Oral Medication for Acne: Top 3 Effective Choices

Oral medications have emerged as a potent arsenal in the battle against acne, especially for cases unresponsive to topical treatments. Dr Justin Boey, Medical Director of Sozo Aesthetic Clinic, shares more from his personal experience, “these medications, administered through the mouth, work systemically to reduce the production of excess oil, fight inflammation, and combat bacterial infections involved in the formation of acne.” They are particularly beneficial for treating moderate to severe acne, including inflammatory, cystic, and acne that risks leaving permanent scars. This article explores the top three effective oral medications for treating acne, their mechanisms of action, efficacy, and potential side effects.

Understanding Acne

Acne is a skin condition that occurs when hair follicles become blocked with oil and dead skin cells, resulting in the formation of whiteheads, blackheads, or pimples. It typically affects the face, forehead, chest, upper back, and shoulders. Although teenagers are more prone to acne, it can affect people of all ages.

The exact cause of acne is unknown, but several risk factors have been identified. These include hormonal changes, diet, stress, and certain medications. Hormonal acne, for instance, is often associated with changes in androgen levels during puberty but can also occur in adults due to hormonal imbalances, typically around the menstrual cycle or in conditions like polycystic ovary syndrome. On the other hand, bacterial acne is caused by an excess of Propionibacterium acnes bacteria on the skin, which can inflame the hair follicles and lead to acne symptoms.

Different Types of Acne

There are various types of acne, each with unique characteristics and causes. These include Comedonal acne, which is characterised by whiteheads and blackheads; Inflammatory acne, which is red and swollen due to the presence of bacteria; Cystic acne, a more severe form of inflammatory acne that occurs when the bacterial infection goes deep into the skin, causing a painful, boil-like infection; and Post-inflammatory hyperpigmentation (PIH), which are flat spots of discolouration left behind after an acne lesion has healed. Understanding the type of acne is crucial for determining the most effective treatment approach.

When should I consider oral medication for acne?

Oral medication for acne becomes a consideration when topical treatments fail to bring about the desired improvements or when acne becomes moderate to severe. It’s also suitable for widespread acne, making topical application impractical. If your acne is predominantly inflammatory, or if you’re suffering from nodular or cystic acne, which carries a high risk of scarring or causing significant hyperpigmentation, oral medications can be a more effective treatment option. Moreover, oral medication is also considered for individuals whose acne is triggered by hormonal changes, such as those seen in polycystic ovary syndrome. It’s important to consult with a healthcare professional or dermatologist to evaluate the severity of your acne and determine the best treatment options for your specific condition.

3 Best Oral Medications for Acne

Before we delve into the specifics of each medication, it’s essential to understand that these drugs require a prescription from a healthcare professional. While these are among the most effective treatments for moderate to severe acne, they carry potential side effects, and a medical professional should continuously monitor their usage. Remember, what works for one person may not work for another, and the best treatment to treat acne is always tailored to individual needs. Here are the top three prescribed oral medications for acne:

1. Antibiotics

Antibiotics function as a powerful weapon against acne, primarily by curbing the growth of acne-causing bacteria on the skin. They work by reducing the concentration of Propionibacterium acnes bacteria on the skin and decreasing inflammation, thereby preventing the formation of new acne lesions. 

Doxycycline

Doxycycline is a commonly prescribed antibiotic for acne. It’s part of the tetracycline group of antibiotics and is particularly effective against inflammatory acne. It works by inhibiting the protein synthesis of the bacteria, thereby stunting their growth. Doxycycline is usually taken once or twice daily, and it’s important to note that it can make the skin more sensitive to sunlight, leading to an increased risk of sunburn.

Minocycline

Minocycline is another tetracycline antibiotic often used in the treatment of acne. Like doxycycline, it hinders bacterial growth by interfering with bacterial protein production. Minocycline is known for its potent anti-inflammatory properties, making it particularly beneficial for treating inflamed acne lesions. It’s usually recommended for patients who do not respond well to doxycycline or other forms of treatment.

While highly effective, these antibiotics should be used under the supervision of a healthcare professional, as prolonged usage of oral antibiotics can lead to antibiotic resistance, reducing their long-term efficacy.

