Merck Manual

Please confirm that you are not located inside the Russian Federation

Drugs Used to Treat Acne

Drugs Used to Treat Acne

Drug

Some Side Effects

Comments

Kills bacteria (applied to the skin)

Clindamycin

Diarrhea (rarely)

Should be avoided in people with inflammatory bowel disease

Dapsone

Temporary skin yellowing when used with another product that contains benzoyl peroxide

Very rarely causes methemoglobinemia (a disorder that impairs the ability of the blood to carry oxygen)

Erythromycin

Rarely irritated skin

Well-tolerated

Frequent development of bacterial resistance

Minocycline

Irritation, dry skin, redness

Foam propellant is flammable. Fire, flame, and smoking should be avoided immediately after application.

Benzoyl peroxide

Dry skin

Possible bleaching of clothing and hair

Allergic reactions (rarely)

Especially effective when combined with erythromycin or clindamycin

Benzoyl peroxide combined with erythromycin: Refrigeration sometimes required

Unclogs pores (applied to the skin)

Tretinoin

Irritated skin (with dryness, redness, and scaling)

Sensitization of skin to sunlight

Apparent worsening of acne when tretinoin is started, sometimes requiring 3 to 4 weeks before any improvement occurs

Requires use of protective clothing and sunscreen during sun exposure

Should be avoided during pregnancy

Tazarotene

Irritated skin

Sensitization of skin to sunlight

Apparent worsening of acne when tazarotene is started, sometimes requiring 3 to 4 weeks before any improvement occurs

Requires use of protective clothing and sunscreen during sun exposure

Should be avoided during pregnancy

Adapalene

Some redness, burning

Increased sun sensitivity

As effective as tretinoin but less irritating

Requires use of protective clothing and sunscreen during sun exposure

Azelaic acid

May lighten skin

Minimally irritating

May be used by itself or with tretinoin

Should be used cautiously in people with darker skin because of skin-lightening effects but can help lighten areas that leave dark skin after healing

Glycolic acid

Stinging

Mild irritation

Over-the-counter product in form of a cream, lotion, or solution used in addition to prescription products but no longer commonly used

Salicylic acid

Stinging

Mild irritation

Over-the-counter product in form of a wash, peel, mask, or lotion used in addition to prescription products

Trifarotene

Dryness, redness, and scaling of the skin

Increased sun sensitivity

Requires use of protective clothing and sunscreen during sun exposure

Kills bacteria (taken by mouth)

Tetracycline

Sensitization of skin to sunlight

Inexpensive and safe, but must be taken on an empty stomach

Requires use of protective clothing and sunscreen during sun exposure

Doxycycline

Sensitization of skin to sunlight

Requires use of protective clothing and sunscreen during sun exposure

Minocycline

Headache

Dizziness

Skin discoloration

Most effective antibiotic according to some experts but is expensive

Erythromycin

Stomach upset

Frequently, development of bacterial resistance to erythromycin

Azithromycin

Stomach upset

Fewer side effects than erythromycin

Frequently, development of bacterial resistance to azithromycin

Sarecycline

Sensitization of skin to sunlight

Stomach upset

Light-headedness,dizziness, or vertigo

Requires use of protective clothing and sunscreen during sun exposure

Trimethoprim/sulfamethoxazole

Stomach upset

Rash

Development of bacterial resistance to trimethoprim/sulfamethoxazole

Unclogs pores (taken by mouth)

Isotretinoin

Possible harm to a developing fetus

Possible effect on blood cells, the liver, and fat (triglyceride and cholesterol) levels

Dry eyes, chapped lips, and drying of the mucous membranes

Pain or stiffness of large joints and lower back with high dosages

Associated with depression, suicidal thoughts, attempted suicide, and (rarely) completed suicide, but whether isotretinoin is the actual cause is unknown

Unclear whether associated with new or worsened inflammatory bowel disease (Crohn disease and ulcerative colitis)

For sexually active women, requires a pregnancy test before they start isotretinoin and at monthly intervals while they are taking the drug, plus use of two forms of contraception or sexual abstinence, beginning 1 month before they start the drug and continuing while they take it and for 1 month after they stop taking it

Requires blood tests to check whether the drug is affecting blood cells, the liver, or fat levels

Blocks action of hormones (taken by mouth)

Contraceptives

High blood pressure (hypertension), blood clots, breakthrough vaginal bleeding (for example, between menstrual periods)

Weight gain

Stomach upset

Headaches

For treatment of acne in females

Spironolactone

Light-headedness

Increased urination

Breast tenderness

Stomach upset

For treatment of acne in females