If you’re one of the 50 million Americans who deals with acne each year,¹ you know how frustrating it can be to deal with breakouts—and it’s even worse when your acne is persistent. The good news: There are plenty of ways that you can treat and help prevent acne, even when it seems like your current method of treatment just isn’t doing the trick. One thing your doctor (or Curology dermatology provider) may recommend is an oral medication.

There are several different kinds of oral medications for acne, and they work in different ways. The type of acne you’re dealing with, your medical history, and your overarching skin goals, will all have an impact on your dermatology provider’s recommendations for your skin.

What causes acne?

Acne vulgaris—aka, acne—is a skin condition in which pores become clogged, resulting in pimples (pustules and papules), blackheads and whiteheads (open or closed comedones), cysts, or nodules.² While acne is most common during adolescence, it can occur into adulthood, too. There are lots of factors that can contribute to acne:³

• Smoking

• Stress  

• Lack of sleep or poor quality sleep

• Diet

• Pore-clogging (comedogenic) products

• Genetics

Now, here are some oral acne medications that your provider may prescribe to treat acne.

1. Spironolactone 

While spironolactone is approved by the Food and Drug Administration for treating conditions like high blood pressure, it’s also used off-label as an oral medication for acne.⁴ It’s a prescription-only diuretic that can be used to treat acne vulgaris in women with persistent hormonally-influenced acne.

How it works: Spironolactone has an anti-androgen effect—basically, it can alter certain hormone levels to decrease sebum production. That, in turn, reduces breakouts. It typically takes at least few weeks for these results to be visible.⁵ 

Spironolactone is generally well-tolerated, but it does have a few potential side-effects that are dose-related.⁶ They include:

• Frequent urination

• Menstrual irregularities

• Fatigue 

• Headache

• Dizziness

• Breast enlargement and/or tenderness

• Hyperkalemia (elevated potassium levels, which can cause additional side effects. This is a rare side effect that is rare in young, healthy individuals with normal liver, adrenal, and kidney function.)

Your Curology dermatology provider may prescribe spironolactone as a part of your acne-fighting treatment options, as it can be useful in treating acne in female patients—especially if they’re dealing with hormonal acne.

2. Doxycycline 

The tetracycline antibiotic doxycycline can treat a variety of conditions including acne, as well as rosacea, skin infections, sexually transmitted infections, and Lyme disease.⁷

How it works: Doxycycline kills and prevents the growth of a wide range of bacteria, including C. acnes—the bacteria that contributes to acne. It also has anti-inflammatory effects. Medical care providers typically prescribe this antibiotic for short-term treatment, about two to four months (though sometimes longer).⁸

Higher doses of doxycycline are more likely to cause negative side effects,⁹ which can include:

• Gastrointesinal disturbances

• Photosensitivity 

Your Curology dermatology provider may prescribe doxycycline to help speed healing and calm inflammation due to acne, in addition to treating rosacea. It should not be used by patients who are allergic to the antibiotic, are pregnant or nursing, or under the age of 12.

3. Prednisone 

Prednisone is a corticosteroid (like a cortisone medicine or steroid) that has an anti-inflammatory effect and suppresses the immune system. It helps to relieve swelling, redness, itching, and allergic reactions.¹⁰

How it works: Prednisone works as an anti-inflammatory and immunosuppressive agent, and can be used in a broad range of issues, including acne and seborrhea. It can also treat acne fulminans, a rare skin disorder in which a painful, ulcerating, and hemorrhagic form of acne develops.¹¹ 

Prednisone is not typically used for extended treatment because of long-term effects of corticosteroids. Potential adverse effects of prednisone include:

• Hyperglycemia

• Insomnia

• Increased appetite

• Hypertension

• Delayed wound healing

Additional high-dose or long-term side effects include:

• Weight gain

• Increased risk of infections

• Skin fragility

• Hypertension

Your Curology dermatology provider may prescribe a short course of prednisone to help decrease inflammation as a part of your acne treatment. It can be taken by people who don’t have sensitivity to the medication, and don’t have certain medical issues including uncontrolled hyperglycemia, diabetes, glaucoma, joint infection, uncontrolled hypertension, and more.¹² Discuss your medical history with your provider to make sure that prednisone is a fit for your treatment plan.