2. Hormonal treatments

Hormonal treatments are another effective method in the arsenal against acne, particularly beneficial for women who experience acne flare-ups in correlation with their menstrual cycle or due to conditions like polycystic ovary syndrome (PCOS)—this class of oral medications works by addressing the hormonal imbalances often at the core of acne development. 

Oral Contraceptives

Oral contraceptives, commonly known as birth control pills, work by regulating hormone levels in the body. They contain estrogen and progestin, which help decrease androgen production, stimulating oil production in the skin. By reducing the production of sebum, oral contraceptives help to prevent acne breakouts. Some common oral contraceptives used for this purpose include ethinylestradiol plus norgestimate, ethinylestradiol plus drospirenone, and ethinylestradiol plus norethindrone. 

Spironolactone

Spironolactone, an anti-androgen medication, blocks the effects of androgens on the skin’s oil glands, hence reducing sebum production. While its primary use is as a heart failure and high blood pressure medication, in lower doses, it’s been found to be effective in treating hormonal acne. It is mainly used in women who show symptoms of androgen excess, like increased hairiness and hormonal acne, especially if other treatments have not worked.

Remember, these hormonal treatments, while effective, require a prescription from a healthcare provider, and their use should be monitored to avoid potential side effects, which can include breast tenderness, weight gain, menstrual irregularities and, in rare cases, blood clots. Before starting these treatments, always discuss the risks and benefits with your healthcare provider.

3. Isotretinoin (Accutane)

Isotretinoin, or Accutane, is a powerful oral medication mainly used to treat severe acne that other treatments have not cured. It is a type of retinoid, a derivative of vitamin A. The drug works by reducing the size and amount of sebum, a type of oil that contributes to acne formation, produced by sebaceous glands in the skin.

By decreasing sebum production, isotretinoin prevents the blockage of pores, the primary cause of acne. It also has anti-inflammatory properties, which help to reduce the redness and swelling associated with acne. Furthermore, isotretinoin can inhibit the growth of acne-causing bacteria by creating a less hospitable environment for its growth. 

Regarding effectiveness, isotretinoin is often considered the ultimate solution for severe cases of acne, especially cystic or nodular acne. It is powerful and has been shown to help clear acne in many cases where other treatments have failed. A course of isotretinoin usually lasts between 16 to 20 weeks, and many patients see significant improvement within this period. 

How long does it take for oral medications to show results?

The duration for noticeable improvement with oral medications for acne can vary considerably, largely depending on the type of medication and the severity of the acne. Generally, it can take anywhere from a few weeks to several months before patients start to see improvements. A more specific timeframe for some common medications is as follows: 

• Antibiotics: Usually, noticeable improvements can be seen within two to three months, though some patients may notice changes as early as a few weeks into treatment.

• Hormonal treatments: The effects of hormonal treatments can take time to come into play. Patients may need to wait two to three months before seeing an improvement.

• Isotretinoin (Accutane): This powerful medication often shows results within four to eight weeks, with many patients experiencing significant improvements within 16 to 20 weeks of treatment. 

What are the potential side effects of oral acne meds?

Oral acne medications, whilst effective, may accompany a few side effects. 

• Antibiotics: Common side effects may include nausea, dizziness, skin discolouration, and increased sensitivity to sun exposure. In such cases, a healthcare professional may recommend patients take their medication with food, avoid direct sunlight, or use a high-SPF sunscreen. 

• Hormonal treatments: Some users may experience breast tenderness, mood swings, weight gain, and irregular menstrual cycles. It’s advisable to seek medical advice if these side effects become troublesome. 

• Isotretinoin: This medication may cause dryness of the skin, lips, and eyes, nosebleeds, and joint and muscle pain. Less common but more serious side effects include headaches, blurry vision, or mood changes. These side effects often subside after completing the course, but it is essential to report any severe or long-lasting side effects to a healthcare professional.

It’s worth noting that these side effects vary from one individual to another, and their manifestation does not necessarily mean one should discontinue their medication. Instead, seeking medical advice would be the best course of action. Always maintain open communication with your healthcare provider throughout your treatment, as adjustments to dosage or medication type can be made if required.

Can oral acne medications be used with other treatments?

