Acne Prescription Medication

Isotretinoin comes with severe and potentially lifelong side effects, and is only approved for use in people with severe and scarring that does not respond to other treatments. However, because of its effectiveness, doctors sometimes controversially prescribe it for milder as well.

Be Your Own Advocate: To avoid a medication merry-go-round, do your own research in order to understand your options. Don’t simply accept any prescription your doctor advises. Arm yourself with knowledge on the available options, and ask questions. And make sure you are speaking to a dermatologist who is an expert in .

Several studies have looked into the question of which prescriptions are most common for . The most recent data comes from a 2014 study that included data from approximately 31 million patient-visits between 2005 and 2010. Here are the top 10 most commonly prescribed medications:

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In this article, we will discuss in more detail the top four most commonly prescribed medications, and then consider changes that have occurred over the years in prescribing practices.

Despite providing only moderate benefit to , tretinoin is the single most frequently prescribed medication. Various treatment guidelines, such as those recommended by the American Academy of Dermatology, consider topical (applied to the skin) retinoids, such as tretinoin, to be the preferred treatment for , except in severe cases. Many guidelines continue to recommend topical retinoids as the first choice of treatment for mild-to-moderate .However, it should be noted that since retinoids like tretinoin only produce partial clearing of , they are almost always prescribed alongside other treatments.

, states, “Retinoids are the core of topical therapy for because they [open clogged pores], resolve the precursor microcomedone lesion, and are antiinflammatory. These agents enhance any topical regimen and allow for maintenance of clearance after discontinuation of oral therapy. Retinoids are ideal for comedonal and, when used in combination with other agents, for all variants.”

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Notes, “Preclinical data suggest that topical retinoids and retinoid analogs may also have direct anti-inflammatory effects. A wealth of clinical data confirms that topical retinoids and retinoid analogs significantly reduce inflammatory lesions.”

Despite the fact that dermatologists consider topical retinoids to be the preferred therapy for , and the fact that guidelines have recommended since 2003 that all patients who have mild to moderate be treated with a topical retinoid, a 2013 study in the

Found that doctors prescribed topical retinoids only to 40% of patients. This study found also that doctors were more likely to prescribe a topical retinoid to young patients and also to female patients, regardless of their age. The authors noted, “Based on the strong clinical evidence, management guidelines have recommended since 2003 that almost all patients should be treated with a topical retinoid except for those with the most severe cases. Nevertheless, according to our findings from the most recent data available, the frequency of topical retinoid use for vulgaris remains low.”

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Isotretinoin, often known by its brand name Accutane®, is the second-most prescribed medication. It is a highly effective oral medication which typically is only approved for the most severe cases of . Patients take isotretinoin usually for 15 – 20 weeks, and in that time it successfully shrinks skin oil glands, usually permanently. Because of its long-lasting effects, it can offer long-term relief from symptoms in the majority of people who take an adequate dosage. In 14.6 to 52% of people, returns to some degree after isotretinoin treatment, but often the that comes back is less severe than before treatment.

Because of isotretinoin’s effectiveness, doctors increasingly prescribe it for mild-to-moderate as well. This practice is highly controversial because isotretinoin is such a powerful medication that it can cause severe birth defects if a patient takes it when pregnant. It also can cause severe, sometimes long-term, side effects. The FDA (U.S. Food and Drug Administration) recommends isotretinoin only for severe nodular .

The combination of clindamycin and benzoyl peroxide, either as a single product that combines both substances (one popular brand name is BenzaClin

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) or as two separate products, is the third-most frequently prescribed medication. Previously it had ranked lower on the list of medications prescribed for . However, doctors prescribe it more frequently now because recent evidence has shown that combination treatment is more effective than either clindamycin or benzoyl peroxide alone.

Clindamycin, also known as clindamycin phosphate, is an antibiotic and is prescribed in its topical form to reduce skin inflammation. However, current guidelines recommend that topical antibiotics not be used alone and that they be used only for a maximum of three months. The reason for these restrictions is that bacteria can become resistant to antibiotics over time. It should also be noted that clindamycin does not work for everyone.

Benzoyl peroxide is a mainstay of treatment and works by quickly and almost completely killing bacteria as well as drying the skin and shedding skin cells, thus keeping pores from becoming clogged. It is available by prescription as well as over-the-counter, in up to 10% strength. One benefit of benzoyl peroxide is that bacteria cannot become resistant to it.

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Minocycline is the fourth-most commonly prescribed medication. It is an oral antibiotic that belongs to the class of antibiotics known as tetracyclines, which are the most widely prescribed oral antibiotics for because of their effectiveness against bacteria and their anti-inflammatory effects. As with topical antibiotics, oral antibiotics should be used for a maximum of three months, and do not work for everyone. When they do work, they only provide moderate benefit, and can come with many side effects, particularly gastrointestinal discomfort.

Other oral tetracycline antibiotics exist (such as doxycycline and tetracycline), but minocycline is prescribed more often because, as is discussed in the following 2011 article in

, it mayaccumulate more inthe skin, providing for better -killing properties and lowered risk of creating resistant bacteria. In addition, it may be better absorbed in the gut and have less food interactions compared with other oral tetracyclines. On a downside, it comes with more side effects, so doctors often prescribe the extended-release form of minocycline to reduce these unwanted effects.

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A 2011 article in The Journal of Clinical and Aesthetic Dermatology found that minocycline accumulated in skin tissue in significantly greater amounts than did other tetracyclines. It also noted that in a six-week study comparing minocycline to other tetracyclines, minocycline decreased bacterialevels 10 times more than did the other tetracyclines, the reduction in bacteria persisting three weeks after the course of treatment. These results may be due to minocycline’s enhanced ability to penetrate skin tissue, thereby reducing the development of resistant bacteria. The authors noted, “Minocycline treatment may have an advantage compared with tetracycline or doxycycline because enhanced tissue penetration may be accompanied by a lower incidence of emergence of resistant [ bacteria] strains.”

The same article described another study that tested antibiotic resistance in 73 strains of bacteria.Compared to other antibiotics, minocycline was the only one that effectively targeted all 73 strains. This result demonstrates that minocycline is effective against most antibiotic-resistant strains of bacteria, which increases its viability.

Prescribing practices for the top 10 most frequently prescribed medications have changed. A comparison of data from the National Ambulatory Medical Care Survey database for the date ranges, 1989 – 2009, 2007 – 2009, and 2005 – 2010, shows us several trends:

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Daniel Kern is the Chief Scientific Officer at . This article is the result of Dan's collaboration with 's team of doctors and medical writers.Me Being Me, brought to you by ® (trifarotene) Cream, 0.005%: Don’t let acne breakouts affect the vibe you project, whether you’re video chatting for work or play.

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Cream is a prescription retinoid indicated for the topical treatment of acne vulgaris in patients 9 years of age and older.

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Yes, the FDA has approved Cream as a prescription acne medication in 2019. Trifarotene, the active ingredient in Cream, is the first new retinoid molecule to receive FDA approval for the treatment of acne in more than 20 years.

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In clinical trials,