Adapalene

What is it:

Made under the brand name "Differin," it is a topical retinoid gel which is applied once a day.1-2 It comes in .1% and .3% strength.

(Learn more from the U.S. National Library of Medicine)

What it does:

Acne is thought to be caused by the skin cells inside the follicle shedding too fast and clogging pores. Differin gel slows down the accumulation of skin cells inside the follicle that plug the pores.1-2 It also has anti-inflammatory effects.3

Considerations:

Exposure to sunlight should be minimized.1-2

About 10-40% of patients experience redness, dryness, scaling, burning, or itchiness. Other adverse reactions were also reported.1-2,4

Brand names:

Differin
Read Reviews  
3.3/5 - 1253 reviews
  1. "Adapalene." MedlinePlus. 2008. American Society of Health System Pharmacists, Inc. 2011.
  2. Noble S, Scott L, Waugh J. "Adapalene: A Review of its Use in the Treatment of Acne Vulgaris." Drugs. 2004; 64(13): 1465-78. Abstract. PubMed. 9 Feb, 2005. link.
  3. Irby C, Yentzer B, Feldman S. "A review of adapalene in the treatment of acne vulgaris". Journal of Adolescent Health. 2008; 43(5): 421-424.
  4. Poulin Y, et. al. "A 6-month maintenance therapy with adapalene-benzoyl peroxide gel prevents relapse and continuosly improves efficacy among patients with severe acne vulgaris: Results of a randomized controlled trial." British Journal of Dermatology. 2011; 164(6): 1376-1382.

Azelaic Acid

What is it:

Made under the brand name "Azelex." Azelex is a cream containing 20% azelaic acid, a naturally occuring acid found in whole grain cereals and animal products. It is normally applied twice daily.1

(Learn more from the U.S. National Library of Medicine)

What it does:

Azelaic acid is thought to help the skin to renew itself more quickly and prevent the buildup of cells that can plug pores, therefore reducing pimple and blackhead formation. It also helps to kill acne bacteria,1 and has anti-inflammatory effects.2

Considerations:

Side effects are generally mild and short lived. Most common, in 1-5% of people are itching, burning, stinging, and tingling. Other side effects were reported in less than 1% of people.

There have been a few reports from darker skinned people of lightening of the skin. Azelaic acid has not been well studied in people with dark complexions.1

Brand names:

Azelex
Read Reviews  
3.9/5 - 212 reviews
  1. "Azelaic acid topical." MedlinePlus. 2008. American Society of Health System Pharmacists. 2011.
  2. Thiboutot D. "Versatility of azelaic acid 15% gel in treatment of inflammatory acne vulgaris." Journal od Drugs in Dermatology. 2008; 7(1):13-16.

Benzoyl peroxide

What it is:

Benzoyl peroxide is available in prescription and over-the-counter medications, in cream, gel, and wash form. It is an anti-bacterial agent.1-2,4-5

(Learn more from the U.S. National Library of Medicine)

What it does:

Benzoyl peroxide is the only known substance which can bring oxygen under the skin surface. Since bacteria cannot survive in the presence of oxygen, when used in an adequate dosage, benzoyl peroxide eradicates 99.9% of these bacteria almost immediately. It also exerts a mild drying and peeling effect, which is thought to help prevent breakouts.1-6 Benzoyl peroxide also helps lessen inflammation.7-9 2.5% benzoyl peroxide is just as effective as higher concentrations with less side effects.6,10

Considerations:

Benzoyl peroxide is able to produce complete clearing of acne only when used in an adequate dosage and within a properly applied benzoyl peroxide regimen.

Some dryness, redness, and itchiness is to be expected in the first few weeks of use.6 Scientists call this initial period the "hardening effect" of benzoyl peroxide.

About 1-3% of people are allergic to benzoyl peroxide and experience an inflammation of the skin or severe crusting.3 This should not be confused with the "hardening effect" of benzoyl peroxide.

