If you feel like you’ve tried every over-the-counter solution available, you might be considering acne solutions offered by dermatologists. In this article, we’ll be taking a look at the medical 🩺 and other options they have for acne prone skin.
Acne Pills: What Are Your Options?
There are four main categories to choose from when it comes to acne pills:
- oral antibiotics
- combined oral contraceptives
- oral retinoids
- a few miscellaneous options.
All of these can help in different ways, but first, what are they?
Oral Antibiotics for Acne
This acne medication, like most pills for acne, is not for acne specifically. Antibiotics became a popular acne solution because acne-causing bacteria, known as P. acnes 🦠, can create minor infections in the pores, which leads to pimples and cysts. The medicine is also known for its anti-inflammatory action.
However, antibiotic effectiveness has been steadily declining due to microbial resistance. This happens when some bacteria develop a genetic mutation that allows them to survive the medicine and multiply. This is caused by over-prescription and unwarranted use over a long period of time.
That said, many dermatologists still prescribe antibiotics 💊, and in some cases, it may be a good option. Usually, they are prescribed together with hormonal therapy and topical treatment.
Topical Antibiotics for Acne
Topical antibiotics for acne can be effective, and they typically come with fewer side effects and a decreased risk for antibiotic resistance. They also tend to be enhanced with other acne-fighting ingredients 💪.
Birth Control Pills for Acne Prone Skin
Of all the acne pills, combined oral contraceptives (a specific form of “the pill”) are one of the best options for oily skin or hormonal acne. This is because combined oral contraceptives (COCs) pair synthetic estrogen and synthetic progesterone to help balance hormones that can increase the oil production that leads to acne. This matters, because too much oil can feed P. acnes bacteria 🦠 that cause pimples and cysts. It also clogs the pores, which results in blackheads and whiteheads.
Retinoids for Acne
Retinoids are concentrated, derivative forms of vitamin A that prevent clogged pores by regulating both skin cell production and skin cell death. Think of them as a pace car for your skin cells.
Because of their mechanism of action, most retinoids are topical gels best suited for blackheads and whiteheads rather than pimples or cysts. This is excepting Accutane, which is taken systemically.
The Truth About Using Accutane for Acne
Accutane (also known as isotretinoin) is a powerful oral retinoid that’s available by dermatologist 👩⚕️ or doctor prescription only. It is usually reserved for use with only the most severe cystic acne that has not responded to any other treatment.
Isotretinoin is no longer sold under the name Accutane, but is now known as Absorica, Claravis, Myorisan, and others. It’s taken in pill form once daily for four to six months, and then acne clears up more or less permanently. In some cases, another four to six-month treatment is necessary, but many people see a significant improvement in even the most severe acne after using Accutane. It is one of the most popular acne pills, but it’s also one of the most controversial.
Problem is, Accutane is associated with rather severe side effects, and its long-term effects are not truly known yet. It’s been proven to cause severe depression, birth defects, Crohn’s disease, and irritable bowel syndrome. In some, it’s hepatotoxic, meaning it can damage the liver.
More common side effects include the following:
- Vision disturbances 👀
- Dry, itchy skin with rashes
- Dry, chapped lips
- Back and joint pain
- Dry nose and nose bleeds.
Because manufacturers already had thousands of lawsuits against them because of these side effects, patients now have to jump through several precautionary hoops before physicians and dermatologists agree to prescribe isotretinoin for acne-prone skin.
There are several prescription topical retinoids you can get from a dermatologist’s rooms 👩⚕️, from Tazorac to Retin-A, and there’s even an over-the-counter (OTC) topical retinoid called Differin.
Epiduo is a prescription 🩺 topical retinoid (adapalene) that is combined with antibacterial benzoyl peroxide. For some reason, the combination of benzoyl peroxide and this retinoid is very effective against cystic acne.
Epiduo Forte is a popular acne treatment for very severe cysts that don’t respond to Epiduo. It contains the same amount of benzoyl peroxide but a higher percentage of adapalene.
Unfortunately, Epiduo Forte is too strong for some, and can cause redness, itchiness, and peeling. This is why we recommend that you start with Epiduo and gradually move to the Forte formulation. It’s also rather expensive, so if you’re on a budget, perhaps consider using OTC Differin, and an OTC benzoyl peroxide together.
Other Acne Treatment Prescriptions
Other than antibiotics 💊, combined oral contraceptives, and Accutane, there are still a handful of medications popularly prescribed by dermatologists.
