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Four Common Types of Oral Medications for Treating Acne

There are many ways to treat acne today, such as topical treatments, oral medications, lasers, and other energy-based devices. Topical treatments are the most common form of acne treatment because individuals can usually find them over the counter. But some people may find this solution not effective, especially those with moderate to severe acne. As a result, oral medications are then prescribed to help treat blemishes by killing bacteria or regulating hormone changes that lead to breakouts. Prescription oral medications for acne can only be obtained from doctors. Speak to your doctor for the appropriate dosage and duration based on your symptoms.

What Causes Acne?

Acne is a chronic inflammatory skin condition that causes spots and pimples to appear on the face, neck, chest, back, and shoulders. It occurs when hair follicles or pores become clogged with overactive sebum, dead skin cells, dirt, and trap bacteria under the skin.

It is common for acne to appear during the teenage years due to hormonal changes that occur during puberty. But 54% of women and 40% of men above 25 continue to suffer acne throughout adulthood[1]. Even in their 30s and beyond, acne breakouts can still occur.

The best way to treat acne is early and aggressively, because of the risk of permanent acne scarring and hyperpigmentation which can be tedious and expensive to remove.

Apart from potential scarring, active acne can also affect emotional health. Individuals may feel unattractive, embarrassed, or self-conscious, which may lead to them being socially withdrawn due to emotional distress[2]. Early treatment can prevent these problems as it is a lot easier to manage acne as compared to treating permanent acne scars[3].

Types of Oral Medications for Acne Treatment

Oral medications are one of the ways to treat acne. There are different types of oral medication used. The most common are:

●       Oral Antibiotics

●       Isotretinoin

●       Birth Control Pills

●       Spironolactone

The doctor’s recommendation is important to advise which type of medication is suitable for you, depending on the severity of your acne and your other health conditions.

1. Oral Antibiotics

Antibiotics are the most often used oral medications for treating and relieving moderate and severe inflammatory acne. They work by killing acne-causing bacteria such as Propionibacterium acnes (P.acnes) which contribute to acne formation, and also help reduce redness and inflammation. 

The most common antibiotics prescribed by doctors are the tetracyclines and the macrolides. Tetracyclines are typically preferred over macrolides due to the lower risk of developing drug resistance. However, macrolides are much safer for pregnant women or young children. 

P. acnes has become increasingly resistant to oral antibiotics in recent years[5]. As a result, your aesthetic doctor may also have to prescribe other antibiotics when these are not showing promising results. Other medical-grade treatments should also be used in conjunction with oral or topical medications to reduce acne resistance. There are other side effects associated with antibiotics, including gastric discomfort, nausea, vomiting, and diarrhea, even if they are generally prescribed for short periods of time. 

2. Isotretinoin

An oral medication often prescribed to individuals with severe acne is isotretinoin frequently marketed as Roaccutane, Acnotin or Accutane. It is a vitamin A derivative known as retinoids. Isotretinoin remains an effective prescription treatment when it comes to treating severe acne[4]. It works by shrinking your sebaceous glands resulting in lowering sebum production and preventing acne formation.

While generally considered safe, doctors will require patients to be reviewed regularly, usually, every 30 days, to monitor progress and side effects closely. Too high a dosage of vitamin A can cause hypervitaminosis A which may cause osteoporosis and damage to your liver and kidney. That is why it is necessary to follow your doctor’s advice. 

Isotretinoin is commonly prescribed when acne does not respond to other treatments. Due to the risk of birth defects, isotretinoin is not suitable for pregnant women or women trying to conceive during this medication's duration. Other side effects include skin irritation, dry skin and rashes. 

3. Birth Control Pills

Birth control pills containing estrogen and progestogens help to reduce the effect of androgens, which are hormones responsible for increased sebum production, and prevent acne formation[6]. For women who experience acne breakouts on their lower jawline and chin during the menstrual cycles, hormones are likely the culprit. Hence, oral contraceptives pills are usually prescribed for women to control their hormones.

The birth control pill creates a stable environment for your skin in favour of synthetic estrogens and progestogens. When you stop using them, you experience a disruption in your body's balance. This may result in pimples, skin inflammation, and a noticeable increase in oil production. Although it may be temporary, it may take you months to see your skin return to normal. It is advisable to speak to your doctor before starting oral contraceptives.

Birth control pills are only suitable for women over the age of 14, reached puberty, and started menstruating. Taking birth control pills before starting menstruation can damage your hormones. Other side effects of birth control pills include spotting between periods, nausea, breast tenderness, headaches & migraine, weight gain, mood changes, light or missed periods, and decreased libido.

Another serious complication of birth control pills is developing a blood clot in your heart, lungs, brain, or legs. The risk is increased in women: 

  • Who smokes
  • Aged 35 and older
  • Medical conditions such as high cholesterol, high blood pressure, diabetes, and conditions that increase the risk of blood clotting 
  • Confined to bed rest or wearing a cast   

It is not advisable for people with a history of depression to take birth control, as it may worsen their condition. 

4. Spironolactone

Spironolactone is a diuretic prescription medication that removes fluid from your body through urination[7]. This drug is often used to treat high blood pressure and heart failure. However, it can also be used to treat acne in women.

Androgens cause your skin to produce excess sebum which clogs pores, causing acne. Hence, this medication helps by slowing down your body’s production of androgen hormones such as testosterone, blocking the effects of androgens and progesterones on the skin, reducing sebum production, and preventing acne.

Some side effects of spironolactone include going to the bathroom more often, changes in your menstrual cycle, breast tenderness, headaches, and lower sex drive.

The Key Takeaway

Each person's skin is different, and acne is caused by a variety of factors. An experienced skin doctor will diagnose the root cause of your acne. When choosing a skin doctor to treat your acne, the medical aesthetics clinic should have the full range of topical, oral medications, and other energy-based treatments to offer you information and options on the different types of treatment suitable for your skin type, concerns, and severity of your acne. If over-the-counter solutions do not improve your acne, it is recommended to consult an aesthetic physician early as untreated acne may leave permanent scars which are difficult and costly to treat.