Benzoyl peroxide, like any other peroxide, can bleach hair and fabric.1

Prescription names:

Benzac AC, Brevoxyl, Triaz, Benzaclin (benzoyl peroxide + clindamycin)
Read Reviews
3.4/5 - 192 reviews
  1. "Benzoyl Peroxide". MedlinePlus. 2010. American Society of Health-System Pharmacists, Inc. 2011 link.
  2. Berger, et. al. Andrew's Diseases of the Skin. Philadelphia: W.B. Saunders Company, 2000.
  3. Drobil M, Lindemayr H. "Contact Sensitization to Benzoyl Peroxide." Contact Dermatitis. 1981; 7(3): 137-40.
  4. Ives T. "Benzoyl Peroxide." American Pharmacy. 1992; 32(8): 33-8.
  5. Weinberg J. "The Utility of Benzoyl Peroxide in Hydrophase Base (Brevoxyl) in the Treatment of Acne Vulgaris." Journal of Drugs in Dermatology. 2006; 5(4): 344-9.
  6. Sagransky M, Yentzer B, Feldman S. "Benzoyl peroxide: A review of its current use in the treatment of acne vulgaris." Expert Opinion on Pharmacotherapy. 2009; 10(15): 2555-2562.
  7. Dutil M. "Benzoyl peroxide: Enhancing antibiotic efficacy in acne management." Skin Therapy Letter. 15(10): 5-7.
  8. Harper J. "Benzoyl peroxide development, pharmacology, formulation and clinical uses in topical fixed combinations." Journal of Drugs in Dermatology. 2010; 8(9): 482-487.
  9. Tanghetti E, Popp K. "A current review of topical benzoyl peroxide: New prospectives on formulation and utilization." Dermatologic Clinics. 2009; 27(1): 17-24.
  10. Fakhouri T, Yentzer B, Feldman S. "Advancement in benzoyl peroxide-based acne treatment: Methods to increase both efficacy and tolerability." Journal of Drugs in Dermatology. 2009; 8(7): 657-661.

Clindamycin

What it is:

Clindamycin is a topical antibiotic which usually comes in a solution, gel, foam, or lotion, and is normally applied twice daily.1-2

(Learn more from the U.S. National Library of Medicine)

What it does:

Clindamycin phosphate is an antibiotic which kills P. Acnes (acne bacteria).1

Considerations:

Burning, itching, peeling, redness, and dryness are the most reported side effects, particularly at the onset of treatment.1,3

Diarrhea, bloody diarrhea, and inflammation of the colon have been reported.1,3

Brand names:

Cleocin T, Clinda-derm, Clindets, Benzaclin (clindamycin + benzoyl peroxide)
Read Reviews  
3.8/5 - 345 reviews
  1. "Clindamycin." MedlinePlus. 2010. American Society of Health-System Pharmacists, Inc. 2011 link.
  2. Krochmal L, et. al. "The Safety and Efficacy of Clindamycin Phosphate Foam 1% Versus Clindamycin Phosphate Topical Gel 1% for the Treamtent of Acne Vulgaris." Journal of Drugs and Dermatology. 2005; 4(1): 48-56.
  3. Cambazard F, et. al. "A Multicentre, Single-Blind, Randomized Comparison of a Fixed Clindamycin Phosphate/ Tretinoin Gel Formulation (Velac) Applied Once Daily and a Clindamycin Lotion Formulation (Dalacin T) Applied Twice Daily in the Topical Treatment of Acne Vulgaris." The British Journal of Dermatology. 2000; 143(3): 498-505.

Dapsone

What it is:

Made under the brand name "Aczone." Aczone is a 5% topical gel that is normally applied twice daily.

(Learn more from the U.S. National Library of Medicine)

What it does:

Dapsone targets the inflammatory component of acne by helping to inhibit the body's inflammatory response. It also possesses antioxidant and minor antibacterial properties.1 Dapsone reduces acne lesion count by approximately 30-45%. Initial studies point toward better efficacy in female patients than in male patients.2

Considerations:

Unlike oral dapsone which is sometimes prescribed for leprosy and other skin infections, topical dapsone does not come with potentially dangerous blood related side effects.4-5 Side effects of topical dapsone are normally mild in nature and can include dryness, rash, and burning.6

Brand names:

