Many people assume prescription treatments work better than over-the-counter options. This is true for many diseases, but acne is an exception. Proper application of benzoyl peroxide can much more predictably and completely clear the skin when compared with most prescriptions.
There are 3 exceptions to this rule, however, and in these cases, acne patients and their dermatologists sometimes choose prescriptions as the chosen course of action:
1. Severe, widespread, and scarring acne: Isotretinoin (Accutane®) is an oral treatment that can achieve long-term remission of acne in about 2/3 of people who take it, but comes with numerous concerning side effects, some of which can be lifelong. It is the #1 birth defect-causing medication on the market, and may leave the user with premature aging and joint pain in the long-term. For these reasons, it is approved only for severe and scarring acne, and must be administered in close partnership with a trusted physician.
2. Poly-cystic ovary syndrome (PCOS): If you are a female who is experiencing irregular menstrual cycles, particularly if you also notice excessive hair growth, your doctor may diagnose poly-cystic ovary syndrome (PCOS). In that case, oral contraceptives (birth control pills) are a hormonal treatment that can clear acne and relieve other symptoms of PCOS simultaneously.
3. Cortisone shots for quick relief of a nodule/cyst: If you find that you are stuck with a very large acne lesion that does not come to a head and is sore to the touch, it is likely that you have a cystic acne lesion. In that case, making an appointment with your dermatologist to get a cortisone shot directly in the lesion can almost immediately reduce inflammation and reduce the chance of scarring.
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