Teenage Acne Prescription Treatments and Their Side Effects

Not every treatment that claims to cure acne actually keeps its promises.  Most teen acne sufferers (and their parents!) have experienced the disappointment of products that fail to deliver, and this can, of course, be heartbreaking.  Not only do many remedies fail to work, they can also be very damaging to the skin and sometimes even the rest of the body. Most prescription acne treatments fall into four groups namely: 

• Normalizing- the medication is shed into the pore to minimize blockages.
• Killing- P. acnes bacteria is targeted and killed.
• Anti-inflammatory- inflammation is reduced and/or prevented.
• Hormonal alteration/manipulation.
• Often a number of prescription treatments are combined so that the acne may be reduced as much as possible.  Unfortunately successful prescription acne treatment is also often the most damaging in terms of side-effects.  Treatments with many side-effects need to be well-monitored by your doctor.  In general most treatments that do work, take time to do so.  It may take about three weeks to show improvement and then over the next three months, the skin should improve until it reaches a point where the changes begin to level out.  Cortisone may show quick improvements in active spots. Your doctor may prescribe: 

Topical Antibiotics

Erythromycin, clindamycin, stiemycin or tetracycline is applied to the skin to kill the bacteria within the blocked follicles. Using the drug on the skin rather than taking it by mouth means that possible side-effects including upset stomach and drug interactions can be avoided.  The topical treatment is as effective as the tablet form but may be impractical if it has to be used over large areas. 

Oral Antibiotics

These are erythromycin or tetracycline antibiotics taken by mouth.  Tetracycline, the better absorbed oxytetracycline, or doxycycline, minocycline or lymecycline are commonly used. The drug kills the P. acnes bacteria but has no effect on oil secretion and abnormal cell behavior that is the real cause of follicle blockage.  Antibiotics have become less effective as resistant bacteria are becoming more and more common.  Once treatment ends acne often reappears. Sub-antimicrobial doses of antibiotics such as minocycline do not kill bacteria and hence cannot induce resistance.  Such dosages may be more effective.   

Hormonal Treatments

In women, acne may be treated by means of hormonal treatments. Combined oestrogen/progestogen methods of hormonal contraception have a positive effect on acne; and cyproterone, in combination with an oral contraceptive containing the progestin drospirenone is effective.  They can be used if the patient is shown to have very high androgen levels but also work where this is not the case.  Low dose spironolactone can be used together with the treatment for its anti-androgenetic properties- where patients have polycystic ovarian syndrome. 

Cortisone Injections

A dermatologist may choose to inject cortisone directly into a larger pimple or pustule.  This will cause it to appear less red and inflamed. The pimple will lie flatter against the skin and make it less noticeable or easier to cover up.  It also helps the skin to heal.  The skin may become white in color for a short while and a small depression may form, but it is less risky than surgical removal of larger spots.   

Topical Retinoids

Topical retinoids such as tretinoin or “Retin-A” work by normalizing the follicle cell lifecycle.  Adapalene (Differin) and tazarotene (Tazorac) are related to vitamin A, but applied as topical creams and have milder side-effects. These side-effects can still be very significant and severe irritation can occur.   Retinoids prevent hyperkeratinization of follicle cells that can create a blockage. Topical retinoids cause an initial flare up of acne and facial flushing in many cases. 

Oral Retinoids

e.g. Accutane, Sotret and Claravis contain a Vitamin A derivative called isotretinoin taken each day for a period of 4-6 months.  Accutane can help to cure acne or keep it at bay for a long time.  Isotretinoin helps to reduce secretion of oils from the glands and is effective in very severe acne.  It works in more than 80% of teens.  It lasts longer than anti-bacterial teen acne treatments and in some people their acne is eradicated permanently.  If you choose to take accutane you will need to be closely watched by a medical doctor/dermatologist because it has many side-effects and some of these can be severe.  In addition approximately 25% of acne teenagers revert back to the skin problem after one treatment.  This means that the treatment might need to be continued for 4-6 months.   A break of a few months between treatments is recommended as the acne can improve on the meantime and the body needs a break.  A third or fourth course is sometimes used.  This is clearly a long-term treatment and its benefits should be carefully weighed against side-effects like dry skin and nosebleeds, liver damage in some people and the need to monitor the patient’s health by means of a blood test. 

 Elevated liver enzymes are disputed by other professionals who say the drug won’t damage the liver.   Blood triglycerides need to be monitored, and routine tests are part of the official guidelines for the use of the drug in many countries. The drug can damage the infants of pregnant women and girls.  Always make sure you are treated by a licensed medical professional.