Aczone
Read Reviews  
3.7/5 - 114 reviews
  1. Kircik L. "Harnessing the anti-inflammatory effects of topical dapsone for management of acne." Journal of Drugs in Dermatology. 2010; 9(6): 667-671.
  2. Tanghetti E, Harper JC and Oefelein MG. "The efficacy and tolerability of dapsone %5 gel in female vs male patients with facial acne vulgarism: gender as a clinically relevant outcome variable." Journal of Drugs in Dermatology. 2012; 11(12): 1417-21.
  3. Tan J. "Dapsone 5% Gel - A New Option in Topical Therapy for Acne." Skin Therapy Letter. 2012; 17(8): 1-3.
  4. Stotland M, Shalita A, Kissling R. "Dapsone 5% gel: A review of its efficacy and safwty in the treatment of acne vulgaris." American Journal of Clinical Dermatology. 2009; 10(4): 221-227.
  5. Fleischer A, et. al. "Dapsone gel 5% in combination with adapalene gel 0.1%, benzoyl peroxide gel 4% or mosturizer for the tretment of acne vulgaris: A 12-week, randomized, double-blind study." Journal of Drugs in Dermatology. 2010; 9(1): 33-40.
  6. Tan J. "Dapsone 5% Gel: A New Option in Topical Therapy for Acne." Skin Therapy Letter. 2012; 17(8): 1-3.

Erythromycin

What it is:

Erythromycin is a topical antibiotic packaged in gel, ointment, pledgets (little take-along packets), and solutions, and is usually applied twice a day.8 It is often combined with benzoyl peroxide.

(Learn more from the U.S. National Library of Medicine)

What it does:

Erythromycin is an antibiotic which kills P. Acnes (acne bacteria).1-2

Considerations:

Ask your doctor before using any other products on your skin while using erythromycin, as it may be too irritating. This includes other prescriptions, over-the-counter medicines (including those listed on this site), and harsh or abrasive cleansers, perfumes, or make-up.2

People report burning as the most frequent side effect, and also peeling, dryness, itching, redness, and oiliness, among others.2

Brand names:

Benzamycin (erythromycin + benzoyl peroxide), Akne-Mycin, A/T/S, Emgel, Erycette, Eryderm, Erygel, Erymax, Ery-Sol, Erythra-Derm, ETS, Staticin, Theramycin Z, T-Stat
Read Reviews  
3.6/5 - 196 reviews
  1. Berger, et. al. Andrew's Diseases of the Skin. Philadelphia: W.B. Saunders Company, 2000.
  2. "Erythromycin". MedlinePlus. 2008. American Society of Health-System Pharmacists, Inc. 2011 link. link.

Isotretinoin (Accutane)

What it is:

Originally under the brand name "Accutane" but now available only in generic form, isotretinoin is a derivative of vitamin A taken in pill form for 15-20 weeks. Doctors normally prescribe it for people with "severe nodular acne" that does not respond to other treatments. Nodules are inflammatory lesions with a diameter of 5mm or more. A single course of 15-20 weeks has been shown to result in complete clearing and long-term remission of acne in many people.1-2

(Learn more on the accutane page of acne.org)

What it does:

Reduces the amount of oil produced by the oil glands.1

Considerations:

THERE IS AN EXTREMELY HIGH RISK THAT A DEFORMED INFANT CAN RESULT IF PREGNANCY OCCURS WHILE TAKING ACCUTANE IN ANY AMOUNT AND EVEN FOR SHORT PERIODS OF TIME. FEMALES WHO ARE PREGNANT OR WHO MAY BECOME PREGNANT WHILE UNDERGOING TREATMENT SHOULD NOT TAKE ACCUTANE. There are many other warnings as well.1-3

Side effects of Accutane are many, some of which include dry and cracked lips, dry skin, dry nose and mouth, mild to moderate muscle or joint aches.1-2,4-7

Brand names:

Accutane, Roaccutane, Accutane Roche
Read Reviews  
3.9/5 - 2007 reviews
  1. "Isotretinoin." MedlinePlus. 2011. American Society of Health-System Pharmacists, Inc. 2011. link.
  2. McLane J. "Analysis of Common Side Effects of Isotretinoin." Journal of the American Academy of Dermatology. 2001; 45(5): 188-94.
  3. Erikson J, Honein M, Paulozzi L. "Continued Occurrence of Accutane-Exposed Pregnancies." Teratology. 2001; 64(3): 142-7. Abstract. PubMed. 2002. link.
  4. Bewley A, et. al. "Isotretinoin Causing Acute Aseptic Arthropathy." Clinical and Experimental Dermatology. 1995; 20(3): 279-281.
  5. Campanella M, V De Francesco, Stinco G. "Acute Arthritis During Isotretinoin Treatment for Acne Conglobata." Dermatology. 1997; 194(2): 195.
  6. Ceyrac, Lehucher D. "Acute Arthritis After Isotretinoin." Dermatology. 1999; 198(4): 406-07.
  7. Cunliffe W, Goulden V, Layton A. "Long-Term Safety of Isotretinoin as a Treatment for Acne Vulgaris." British Journal of Dermatology. 1994; 131(3): 360-3.

