Medically reviewed by Patrick Carroll, MD
Written by Our Editorial Team
Last updated 2/24/2020
Dealing with acne can be a stressful, challenging experience. Most people develop acne in their teens, usually due to a combination of excess skin sebum (an oily substance that protects your skin from moisture, bacteria and fungus) and inflammation of the skin and hair follicles.
While most people’s acne disappears on its own over time, many people experience persistent, problematic acne that can stick around for years at a time. For some of these people, prescription acne medication is the most viable answer.
Some people even develop cystic acne — painful, red acne breakouts that are caused by infected and inflamed pores.
There are numerous acne treatments on the market, ranging from over-the-counter creams and facial washes, to powerful prescription medicine aimed at controlling the development of acne at its source.
Most of the time, doctors will suggest prescription acne medication to treat severe or persistent cases of acne, where over-the-counter products like skin creams, facial washes and gels simply aren’t effective.
Below, we’ve listed and compared the most widely used prescription acne medicines on the market. We’ve also explained the potential benefits and side effects of today’s most popular prescription acne medications to help you better understand how each treatment works.
While over-the-counter acne medication (like Clearasil® and Proactiv®) are effective at managing minor outbreaks of facial acne, many people experience persistent acne that just doesn’t go away with regular, store-bought treatments.
Up to 50 million people in the United States are affected by acne annually, ranging from mild breakouts to severe cystic acne.
Over the last few years, there’s also been a rise in the number of adults seeking treatment for acne — often acne that developed specifically in their adult years, rather than originally forming while they were in adolescence.
Prescription acne medication (like tretinoin and isotretinoin, both of which are covered in more detail below) offer a stronger level of acne treatment than store-bought products, making them essential for many people with persistent, cystic or other severe cases of acne.
Acne can occur for a variety of reasons, ranging from skin bacteria to excessive levels of sebum production. Because of this, there are several different types of prescription drugs used to treat acne. And for each of those specific drug types, there are specific drugs that fall under them.
Retinoids are some of the most widely used prescription medications for treating and preventing acne. They’re available as both topical (tretinoin) and oral (isotretinoin) drugs, with both options offering a significant level of long-term skin improvement.
Tretinoin is a topical retinoid that’s available as a cream, gel or solution. Approved by the FDA in 1971, tretinoin is one of the most widely used and effective topical treatments for acne, including outbreaks of inflamed and cystic acne.
Our Tretinoin 101 guide covers tretinoin in detail, from the drug’s development and mechanism of action to its benefits as an acne and anti-aging treatment.
In the United States, tretinoin is a prescription medication for severe acne. It’s sold in a variety of strengths, which are prescribed specifically to patients with different skin types. The most common brand names for tretinoin include Retin-A®, Refissa® and Renova®.
There are numerous studies showing tretinoin’s benefits as an acne treatment. In a 2009 study, people given tretinoin for 12 weeks showed significant improvement in facial acne than people given a non-therapeutic placebo over the same period.
Another study from 2015 produced similar results. Acne patients were split into three groups and given either a mix of benzoyl peroxide and clindamycin, a mix of tretinoin and clindamycin or a mix of benzoyl peroxide and nadifloxacin.
The tretinoin/clindamycin group, which received a gel that was 0.025 percent tretinoin and one percent clindamycin, showed drastic improvement, going from an acne level of 13.70 ± 4.80 to 1.30 ± 2.95 after 12 weeks of consistent tretinoin use.
Tretinoin usually produces measurable results within 12 weeks (however, it should be noted that seeing noticeable results can take months), with a reduction in acne and an improvement in skin quality. However, it can often cause a temporary increase in acne and skin dryness during the first few weeks of treatment; a time period called the tretinoin "purge."
Because tretinoin is a topical medication, it has few systemic side effects and is only associated with minor common skin side effects. Overall, it’s a safe and effective medication that gets rid of acne for the long term without the side effect of stronger oral anti-acne medications.
Isotretinoin is an oral retinoid that treats and prevents acne. Oral isotretinoin is usually viewed as the most powerful acne medication for severe acne on the market and is typically used to treat only the most persistent cases of acne that don’t respond to other treatments.
Dermatologists usually recommend isotretinoin for cystic acne and other severe acne that can cause permanent scarring. Most people know of isotretinoin under the brand name Accutane®.
Like tretinoin, isotretinoin usually produces a noticeable reduction in acne within several weeks of use. And like tretinoin, in some cases, isotretinoin can lead to a temporary increase in acne and dry skin for the first few weeks of treatment. This usually goes away within a few months of regular use.
