irritating the skin. These products can help, but in some cases, prescription-strength salicylic acid may be the best solution.
We recommend salicylic acid for most skin types and most acne problems because it is relatively gentle, but still effective. If you have oily skin or deal primarily with blackheads or whiteheads, salicylic could be the perfect solution for you.
Retinoids are a very broad class of acne medication that includes both mild over-the-counter products and serious medications that should only be taken as a last resort. Generally, retinoids are united by their basic make up. All retinoids are concentrated derivatives of vitamin A, and they work by changing the life cycle of the skin cells.
Retinoids guide the skin cells through their life cycle at a healthy pace. If skin cells are produced quickly but take too long to die, then they cling to the pore and cause a clog. Acne can also result from skin cells being produced slowly but dying quickly because the skin cells die before they reach the surface, and there aren’t enough new ones to push the old ones out of the way.
Retinoids even out this process. Some do so more gently than others, but generally speaking, all retinoids help regulate skin cell production and skin cell death. Gentle retinoids, like Differin, which is available over-the-counter, come with very mild side effects, like dry skin, similar to benzoyl peroxide or salicylic acid. The advantage of Differin is that it can help with cystic acne.
The strongest retinoid available is isotretinoin, commonly known as Accutane. Accutane is an oral acne medication, and it can be very effective in treating cystic acne, but it comes with many side effects, such as dry skin, back pain, or nose bleeds, and there is a chance for more significant side effects, like serious mood disturbances, seizures, or migraines. In addition, Accutane is an identified teratogen, meaning it causes serious birth defects. Anyone capable of becoming pregnant must agree to use two forms of birth control while taking Accutane.
Both oral and topical antibiotics can be prescribed to treat acne, but they are not our top recommendation. They can play an important role in getting acne under control, but they are not a long-term solution.
Antibiotics work by providing a surge of medication that kills off bacteria. This works for illnesses like strep or minor skin infections where bacteria have temporarily grown out of control, but it is not overly effective in treating acne. This is because p. acnes always live on the surface of the skin. Using antibiotics can help treat the pimples or cysts that you already have, but once you stop using the antibiotics, they will likely come back again.
Unfortunately, you have to stop taking the antibiotics after only 3 months, which is why we don’t recommend it as a long-term solution. Antibiotics can only be taken for a limited time because of antibiotic resistance. This is when bacteria are exposed to an antibiotic long enough that some of them are no longer affected by the antibiotic. Because bacteria reproduce so quickly, it doesn’t take long to create a large number of bacteria that can’t be killed by that antibiotic anymore.
For acne, this is frustrating, but generally not the end of the world. That’s why many people using antibiotics for acne take them much longer than 3 months. This is a problem though. Taking one antibiotic too long can make you resistant to many other antibiotics. Eventually, when you have a more serious infection or illness, the antibiotic may not work. It gets worse when you consider how easily bacteria spread from person to person. Doctors are growing increasingly worried about general antibiotic resistance, the possibility that someday we won’t be able to use antibiotics at all. Because of the issues associated with antibiotics, we recommend trying other acne medications first.
For some people, hormones play a large role in acne, so a medication that helps regulate those hormones could be the best solution. Stress hormones definitely cause acne because they send a distress signal to the body saying that it is in danger, which triggers the inflammation response to help protect the body from an attack. Unfortunately, there is no medication for the daily stressors that could be contributing to your acne. There are medications that can help reduce acne related to other hormones, though.
Everyone produces some amount of both estrogen and testosterone, and the relationship between these hormones can sometimes lead to increased acne. Increased testosterone compared to a person’s normal level can cause acne, but it’s all relative. For example, men typically have more testosterone, but they do not usually have more acne. Most women produce more estrogen and less testosterone, but a week or so before menstruation, estrogen levels drop significantly which causes premenstrual acne. Because estrogen balances out testosterone, decreased estrogen results in a relative increase in testosterone levels.
One way to help control acne caused by hormone fluctuations is to control the hormones. The two most popular hormone regulating acne medications are combined oral contraceptives (birth control) and spironolactone.
Not all birth control can help prevent acne, so if it’s important to look for combined oral contraceptives specifically. This type of birth control increases estrogen, which helps balance out the hormones to keep acne at bay. Spironolactone takes the opposite route; it works by decreasing the production of testosterone and other androgens.
Birth control and spironolactone can both help reduce acne, but only if it is caused by hormones. Another potential issue is that both medications can produce feminizing features, so they are not the best choice for some men.