Oral antibiotics

What it is:

Oral antibiotics are taken in pill form usually once per day.

(Learn more about Doxycycline, Minocycline, Levofloxacin, Co-trimoxazole AKA sulfamethoxazole/trimethoprim from the U.S. National Library of Medicine)

What it does:

Oral antibiotics help stop the growth of P. Acnes (acne bacteria), from the inside out.1 Antibiotics also have an anti-inflammatory effect.2-4

Considerations:

Regardless of the type of antibiotic prescribed, only about one half of patients respond. When antibiotics do produce results, these results are moderate at best.5-8

Oral antibiotics should be used for only a short period of time, up to 6 months. However, even within this short time frame, antibiotics have been implicated in the proliferation of resistant colonies of bacteria.

Some antibiotics cause increased sensitivity to sunlight. Exposure to the sun could cause a rash, itchiness, or redness, and you may be burnt more easily, so you'll want to wear protective clothing and sunscreen.2

Side effects may include upset stomach, diarrhea, nausea, headache, vomiting, dizziness, or light-headedness as your body becomes accustomed to it.2

Minocycline is less prescribed because it works no better than any other antibiotic and comes with safety concerns, including the possibility of irreversible skin pigmentation.8-10

Brand names:

Vibramycin (doxycycline), Minocin (minocycline), Bactrim/Septra (co-trimoxazole AKA sulfamethoxazole-trimethoprim)
Read Reviews  
3/5 - 2026 reviews
  1. Kawabata S, Kurokawa I, Nishijima S. "Antimicrobial Susceptibility of Propionibacterium Acnes Isolated from Acne Vulgaris." European Journal of Dermatology. 1999; 9(1): 25-8.
  2. "Tetracycline." MedlinePlus. 2008. American Society of Health-System Pharmacists, Inc. 2011 link.
  3. Mays RM, et al. "New antibiotic therapies for acne and rosacea." Dermatology and Therapy. 2012; 25(1): 23-37.
  4. Perret LJ, and Tait CP. "Non-antibiotic properties of tetracyclines and their clinical application in dermatology." Australasian Journal of Dermatology. 2013; [ahead of print].
  5. Torok HM. "Extended-release Formulation of Minocycline in the Treatment of Moderate-to-severe Acne Vulgaris in Patients Over the Age of 12 Years." The Journal of Clinical and Aesthetic Dermatology. 2013; 6(7): 19-22.
  6. Leyden JJ, et al. "A randomized, phase 2, dose-ranging study in the treatment of moderate to severe inflammatory facial acne vulgarism with doxycycline calcium." Journal of Drugs in Dermatology. 2013; 12(6): 658-63.
  7. Kawaya A, Wada T, and Oiso N. "Clinical effectiveness of once-daily levofloxacin for inflammatory acne with high concentrations in the lesions." The Journal of Dermatology. 2012; 39(1): 94-6.
  8. Chiou WL. "Oral tetracyclines may not be effective in treating acne: dominance of the placebo effect." International Journal of Clinical Pharmacology and Therapeutics. 2012; 50(3): 157-61.
  9. Garner SE, et al. "Minocycline for acne vulgarism: efficacy and safety." Cochrane Reviews. 2012; 15: 8.M
  10. Kim SJ and English JC. "Minocycline-Induced Hyperpigmentation." Journal of Pediatric and Adolescent Gynecology. 2011; 25(1): 77-78.
  11. Johnston S. "Feeling blue? Minocycline-induced staining of the teeth, oral mucosa, schlerae and ears - a case report." British Dental Journal. 2013; 215(2): 71-3.

Oral contraceptives (birth control pills)

What it is:

Birth control pills contains progesterone and estrogen.