Aldactone for Hormonal Acne
Originally created in 1985 to treat hypertension, Aldactone (also known as spironolactone) is often prescribed off-label to treat moderate to severe acne. It reduces excess sebum production by suppressing the excretion of certain androgenic hormones (such as testosterone). However, it does come with a few caveats.
Spironolactone has the so-called black box warning, which is the highest level of caution the FDA can assign a medication, because it can cause tumors. However, this warning was based on outdated studies using doses almost 500 times the normal prescription doses. Recent research has found no evidence of low-dose spironolactone tumor growth—in fact, just the opposite. One in vitro study demonstrated its action against the type of cancer cells responsible for relapses.
The same applies to the warning against renal toxicity. This is a possibility, but only in higher doses ❌.
It may not be the best option for men with acne prone skin, because the medication tends to cause gynecomastia (growing small breasts).
Prednisone for Severe Acne
Prednisone is an oral corticosteroid, and its main function is to suppress the immune system slightly in order to reduce inflammation. This can help with a wide variety of issues, including inflammatory acne. Bacteria and oil production play a large role in causing acne, but inflammation 🔥 is key.
However, prednisone is not free from potential issues, because it’s only a short-term solution. Corticosteroids cannot be safely taken for longer than three weeks; extended use is associated with severe side effects in some, including:
- high blood sugar 📈
Most dermatologists 👩⚕️ recommend that prednisone be used to help control acute cases of severe inflammatory acne, like cystic acne.
Cortisone Shot Acne Treatments
Cortisone shot acne treatments are a dermatologist acne solution that can help get rid of cysts almost overnight, but despite these amazing results ✔️, they need to be used sparingly.
A cortisone shot reduces the swelling and allows your acne treatment products to actually work and get rid of the infection causing the cyst, which is great. However, too much cortisone, or too many cortisone shots, can cause scarring and other side effects. Like prednisone, cortisone shots are not meant to be a longer lasting solution, but rather a short-term acne treatment for a particularly bad cystic breakout persisting for weeks despite good skin care.
Dermatologist Acne Procedures
Dermatologists 👩⚕️ can also perform various skin care procedures that can help reduce acne. Including the already-mentioned cortisone shots, they also offer procedures like chemical peels, microdermabrasion, and microneedling.
We prefer these procedures, because the majority are not taken systemically, meaning that if performed by a skilled professional, they will have very few harmful side effects.
What Is a Chemical Peel for Acne?
A chemical peel for acne is a procedure where a dermatologist applies an acidic solution to your skin, allows it to set, then removes it. The process exfoliates your skin, so excess oil and dead skin cells are stripped away. It also stimulates the skin to produce more collagen, and reduces the size of your pores as well as wrinkles.
Many before-and-after results have shown that especially acne scars can improve greatly with a chemical peel. But not all chemical peels are the same, and not all dermatologists who apply them are the same. Chemical peels are safe for all skin types and skin colors, but make sure your dermatologist has experience performing chemical peels on skin of color.
It’s important that your dermatologist 👩⚕️ knows what they’re doing before you get a chemical peel for acne. You also want to make sure you’re getting the chemical peel that meets your needs and expectations, as some are more extreme than others. The main categories are refreshing, medium, and deep peels.
The Refreshing Peel
A refreshing peel uses relatively gentle acids to exfoliate the very top layer of your skin. It is not painful and very few people report even moderate discomfort.
Afterwards, your skin might be a little red and itchy, and you’ll need to wear sunscreen ☀️ every day for the next few weeks, but other than that there should be few to no side effects. However, it’s also the least effective of all the types of chemical peels. You will probably notice a reduced number of blackheads and whiteheads, and your skin tone may become more even.
The Medium Peel
A medium peel exfoliates beyond the top layer of the skin and provides more obvious results, It is still considered to be essentially painless. Harsher chemicals are used for a longer period of time, so if you have dry 🌵 or sensitive skin, we recommend checking with your dermatologist that this procedure is right for you.
Even if you have tough or oily skin, this procedure often requires a longer recovery time than a refreshing peel. Your skin will likely be slightly swollen, and blisters may form. Like with a refreshing peel, you should wear sunscreen every day until your skin has healed fully, but you will also likely have to do a few other things, like take certain medications or apply special medicated lotion.
The Deep Peel
A deep peel is a bit of a misnomer because it makes it seem like it’s just a bit more extreme than a refreshing or medium peel. In reality, though, it is a serious procedure that requires sedation and a week of recovery at home 🏠.
