Over-the-counter benzoyl peroxide is a reasonably potent first line acne treatment and is available inexpensively in OTC preparations. It’s a very reasonable first start for treatment.
Prescription medications include:
- Topical vitamin A related medications (tretinoin [available generic and in several brand name formulations], adapalene [Differin®], tazarotene [Tazorac®])
- Topical antibiotics (erythromycin and clindamycin)
- Various oral antibiotics
- Hormonal treatment (birth control pills, for women)
- Oral isotretinoin
For patients with relatively mild acne, a topical vitamin A medication with a topical antibiotic can be used. Bacteria can become resistant to antibiotics, but combined use with a benzoyl peroxide product helps prevent resistant organisms from developing. This topical approach is the foundation of treatment.
For more severe acne, oral antibiotics are used, possibly with birth control pills for women.
Because combining multiple treatments makes using the medications complicated for patients, combination drugs that combine multiple agents may simplify the treatment (Epiduo®, Ziana®, Benzamycin®, Benzaclin®, Duac®).
For patients with severe, scarring acne that is unresponsive to these treatments, oral isotretinoin is often like a miracle. Unfortunately, it has many side effects, the worst of which are severe teratogenicity (causing birth defects) and depression.”