(Learn more)

What it does:

Birth control pills help decrease testosterone levels, which in turn decreases the severity of acne in women. Studies show on average a 30-60% decrease in total "lesions."1-4

Considerations:

Cigarette smoking with oral contraceptive use increases the risk of serious heart disease.2

There are many negative side effects and poistive side effects to taking birth control pills for acne. Talk to your doctor to decide if it is right for you.1-3

While it is a widely held belief, evidence does not show a correlation between pregnancy rates and concurrent administration of birth control pills and oral antibiotics. [With the exception of anti-tuberculosis drugs like rifampin.]

Brand names:

Ortho Tri-Cyclen, Estrostep, Yaz
Read Reviews  
3.5/5 - 4823 reviews
  1. Berger, et. al. Andrew's Diseases of the Skin. Philadelphia: W.B. Saunders Company, 2000.
  2. Salvaggio HL and Zaenglein AL. "Examining the use of oral contraceptives in the management of acne." International Journal of Women's Health. 2010; 2: 69-76.
  3. "Estrogen and Progestin (Oral Contraceptives)." MedlinePlus. 2011. American Society of Health-System Pharmacists, Inc. 2011 link.
  4. Bettoli, et. al. Fast Facts-Acne. Oxford, UK: HealthPress Limited, 2004.

Sodium sulfacetamide

What it is:

Sodium Sulfacetamide is a "sulfonamide," which was a wonder drug before other antibiotics and penicillin came into existence. It is still used for its antibacterial activity. It is used topically on the skin.1,3

(Learn more from Wikipedia)

What it does:

Sodium Sulfacetamide curbs the growth of acne bacteria. It also has anti-inflammatory effects.1-4

Considerations:

People have died due to severe reactions to sulfonamides, although rarely.4

Side effects in clinical trials were experienced by less than 2% of patients, and include irritation, stinging and burning.4

Brand names:

Klaron, Novacet, Sulfacet-R
Read Reviews  
4.2/5 - 126 reviews
  1. Bettoli, et. al. Fast Facts-Acne. Oxford, UK: HealthPress Limited, 2004.
  2. Fulton, James E. Acne Rx. James E. Fulton Jr., M.D., PhD: 2001.
  3. "Sodium Sulfacetamide Topical." Drugs.com. 2009. Cerner Multum, Inc. 1996-2006.
  4. Draelos Z. "The multifunctionality of 10% sodium sulfacetamide, 5% sulfur emollient foam in the treatment of inflammatory facial dermatoses." Journal of Drugs in Dermatology. 2010; 9(3): 234-236.

Spironolactone

What it is:

Spironolactone is a prescription medication in tablet form used to treat certain patients with hyperaldosteronism (the body produces too much aldosterone, a naturally occurring hormone), low potassium levels, and in patients with edema (fluid retention) caused by various conditions.1

(Learn more from the U.S. National Library of Medicine)

What it does:

Spironolactone is a potassium-sparing diuretic that has been used as an androgen-receptor blocker to treat acne and hirsutism in women (excessive hair growth).1-2

Considerations:

Side effects include muscle weakness, pain or cramps, lack of energy, loss of appetite, unusual bleeding or bruising, and more.1

Brand names:

Spironolactone, Aldactone
Read Reviews  
4.2/5 - 1673 reviews
  1. "Spironolactone." MedlinePlus. 2009. American Society of Health System Pharmacists, Inc. 2011.
  2. NH Shear. "Help for Recalcitrant Acne -- A Role for Spironolactone?" Journal Watch Dermatology (October 2000). 8 April 2008.

Tazarotene

What it is:

Made under the brand name "Tazorac." Tazorac is a retinoid gel that contains tazarotene, a vitamin A derivative, in 0.05% or 0.1% concentration and is usually applied to the skin once per day. It is used for both psoriasis and acne.1 It can be used in conjunction with other topical treatments.2

(Learn more from Wikipedia)

What it does:

Like other retinoids, tazarotene is thought to mediate inflammation and help pores from becoming clogged.3 Trials show on average about a 50% improvement in "lesion" counts after 12 weeks.4-6

Considerations:

Because tazarotene is a retinoid (vitamin A derivative), like Accutane, it should not be used by women who are pregnant because of potential harm to the fetus.