Deep peels use carbolic acid, an intense acid that exfoliates the top two layers of skin completely, resulting in severe crusting, swelling, and blistering for several days. Recovery may take several weeks and include medications and medicated lotions. Unlike the other peels, this one is reported to be moderately uncomfortable to mildly painful.
Although this acne treatment is more extreme, it also produces more dramatic results. Most patients notice a huge difference as soon as the skin starts to heal, and the improvements last for several years.
Dermabrasion and Microdermabrasion for Acne
Microdermabrasion for acne works in much the same way as a refreshing chemical peel does. The goal is to exfoliate all the excess oil and dead skin cells to make room for new, healthy skin cells. Chemical peels do this through chemical treatments, and microdermabrasion does this through tiny crystals sprayed onto the skin.
This is a popular dermatologist acne solution, but it can also be performed by aestheticians at spas. If you’re nervous about the results, we always recommend seeing a dermatologist 👩⚕️.
It’s a quick, gentle procedure that may help reduce blackheads and whiteheads, but is not a great option for inflamed acne, like pimples or cysts. The crystals will likely only irritate inflamed acne 🔥, which can be painful. It might also make the acne worse.
You should also avoid microdermabrasion for acne if you’re taking Accutane or any other oral retinoid, and you should check with your dermatologist if you’re using a topical retinoid. Retinoids increase skin sensitivity and fragility, so microdermabrasion may end up doing more harm than good.
What Is the Difference Between Microdermabrasion and Dermabrasion?
Dermabrasion involves a dermatological tool that “sands” down the skin, which can be a much harsher process than microdermabrasion. It’s also unsafe for skin of color.
Microdermabrasion will not leave any hyperpigmentation or light spots in any skin color, while dermabrasion has been known to cause discoloration.
Is Microneedling Safe for Acne Prone Skin?
Microneedling is exactly what it sounds like: tiny needles being applied to the skin. This is meant to stimulate the skin cells’ healing response so that they produce more collagen and to reduce wrinkles and scarring, and provide a more even skin tone overall.
There are at-home microneedling devices, but dermatologists 👩⚕️ warn against using these. They say that the needles on these devices are too short, too dull, and too hard to clean. At best they will simply draw more blood to the skin and make it appear brighter, and at worst it could actually cause infection or scarring.
Dermatologists further say that when done properly by (preferably) a medical professional, it can help reduce the appearance of scars significantly, but it’s not the best choice for acne itself. This is because breakouts can actually be worsened by this process, as the needles can break the skin, and cause worse infection because of increased bacterial spread 🦠. So, we don’t recommend this as one of the best acne treatments.
Home Remedies as Acne Solutions
Many people prefer a home treatment over visiting a dermatologist 👩⚕️, and that’s totally OK. Home remedies as a topic is an article on its own, but there are a number of home remedies that are known to help treat and prevent breakouts by:
- reducing sebum production
- clearing pores
- killing skin bacteria 🦠
- soothing skin irritation naturally and safely.
Tea tree oil, for instance, has antibacterial properties, but its action against P. acnes 🦠 is not firmly established. The efficacy of tea tree oil against acne may be more due to its anti-inflammatory function, which reduces swelling. A few drops will be a useful addition to homemade acne products, and it works well as a spot treatment too. Start by applying twice a day, and increase frequency only if your pimples don’t respond, and if it’s not too abrasive. Always use it with a carrier oil on sensitive skin, though.
The Best Acne Medicine Starts Here
The first and most important step toward clear skin is a gentle, consistent skin care routine, because using the wrong acne products for your skin type can lead to breakouts 📝.
Products don’t need to be prescription-only; they can simply be a good over-the-counter treatment system, like the Basic Kit from Exposed Skin Care. It contains our Facial Cleanser, Clearing Tonic, Acne Treatment Serum, and Clear Pore Serum, which work together to treat your skin as gently as possible while still fighting acne 🏆.
We understand that harsh acne treatments only serve to irritate the skin, which often leads to inflammation. Since inflammation is at the heart of all acne, our products don’t encourage this, but they don’t sacrifice any efficacy against pimples.
We include both scientific and natural ingredients in each and every one of our products. Some contain benzoyl peroxide and peppermint oil, others utilize salicylic acid and green tea extract, but no matter what the combination, we make sure our ingredients balance out to a gentle and effective formula for decreased acne. Dermatologist acne solutions are excellent resources for moderate to severe acne, but you might be surprised at how much your acne can improve just by using a consistent skin care routine, like Exposed.