Welcome to the 5th part of our Ultimate Guide to Beating Acne series! Last time we covered the first line of defense most acne sufferers will go through with a review of the most popular acne spot treatments.

Unfortunately some people have more persistent forms of acne that’ll need something a little stronger than OTC products and the help of a doctor.

If you’ve tried everything in the previous post and still struggle with breakouts, we’ve outlined some popular acne treatments that require a prescription below.

Let’s get straight into it.

Azelaic Acid

Azelaic acid is usually sold as a cream but it also comes in gel form. It’s commonly used to treat rosacea as well as acne — both of which it helps reduce the redness of on your skin.. Even though some skincare products contain a small concentration of azelaic acid as an ingredient, these are few and far between. The prescription versions are much stronger and better suited for treating more severe types of acne.

Azelaic acid works by helping kill the acne causing bacteria on your skin. It also has anti-inflammatory effects, helping fade the marks left behind by pimples, nodules and other inflammatory types of acne, and helps dislodge keratin, a skin protein that can clog pores.

It’s usually applied twice daily, once in the morning and again at night.

Most people find that it takes a month or so for it to really start working so don’t get discouraged if you aren’t seeing results at first. This is also true for many of the other acne treatments requiring a prescription.

That being said, burning and stinging are both somewhat common side effects as well as irritation. If you find azelaic acid continues to irritate your skin past the first couple weeks you should start considering a smaller and less powerful concentration.

A 20% concentration has been shown to be effective against moderate levels of acne while a 15% concentration was found to be comparable in strength to a 5% concentration of benzoyl peroxide.

After you apply the azelaic acid, wait about 15-20 minutes for it to fully absorb into your skin. Moisturize afterwards if you’re experiencing irritation or dryness.

Note: Some people also find that azelaic acid lightens the pigment of their skin! The same properties that allow it to fade hyperpigmented skin cells also inhibit the skin from producing melanin. If you have a darker skin tone we recommend you try one of the treatments discussed below instead.

Want to try an OTC product that contains azelaic acid first? Try the exfoliating mask by Via Cosmedics which also contains glycolic and salicyclic acids — two ingredients we recommended in our spot treatments review.

Exfoliating & Clarifying UltraMud – Skin Clearing, Pore Refining – Facial Mud Mask Enhanced with Glycolic, Salicylic, Mandelic, Azelaic Acids

Final Verdict: We recommend trying azelaic acid because it’s proven to work in scientific studies testing its effectiveness and comes with minimal side effects compared to the other treatments below.

Cortisone Shots

If you have a big event coming up (like prom or a wedding) and need a quick fix for a bothersome pimples or cystic acne, taking a trip to the doctor’s office for a cortisone shot may be just what you’re looking for.

Cortisone shots inject you with a hormone naturally produced by your body called corticosteroid. While it’s technically a steroid, this isn’t the same kind of steroid that bodybuilders use because it isn’t anabolic meaning it won’t help build up muscle. It’s usually given to reduce inflammation and in this case, it can quickly diminish the size of cysts, nodules and other types of acne in general.

Because it works really fast, getting a cortisone shot is a good way to quick start the recovery process and begin healing your skin immediately.

The most worrisome potential side effect of a cortisone shot is that it can leave a “sunken-in” area where the acne used to be. This happens because the cortisone atrophies the skin’s tissue surrounding the area of the shot. This mark can actually stick around for a couple of months, depending on the size of the cyst or nodule but it’ll eventually turn back to normal. This doesn’t always happen but if you’d rather not run the risk at all you shouldn’t take the shot. Ask your dermatologist or doctor if you’re worried about it and they’ll give you more specific info based on your situation.

Since you can only get these at a doctor’s office, you can’t realistically rely on cortisone shots as a long-term treatment. The occasional visit when an urgent skin emergency comes up is what they’re best used for.

Final Verdict: Cortisone shots are good for a quick fix before a big event but they can’t be relied on to consistently handle breakouts. Still, if you find yourself in that type of situation we recommend them as an option to explore.

Tretinoin & Retin-A

Tretinoin, more commonly known as Retin-A is a type of retinoid which like Accutane, is essentially a synthetic version of Vitamin A. Even though it’s most commonly used for anti-aging and reducing the appearance of wrinkles, it also works pretty effectively for treating acne.

How does Retin-A work? It dramatically increases the turnover rate of skin cells, similar to the way an exfoliant like salicylic acids works. The only difference is that Retin-A is much stronger which is why it’s only available with a prescription in the United States.

Since it removes the older skin cells at the outermost layer of your skin to reveal the younger ones underneath, Retin-A can also be used to reduce discoloration and hyperpigmentation of marks left behind by acne. These are the little red or purplish spots that can take months to go away on their own.

Retin-A comes in a variety of different forms and is applied topically to the skin. It takes consistent use of about a month or two before you really start noticing any improvement. In the meantime you should expect redness, flakiness, dryness, and just irritation in general. These are all common side effects while your skin takes time to get used to the treatment, similar to other acne medications. After the adjustment period, these side effects become more manageable.