Exposure to sunlight should be avoided. Wind or cold may be more irritating when taking tazarotene.

Side effects occured in 10-30% of patients and included dry peeling skin, burning, stinging, dry skin, redness, and itchiness.

Brand names:

Tazorac
Read Reviews  
3.5/5 - 591 reviews
  1. "Tazarotene (Topical)." MedlinePlus. 2006. Thomson Healthcare. 2000.
  2. Del Rosso JQ and Tanghetti E. "A status report on topical tazarotene in the management of acne vulgarism." Journal of Drugs in Dermatology. 2013; 12(3): s53-78.
  3. Chivot M. "Retinoid Therapy For Acne: A Comparative Review." American Journal of Clinical Dermatology. 2005; 6(1): 13-9.
  4. Berson S, et. al. "Tazarotene Cream in Acne Clinical Study Investigator: Effects of Tazarotene 0.1% Cream in the Treatment of Facial Acne Vulgaris: Pooled Results from Two Multicenter, Double-Blind, Randomized, Vehicle-Controlled, Parallel-Group Trials." Clinical Therapeutics. 2004; 26(11): 1865-73.
  5. Berson D, et. al. "Once-daily Tazarotene 0.1% Gel Versus Once-Daily Tretinoin 0.1% Microsponge Gel for the Treatment of Facial Acne Vulgaris: A Double-Blind Randomized Trial." Cutis. 2002; 69(2): 12-9.
  6. Feldman SR, Werner CP and Alio Saenz AB. "The efficacy and tolerability of tazarotene foam, 0.1%, in the treatment of acne vulgarism in 2 multi center, randomized, vehicle-controlled, double-blind studies." Journal of Drugs in Dermatology. 2013; 12(4): 438-46.

Tretinoin

What it is:

You may have heard of tretinoin in reference to "Retin-A" wrinkle treatments. Tretinoin is retinoic acid and vitamin A acid combined, and comes in various strengths in creams, gels, and liquids for topical use on the skin. It is used to treat acne and also to treat sun damaged skin or wrinkles and is usually applied once per day.1

(Learn more from the U.S. National Library of Medicine)

What it does:

It is thought to help unplug follicles and keep pores clear. It also increases the speed at which surface skin cells are replaced and helps reduce inflammation. A study done on Retin-A Micro, a particular brand of tretinoin, showed a 32-45% reduction in total "lesions."2

Considerations:

Despite the frequent referencing of an initial flare of acne when starting is tretinoin, there is no science evidence to back this up. You should not expect an initial worsening of acne.3-4

Exposure to sunlight should be minimized as you may be more sensitive to its rays.

Ask your doctor before using other medication on the skin, especially anything containing sulfur, resorcinol, or salicylic acid, as the combination may be too irritating. Abrasive soaps and cleansers should be used with caution for the same reason.

Side effects can include skin irritation, swelling, lightening or darkening of the skin, an increase in acne sores, excessive redness, and crusted or blistered skin.

Brand names:

Retin-A, Retin-A Micro, Avita, Renova
Read Reviews  
3.5/5 - 1317 reviews
  1. "Tretinoin." MedlinePlus. 2010. American Society of Health-System Pharmacists, Inc. 2011. link.
  2. Zaenglein A. "Topical retinoids in the treatment of acne vulgaris." Seminars in Cutaneous Medicine and Surgery. 2008; 27(3): 177-1832.
  3. Yentzer B, McClain R, Feldman S. "Do topical retinoids cause acne to flare?" Journal of Drugs in Dermatalogy. 2009; 8(9): 799-801.
  4. Leyden JJ, et al. "Effects of topical retinoid therapy on acne lesions: a psychometric assessment." Cutis. 2012; 90(1): 46-50.

Whatever medication you decide to use, it is important to properly wash your skin before treating.

1 Wash your face only twice per day, morning and evening. Excess washing can cause irritation.


2 Use only your bare hands to wash, and wash for 10 seconds or less. Washcloths and hand-held cleansing devices are unnecessarily irritating. Consider the act of washing as simply prepping your skin for medication, nothing more. Washing itself does not clear breakouts since dirt does not cause acne, so there is absolutely no need to scrub.


3 Pat dry. Do not rub dry. Rubbing the skin is irritating, and excess irritation can perpetuate the acne cycle. Gently pat dry.