“If topical treatment alone does not improve acne, or if acne is severe or extensive, oral medications are the best option. If you’ve tried several topical medications without success, or if your condition is severe, oral acne medications are usually the next step in the treatment process. Treatment usually includes oral antibiotics and applying a prescription gel or topical cream to the skin. Depending on people with acne, treatment may include using prescription creams to prevent acne, taking antibiotics to kill bacteria that contribute to acne, or, if acne is severe, taking stronger medications such as like isotretinoin, or even minor surgery. Even if you have tried topical acne treatments such as creams or gels without any lasting results, laser therapy may be the right solution for you. While I would like you to try natural remedies first, if you are not seeing improvement and severe hormonal acne is making your quality of life worse, other treatments can make a real difference. While it may take a while, treating hormonal acne from the inside out until your hormones are in their natural, happy balance will allow your skin to truly heal.

While my approach isn’t an instant solution, and won’t replace everyone’s multi-drug regimen, hormonal acne can be very sensitive to a more holistic approach, which means less medication and more patches. While the studio treatments offered by Carolina Skin Care can be very effective in treating acne, patients should also commit to taking care of their skin at home. Multiple topical treatments, whether it’s steroids for eczema or topical antibiotics for acne, topical treatments may help in the short term, but in the long run, it can damage the skin, making you more likely to take it in the future. In addition to other treatments, you can take the most obvious step to soothe stress-related acne: reduce stress. If the creams and antibiotics you have been prescribed are not working, or if you cannot tolerate the side effects that medications may cause, you may want to consider acne treatments, which can be provided at your doctor’s office. Other treatments include birth control pills to control acne, hormonal drainage and extraction, and laser and phototherapy.”

1. Acne Tablets (Oral Medications)

Oral medications are often prescribed for moderate to severe acne or when topical treatments alone aren’t sufficient.

• Antibiotics: Oral antibiotics like doxycycline and minocycline are commonly prescribed to reduce inflammation and kill bacteria on the skin (e.g., Zaenglein, A. L. et al., 2016). These are typically used for moderate acne but may cause side effects such as gastrointestinal issues or sun sensitivity.
• Isotretinoin (Accutane): Isotretinoin is a powerful oral medication that reduces sebaceous gland activity, preventing clogged pores and reducing inflammation. It is usually prescribed for severe cystic acne or acne that hasn’t responded to other treatments. It has significant side effects and requires monitoring (e.g., Koo, J. et al., 2009). Common side effects include dry skin, lips, and potential birth defects, so strict precautions need to be followed during treatment.
• Hormonal Treatments: For females with acne linked to hormonal fluctuations (e.g., pre-menstrual acne or polycystic ovary syndrome), hormonal treatments like birth control pills or spironolactone (an anti-androgen) are often effective. Spironolactone works by blocking the effects of androgens (male hormones), which can reduce sebum production and improve acne (e.g., McClain, M. et al., 2015). Birth control pills, particularly those with both estrogen and progesterone, are effective at regulating hormones.

References:

• Zaenglein, A. L., et al. (2016). Guidelines of care for acne vulgaris management. Journal of the American Academy of Dermatology, 74(5), 945-973.e33.
• Koo, J., et al. (2009). Isotretinoin treatment for acne: A review of the current literature. Journal of the American Academy of Dermatology, 60(3), 547-553.
• McClain, M. T., et al. (2015). The role of hormonal therapy in the treatment of acne in women. Journal of Drugs in Dermatology, 14(6), 636-642.

2. Pustules (Inflamed Pimples)

Pustules are a type of inflamed acne lesion filled with pus. These occur when the walls of the pore break, causing bacteria and oil to spread and create an inflammatory response.

• Benzoyl Peroxide: A widely used topical treatment that kills acne-causing bacteria (Propionibacterium acnes) and helps reduce inflammation. It can be used as a gel or cream. A 2.5% concentration is often effective with fewer side effects than higher concentrations (Zaenglein, A. L., et al., 2016).
• Salicylic Acid: This beta-hydroxy acid (BHA) exfoliates the skin, helping to prevent clogged pores. It’s particularly useful for mild acne and can help with the inflammation in pustules. It also has anti-inflammatory properties (Bowe, W. P., & Shalita, A. R., 2008).
• Topical Retinoids (e.g., Adapalene): Retinoids, like adapalene, encourage cell turnover, preventing pores from becoming clogged. They also have anti-inflammatory effects, which can help with pustules and overall acne inflammation (Elias, P. M., et al., 2016).

References:

• Bowe, W. P., & Shalita, A. R. (2008). The role of topical retinoids in the management of acne vulgaris: A comprehensive review. American Journal of Clinical Dermatology, 9(2), 81-87.
• Elias, P. M., et al. (2016). Topical retinoids: Mechanisms of action in acne. Journal of Drugs in Dermatology, 15(7), 818-824.

3. Blackheads (Comedones)

Blackheads form when a pore becomes clogged with oil, dead skin cells, and debris. The exposure to air causes the trapped material to oxidize and turn dark. Treatments for blackheads focus on preventing clogging and clearing the pores.

• Salicylic Acid: This BHA penetrates the pore lining to dissolve the oils that cause blockages. It’s one of the most effective treatments for blackheads and is often included in cleansers and toners (Zouboulis, C. C., et al., 2009).
• Retinoids (Adapalene): As with pustules, retinoids are useful for clearing blackheads by promoting cell turnover and preventing clogged pores. Retinoids are available both over-the-counter and in stronger prescription forms (Zaenglein, A. L., et al., 2016).
• Clay Masks: Clay-based masks, like those containing bentonite or kaolin, are known for absorbing excess oils from the skin, making them useful for people with oily, blackhead-prone skin (Zouboulis, C. C., et al., 2009).
• Comedone Extractors: These are tools designed to remove blackheads mechanically. While they can be effective, they should be used with caution to avoid scarring or irritation.

References:

• Zouboulis, C. C., et al. (2009). Acne vulgaris and the sebaceous gland. Clinics in Dermatology, 27(1), 5-12.
• Zaenglein, A. L., et al. (2016). Guidelines of care for acne vulgaris management. Journal of the American Academy of Dermatology, 74(5), 945-973.e33.

General Skincare Tips:

• Gentle Cleansing: Wash your face twice daily with a gentle, non-comedogenic cleanser to avoid irritating the skin. Harsh scrubbing or over-cleansing can worsen acne.
• Moisturizing: Even oily skin needs hydration. Look for non-comedogenic (won’t clog pores) moisturizers that are lightweight and oil-free. Moisturizers that contain glycerin or hyaluronic acid are good options (Michaels, J. R., & Menter, A., 2013).
• Sunscreen: Acne treatments like retinoids or benzoyl peroxide can increase sun sensitivity, so it’s important to wear a broad-spectrum SPF 30 or higher daily (Zaenglein, A. L., et al., 2016).

References:

• Michaels, J. R., & Menter, A. (2013). Acne management in adults: A comprehensive review. Journal of Clinical and Aesthetic Dermatology, 6(11), 29-39.