Oral Acne Medicine

Acne forms when sebum and skin cells get stuck in the pores. Normally, the sebum produced by the sebaceous glands is discharged onto the skin, but sometimes a plug of skin cells and oil will form in the pore. From here, bacteria begins to breed in the clogged pore, causing inflammation and tenderness. Acne medications address various causes of acne, including inflammation, oil production, bacterial growth and androgen production. Treatment of acne may involve multiple medications, both topical and oral.

Antibiotics not only kill a common acne-causing bacteria, (P. acnes), but they also have anti-inflammatory properties. Antibiotics used for the treatment of acne are usually in the tetracycline group, which includes minocycline and doxycycline, or trimethropim/sulfamethoxazole, which includes Bactrim and Septra. Though these medications are still effective, the P. acnes bacteria is becoming resistant to some antibiotics; erythromycin is rarely used for this reason. Antibiotics are usually used in conjunction with a topical treatment, often containing benzoyl peroxide.

Androgens can cause or exacerbate acne, and there are some medications that address this. Oral contraceptives such as Ortho-Tricyclin can help clear skin, but these medications are only available to women. Spironolactone, a mild diuretic, also has anti-androgen effects, and can be used by men or women.

Isotretinoin, or Accutane is a very effective treatment for severe acne. Derived from Vitamin A, this medication decreases sebum production, is anti-inflammatory and reduces P. acnes. It is sometimes initially given with steroids, as acne may worsen at the beginning of treatment. However, there are risks associated with Accutane. It can cause birth defects, so women must be on a reliable form of birth control. Depression, mood swings and suicidal ideation have been noted in some patients, particularly adolescents and those with a history of depression or mental illness. Finally, Accutane can alter the healing process, so surgeries and cosmetic procedures, such as microdermabrasion, tattoos, piercing and even leg waxing, should not be attempted during treatment.

Laboratory tests are common before and during therapy with oral acne medications. Electrolytes are monitored when on spironolactone, and complete blood counts are ordered periodically when the patient is taking trimethoprim/sulfamethoxazole. Tests of antibody levels and liver enzymes are often performed on patients who will likely be on minocycline for over a year. Patients on Accutane are tested monthly for cholesterol and triglyceride levels, liver enzymes and complete blood counts. Pregnancy testing is done twice before the start of therapy with Accutane, and monthly thereafter.