Yes, oral acne medications can often be used with other treatments to maximise the effectiveness of acne management. Depending on the type and severity of the acne, as well as the individual’s response to treatment, healthcare professionals may recommend a combination approach. 

For instance, topical treatments (creams, gels, or lotions applied to the skin) containing ingredients like benzoyl peroxide or salicylic acid can be used alongside oral medications to tackle acne from different angles. While oral medications work internally to regulate hormones or reduce inflammation, topical acne treatments also can directly target the skin’s surface, exfoliating the skin, unclogging pores, and reducing acne-causing bacteria.

Simultaneously, in-office treatments such as light therapy or chemical peels might be recommended for certain individuals. Pairing these treatments with oral medications can enhance the overall results, providing complementary effects that can lead to clearer skin. 

Moreover, adjunct treatments like an appropriate skincare regimen or dietary modifications can also be advised with oral medications to improve skin health holistically. 

However, discussing additional treatments with a healthcare provider before combining them with oral medications is essential to avoid potential adverse interactions or side effects. Always follow the advice of a medical professional when it comes to multi-faceted acne treatment.

Are oral acne meds safe during pregnancy?

The safety of oral acne medications during pregnancy is a crucial consideration, as some of these medications might have potential risks or harmful effects on the developing fetus. 

• Antibiotics: Certain antibiotics are considered safe for use during pregnancy, although some types, particularly tetracyclines, are strongly advised against as they can cause tooth discolouration in the developing fetus.

• Hormonal treatments: These medications are generally deemed safe for use during pregnancy but should not be used if pregnancy is suspected or confirmed.

• Isotretinoin (Accutane): Isotretinoin is a potent medication with a high risk of congenital disabilities and miscarriage. Due to these severe risks, isotretinoin is contraindicated in pregnancy and women who are attempting to conceive. 

Upon deciding to attempt conception or upon confirming pregnancy, it is advised to consult with a healthcare professional to discuss acne treatment options. Any medication changes should be done under the guidance of a healthcare professional. Safe alternatives to oral medications include topical treatments that can be used safely during pregnancy. 

When can I stop oral acne medication?

The decision to stop oral acne medications should not be made lightly, and it’s crucial to speak with a healthcare professional before making any changes to your treatment plan. Generally, oral acne medications are discontinued when the desired improvement is achieved, the acne is no longer active, or if a patient experiences severe side effects. However, the timeline for this varies widely between individuals and depends on the type and severity of acne.

Abrupt discontinuation of some oral acne medications without professional guidance could result in acne flaring up again or other potential health implications. Therefore, it’s paramount to consult with a healthcare provider who can guide you on how to gradually decrease the medication dosage while monitoring your skin’s condition. This stepwise reduction helps the body adjust to the change and minimises the risk of acne returning.

In some cases, the healthcare provider may suggest transitioning to other forms of topical treatment, such as topical applications, dietary changes, or lifestyle modifications, to maintain the benefits of the oral medication and prevent the recurrence of acne. The aim is to ensure the most effective long-term skin health management, with personalised advice based on your specific needs and circumstances.

Seek Professional Advice for Acne Treatment

With the myriad of options for acne treatment available, an informed decision must be made. Our seasoned medical professionals at Sozo Clinic are ready to provide personalised advice and guide you through the right treatment plan that suits your needs. Our team’s approach is anchored on a comprehensive understanding of oral acne medication’s impact on your overall health, particularly during crucial times such as pregnancy. Every individual’s health journey is unique; thus, our guidance is tailored to your specific circumstances. 

Conclusion

Acne can be a persistent and challenging condition to deal with, but there are a variety of treatments available, including oral medications. 

However, these treatments are not without potential side effects and interactions, so seeking professional advice before starting or changing your treatment regimen is essential. Combining treatments, such as oral medication with topical treatments or lifestyle adjustments, can often be more effective, but this should always be done under the guidance of a healthcare provider. 

Crucially, suppose you’re pregnant or planning to become pregnant. In that case, discussing your treatment options with your healthcare provider is vital due to the potential risks associated with certain types of oral acne medications. Ultimately, the goal is to find a treatment plan that effectively manages your acne while considering your overall health and well-being.