Oral Medications for the Treatment of Acne

The global prevalence of acne is estimated to be 9.4% in the general population. However, its prevalence can reach as high as 83–95% in adolescents. This article reviews the oral treatments used in the treatment of acne.

Key takeaways:
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    Cutibacterium acnes is a type of bacteria that plays an important role in the formation of acne.
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    Oral medications can be used to treat moderate-to-severe acne or acne that does not respond to topical therapies.
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    The use of antibiotics should only be used for a maximum of 6 months and in conjunction with a topical medication.
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    Isotretinoin can produce significant birth defects and should only be used in conjunction with methods to prevent pregnancy when used in women.
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    Talk with your doctor to determine if oral medications are right for you.

Causes of acne

Acne is caused by an inflammatory reaction within the pilosebaceous unit, which consists of the hair, hair follicle, and sebaceous gland. During puberty, the increase in hormones results in the increased production of sebum (an oily substance) by the sebaceous gland. The flow of sebum to the surface of the skin can become obstructed and result in the formation of a pimple.

In addition, the bacteria, Cutibacterium acnes, commonly present on the skin also plays an important role in the formation of acne. This bacteria produces an inflammatory response that leads to the formation of acne. In severe cases, it can lead to the formation of pustules, cysts/abscesses, and nodules.

Treatment options for acne

Proper skin hygiene can help to reduce the formation of acne. Using gentle skin cleansers and avoiding aggressive scrubbing of the skin is typically advised. Soap-free cleansers, oil-free moisturizers, and sunscreen are important components to good skin care.

Topical medications are considered the first-line treatment option in patients with acne. These typically consist of various agents that have anti-microbial and anti-inflammatory actions.

Oral medications are considered in patients that do not respond to topical treatment and in cases with inflammatory lesions such as pustules, abscesses, and nodular lesions. Below is an in-depth review of the oral options typically used in the treatment of acne.

Oral medications for acne

Antibiotics

These should be used with a topical agent such as benzoyl peroxide and for no longer than 6 months.

  • Tetracyclines are the most common class of antibiotics used for acne and include doxycycline, minocycline, and sarecycline. They are often given once to twice a day and should be taken on an empty stomach. Side effects include nausea, vomiting, sensitivity to the sun, C. difficile colitis, and a lupus-like syndrome.

Pregnant women, breastfeeding women, and children under 8 years of age should not use tetracyclines due to adverse effects on the fetus and the development of teeth in young kids.

  • Macrolides such as azithromycin and erythromycin can be used if you have a contraindication to the use of tetracyclines. Azithromycin can be used as a once to three times a week medication while erythromycin is often taken twice a day. Gastrointestinal side effects are the most common such as nausea, vomiting, and diarrhea.
  • Cephalexin and trimethoprim-sulfamethoxazole are last-line agents and should only be used if you can not tolerate the options listed above.

Isotretinoin

This medication is very effective in the treatment of severe acne. However, its side effects prevent it from being used routinely. These include vomiting, muscle pain, sensitivity to the sun, hair loss, elevated triglycerides, and low blood cell counts.

This medication can cause significant birth defects and should not be used in pregnant women. Prior to starting the medication, a negative pregnancy test must be documented and proper contraception should be used. It is not advised to attempt to get pregnant until you are off the medication for at least one month.

Hormonal therapy

Oral contraceptives can be used by women over the age of 15 to help control certain types of acne. The oral contraceptive must contain estrogen derivatives to be effective. The side effects include headache, nausea, bloating, high blood pressure, and blood clots.

Spironolactone

This medication blocks and reduces the effects of androgens (testosterone) in the body which reduces sebum production and can improve acne. This should only be used in females and is typically taken once to twice daily. Side effects include menstrual irregularities, breast tenderness/enlargement, vomiting, diarrhea, and elevated potassium levels.

This should not be used in pregnant women or in women attempting to become pregnant as it is dangerous to the developing fetus.

Corticosteroids

These medications include prednisone and methylprednisolone and work to reduce inflammation. They can be effective in the treatment of severe inflammatory acne. The side effects include weight gain, depression, high blood pressure, elevated blood glucose levels, and suppression of cortisol production by the body.

Choosing the best oral medication for you

When choosing the right oral medication there are a few factors that must be considered. The type of acne and the severity of acne is important in choosing an effective therapy. Also, factors such as pregnancy, age, and gender play an important role in selecting the best medication to treat your acne.

It is essential to have a discussion with your doctor to determine the best medication for you. Many of these medications have serious side effects and should be taken only under the direction of a physician.

The treatment of acne can involve many different therapy options including topical and oral medications. Oral medications can be very effective in certain types of acne but come with side effects that require monitoring. Also, consult your physician before starting any medication and help choose the best medication to treat your type of acne.

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