One way to help you get over the initial rocky start is to try applying it less often in the beginning. So instead of using it daily or every other day, apply it only a couple times a week. This way your skin is slowly eased into it.

You need your skin in a clean state when applying Retin-A so cleanse beforehand and remove any makeup you have on. You only need a tiny amount applied in a thin layer evenly over your skin, avoiding the eye and mouth area. Don’t use larger amounts than needed because it won’t do anything to make it work faster. You’ll just be irritating your skin more.

You will definitely want to moisturize after the Retin-A finishes absorbing. Moisturizing will help reduce the severity of unwanted side effects like dryness and irritation.

It’s also best to limit your exposure to the sun after applying Retin-A because like other AHA exfoliators, it increases your skin’s photosensitivity meaning UV rays from the sun will do more damage than usual.

Sidenote: Don’t confuse retinol with Retin-A! While both are Vitamin A based, Retin-A is much stronger and you won’t be able to find it in OTC skincare products.

Final Verdict: We recommend Retin-A because it does its job exceptionally well and will not only help treat acne but also leave your skin looking and feeling younger since it’s primary use is to reverse the effects of aging. Skin irritation is a problem but that’s not that bad when compared to the potential side effects of other prescription treatments.

Oral Antibiotics

There are many different types of oral antibiotics used to treat acne with the two most common being Minocycline and Doxycycline. They both work by killing the acne causing bacteria on your skin from the inside out.

We’re not the biggest fans of taking oral antibiotics for acne. Results seem to be inconsistent and a large majority of patients don’t even respond to any of them. Not to mention the laundry list of potential side effects hanging over your head. When these antibiotics do work, the results aren’t usually anything to brag about.

It may sound like we’re discouraging you from taking oral antibiotics for your acne (and we are) but again, if you really want to, talk to your dermatologist or doctor to get more specific info for your circumstances. There are a variety of things you shouldn’t be taking alongside these kinds of medications and if you have pre-existing conditions which interfere you won’t even be allowed to try them.

Realize that antibiotics are an option to treat acne and they can work for you. We just recommend you start elsewhere for the reasons mentioned above.

Also note you have options other than just minocycline and doxycycline. Those are two of the most common but new oral antibiotic treatments for acne are released every year. Whether they’re effective for the majority of people with minimal long-term side effects remains to be seen.

If you’ve used oral antibiotics before and found they helped you out, let us know in the comments below. We’d really like to hear about it and you can help others out who may be interested too.

Final Verdict: Too many side effects compared to the other treatments and unreliable results keeps us from recommending oral antibiotics for acne when there are other treatments available that have a higher success rate and less side effects.

Accutane

The infamous drug known as Accutane, and less commonly by its generic name Isotretinoin, has long been considered the best medical treatment we have today against the most severe types of cystic acne.

What does Accutane do? It completely shuts down your skin’s production of sebum. If you recall, we mentioned earlier how oily skin is basically public enemy number one to all acne sufferers out there. With a dry face, and we’re talking about truly dry here not dry skin types, acne has a MUCH harder time of thriving and showing its ugly face on the surface of your skin.

When you use Accutane, think of it as you metaphorically sticking a pitchfork right through the heart of acne to make sure it not only dies…… but also stays dead.  Often times, once someone gets off Accutane, usually after about six months, they find they don’t breakout anymore at all. Other people still get an occasional pimple but the severity of the problem goes WAY down and it becomes much more manageable.

Accutane behaves like a synthetic mega dose of Vitamin A, and taking too much at once is toxic. If you go to a dermatologist or doctor and they decide Accutane is right for you, you’ll likely be taking a daily dose of about 1 mg per kg of bodyweight which might not seem like much but it’s likely more than enough to treat anything you’re dealing with.

Some people seem to have an allergic reaction to Accutane, or find that it doesn’t help their condition at all. These people are in a TINY minority but they do exist. And Accutane does have a reputation for undesirable side effects. Dryness which affects not only your skin but also your lips and mouth is the most bothersome but nausea, dizziness, or aches in general are also somewhat common. Some people have even reported depression as a side effect. That’s pretty extreme and unlikely to happen to you but Accutane has been in the spotlight for numerous cases brought up against its manufacturers throughout the years.

This is why in general we recommend Accutane as a last resort treatment. If all else fails, and you tried everything we mentioned before this, including all the tips and routines and treatments and you still can’t get your acne under control, then go to your doctor and demand they give you something. If not the Retin-A or oral antibiotics, it will likely be Accutane.

Side Note: If you’re pregnant or expecting to be: Do not take Accutane! You won’t be prescribed anyways but we thought we’d mentioned it.

Final Verdict: We recommend Accutane if all else fails. It is the most capable and arguably powerful prescription acne medication we have for acne sufferers in today’s day and age although its serious potential side effects keeps us from recommending it as a first resort treatment when there are other options available with less serious side effects.

Up next in our Ultimate Guide to Beating Acne we’re going to tackle the problem of hyperpigmentation and how to get rid of those pesky acne scars.

 Featured Image by Caitlin Regan // CC BY // Flipped & Filtered Original