• Benzoyl peroxide: While some benzoyl peroxide preparations may be found over the counter, prescription-strength preparations are sometimes more effective. Benzoyl peroxide works by releasing free oxygen radicals that oxidize bacteria thereby killing the bacteria that cause acne. It is effective both alone and in combination with other topical medications. To date, bacterial resistance of P. acnes (the bacteria that cause acne) to benzoyl peroxide has not been reported. Benzoyl peroxide comes in many formulations: lotions, washes, gels, foams, creams, and pads. It can cause bleaching when it comes in contact with clothing or towels. 
• Topical retinoids: These are vitamin A derivatives that help the skin turn over more quickly, resulting in the unclogging of pores and follicles, reducing the numbers of comedones and inflammatory lesions. They include Differin (adapalene), Retin-A and Atralin (tretinoin), and Tazorac (tazarotene). Skin irritation, dryness, redness, and peeling can sometimes be seen during the initial weeks of use. Washing your face with a mild cleanser and limiting the use of other drying agents can help minimize these effects. If the irritation persists, using the topical retinoids every other day or every third day can also be helpful. Sun sensitivity may be increased while on these medications 
• Topical antibiotics: Topical antibiotics are effective against P. acnes and also help reduce the inflammation associated with acne. The most common agents include topical clindamycin and topical erythromycin. These are sometimes combined with benzoyl peroxide (as seen with Benzaclin, Duac, and Benzamycin) to reduce the possibility of bacterial resistance. 
• Sulfur-based medications: Sulfur is thought to help acne through its antibacterial and keratolytic properties. It helps the skin turn over, resulting in fewer clogged pores and follicles. It is believed that when sulfur reacts with cysteine in the skin, it produces hydrogen sulfide which helps break down keratin. It also produces pentathonic acid, an agent that is toxic to fungus and inhibits P. acnes. Sulfur-based medications are most commonly seen in combination with sodium sulfacetamide, as seen in Plexion, Clenia, Avar, and Ovace. 

• Oral antibiotics: Antibiotics by mouth are one of the most common medications used to treat acne. Antibiotics improve acne via their ability to reduce inflammation as well as their effectiveness against P. acnes. The most commonly used group of antibiotics used in the treatment of acne is the tetracycline family. Of these, doxycycline and minocycline are the most effective. Minocycline is often considered to be more effective than doxycycline because of less resistance to P. acnes. Using antibiotics with benzoyl peroxide may reduce the possibility of resistance. Other antibiotic classes are used less commonly and include trimethoprim with sulfamethoxazole, azithromycin, and ampicillin. 
• Hormonal therapies: Since acne is often influenced by hormones, it makes sense that medications that target hormones can be effective to treat acne. Birth control pills can regulate some of the hormonal surges that worsen acne, and they can be effective for many patients, particularly those with cyclical flares. Typically a gynecologist will review your risk factors and prescribe an appropriate birth control pill. Spironolactone is another hormonal therapy. While this medication is not technically FDA-approved to treat acne, it has been used “off-label” for years. It can be very effective in patients who have failed numerous other therapies. This medication may not be for everyone, and if you have a personal or strong family history of breast, ovarian, or uterine cancer it may not be right for you (see the black box warning associated with spironolactone here). 
• Oral retinoids: Isotretinoin (Accutane, Sotret, Claravis) is highly effective in the treatment of nodulocystic acne and refractory acne vulgaris. If you haven’t responded to any other therapy for acne, if you are starting to develop deep, pitted scars, or if you have painful acne lesions, Dr. Jogi may talk to you about the risks and benefits of isotretinoin. It works by shrinking oil glands and decreasing their output, resulting in decreased oil production. Its effects have the potential to last long after the typical 5-6 month course of therapy. Because of the potential for side effects including, most importantly, birth defects if taken during pregnancy, only a licensed physician who is very familiar and comfortable with isotretinoin may prescribe the drug.  If done safely, it can be a very safe and effective means of combating your acne.

If you would like Dr. Reena Jogi, board-certified dermatologist in Houston, Texas to evaluate and treat your acne, please call 281.558.3376 to schedule a consultation, or click here to register online as a new patient.