Overall, isotretinoin is highly effective.
A retrospective study of isotretinoin users showed that more than 95 percent of users experienced excellent, good or fair results from the medication over a period of one to 12 months, with only 5.6 percent of study participants experiencing a relapse after the treatment.
However, one downside of isotretinoin is its side effect profile. In the study linked above, 56 percent of participants experienced some degree of side effects, with around seven percent of patients discontinuing the drug completely due to significant side effects.
Additionally, isotretinoin can cause serious birth defects and therefore should not be used by pregnant women or while breastfeeding. Women of child-bearing age need to be careful about when they use isotretinoin if they intend to get pregnant.
In short, isotretinoin is a powerful and highly effective acne treatment that’s usually reserved for severe cases of acne due to its side effects.
While isotretinoin works extremely well for preventing acne, its larger and more severe range of side effects make it a treatment option that’s usually reserved only for persistent cases of acne that don’t go away with tretinoin or other topical treatments.
Because antibiotics reduce the amount of bacteria in hair follicles and skin, they’re widely used in the treatment and management of acne.
A range of different antibiotics are used to treat acne. Antibiotics tend to be prescribed for short periods — often in combination with a topical retinoid or other acne medicine — as long-term use of antibiotics can lead to antibiotic resistance.
Like all prescription medications, antibiotics can cause side effects. People that use antibiotics for acne commonly experience things like photosensitivity, gastrointestinal issues and, in rarer cases, allergies in people sensitive to certain antibiotic medications.
Tetracycline antibiotics, such as doxycycline, minocycline and lymecycline, are frequently used as treatments for acne.
Of the tetracycline antibiotics, doxycycline is the most commonly used for acne. Doxycycline is usually prescribed to treat inflammatory acne — a form of acne that results in red, inflamed skin blemishes that can be nodular (large, deep pimples) or cystic (large and severely inflamed).
Doxycycline is almost always used with a retinoid or other topical prescription acne medication, such as benzoyl peroxide. When used daily, it works quickly and effectively to stop inflammation and bacteria, helping you deal with outbreaks of acne and prevent them from coming back.
An oral antibiotic, erythromycin is also used primarily to treat cases of inflammatory acne. As with doxycycline and other antibiotics, erythromycin works by killing the bacteria that can worsen acne and cause skin inflammation.
Trimethoprim is another widely used antibiotic for treating acne. Studies have shown that regular use of trimethoprim in combination with one percent clindamycin lotion results in “significant improvements” in facial and body acne over the course of eight months of treatment.
In addition to oral antibiotics, some dermatologists prescribe topical antibiotic creams and gels for treating and preventing acne. Topical antibiotics have fewer potential side effects than oral antibiotics and are usually prescribed for less severe and persistent cases of acne.
Some of the most frequently prescribed topical antibiotics for treating acne include clindamycin and erythromycin. Topical antibiotics are often used as an alternative to oral antibiotics in young children due to their less extensive side effect profile when compared to oral acne medication.
Women with acne can also use hormonal birth control as a treatment option. Right now, three birth control pills are approved by the FDA for treating acne in the United States — Estrostep®, Ortho Tri-Cyclen® and YAZ®.
All of these pills contain a combination of estrogen and synthetic progestins, meaning they’re only suitable for use by women.
In addition to prescription medications, doctors often recommend the use of over-the-counter acne medication.
Some of the most common over-the-counter acne medications include adapalene, which is a topical retinoid similar to — but less powerful than — tretinoin, and retinol, which is widely used in over-the-counter cosmetic products and skin ointments.
Our guide to tretinoin and over-the-counter acne products explains how many non-prescription acne treatments work, as well as their effectiveness compared to prescription medications like tretinoin.
Acne can vary hugely in severity and difficulty of treatment, meaning that the right solution for you could be completely different to the right solution for another person.
Because of this, there’s no “best” acne medication for everyone. If you have persistent or severe acne that doesn’t seem to respond to over-the-counter acne medication, the best approach is to talk to your doctor or schedule an appointment with a qualified dermatologist.
The right doctor will be able to check your acne and recommend a suitable treatment based on your symptoms and previous experiences with acne medication. They may prescribe a topical or oral retinoid, an antibiotic, an over-the-counter cream or a combination of several products.
By following your doctor’s instructions and regularly using your acne medication, you’ll be able to significantly reduce the severity of your acne, improve your skin and prevent future outbreaks over the long term.
Would you like to learn more about the acne medications listed above? Our Tretinoin 101 guide covers everything you need to know about tretinoin, one of the most widely used topical retinoid medications for treating and preventing acne.