The first line of prescription medications include topical retinoids and antibiotics. Using these drugs in combination often produces the best results, but they must be taken for as long as the acne persists, which, for some people, can be many years. Although generally well-tolerated, they frequently cause skin dryness and irritation.
Persistence and patience are required. "Teens want to see the dermatologist today and be better tomorrow," says Dr. Karl Beutner, associate clinical professor of dermatology at UC San Francisco and co-author of the American Academy of Dermatology's current acne treatment guidelines. "For medications to be efficacious, they need to be used religiously. It often takes good compliance over a long period of time to see the difference."
Oral antibiotics including doxycycline and minocycline are also mainstays of treatment, particularly when topical fail.
Isotretinoin, best known by the brand name Accutane, has typically been a drug of last resort, used by those with severe acne. Because the drug can cause serious birth defects when taken during pregnancy, the Food and Drug Administration has required that girls and women who use Accutane join a registry and undergo monthly pregnancy tests while on the medication.
This past June, however, Accutane was pulled from the market amid concerns that it might also be linked to a higher risk of inflammatory bowel disease. Generic versions are still available.