4. Azithromycin 

This antibiotic is one of the most-prescribed antimicrobial drugs in the U.S. Not only is it used to help treat acne, it’s also FDA-approved to treat some upper respiratory infections including pneumonia and chronic obstructive pulmonary disease (COPD).¹³ 

How it works: Azithromycin treats acne by fighting against bacteria and reducing inflammation. Like other oral antibiotics for acne, it should be used for short-term treatment, about three to four months.

Few patients stop using azithromycin due to adverse effects, but it can have some gastrointestinal symptoms including nausea and diarrhea.

Your Curology dermatology provider may prescribe azithromycin to help speed up the acne-healing process and to calm inflammation. It should not be used by pregnant people or children under the age of 8, or by patients with a history of severe hypersensitivity to azithromycin or another macrolide antimicrobial. Talk to your provider to see if azithromycin is right for your acne treatment plan. 

5. Minocycline 

This antibiotic can fight off bacteria that contributes to acne, in addition to treating bacterial infections, including pneumonia. It also has an anti-inflammatory effect.¹⁴

How it works: Similar to doxycycline, minocycline kills and prevents the growth of bacteria that contribute to acne, to treat acne breakouts. Because it’s an oral antibiotic, it’s typically used for short-term treatment.

Use of minocycline can result in some side effects, including:

• Gastrointestinal distress

• Photosensitivity

• Hyperpigmentation of skin

• Discoloration of nails

• Teeth-staining and bone growth inhibition are rare side effects and are more common in children than adults.

Your Curology dermatology provider may prescribe minocycline to treat your acne and reduce inflammation. If you’re pregnant or have a sensitivity to tetracycline antibiotics, avoid taking minocycline. This antibiotic may not be suitable for minors under a certain age, so talk to your provider to make sure it’s a fit for you and your own skincare concerns.

6. Keflex (Cephalexin)

Keflex is the brand name for cephalexin, an oral antibiotic that can treat acne, in addition to urinary tract infections, gonorrhea, respiratory tract infections, and more.¹⁵

How it works: Because it’s an antibiotic, cephalexin treats acne by fighting off the bacteria that may contribute to it. It is typically intended for short-term use only.

Potential side effects can include, but are not limited to:

• Abdominal pain

• Diarrhea

• Nausea

• Vomiting

Your Curology dermatology provider can prescribe cephalexin as a treatment for persistent acne if appropriate. However, avoid this oral antibiotic if you have a sensitivity to cephalosporins or a penicillin allergy. Cephalexin can have negative interactions with some medications, so talk to your provider about your medical history, including any medications you currently take.

7. Fluconazole 

If you’re dealing with pityrosporum folliculitis (aka fungal acne),¹⁶ your provider may recommend fluconazole, which is one of the most widely used antifungal agents.¹⁷ It is FDA-approved to treat urinary tract infections, yeast infections, and meningitis, among other infections.

How it works: As an antifungal treatment, fluconazole targets the yeast that can contribute to the development of fungal acne.

Most patients tolerate fluconazole well, though it can lead to some side effects, particularly gastrointestinal symptoms that include:

• Nausea

• Diarrhea

• Abdominal pain

• Vomiting

Your Curology dermatology provider can prescribe fluconazole to help treat fungal acne, but you should avoid this medication if you have an allergy to it, or certain heart conditions, like a slow or irregular heartbeat. It should not be taken with certain medications, so always give your medical provider the lowdown on your medical history!

8. Isotretinoin 

Isotretinoin, a vitamin A derivative, is often known by its former brand name, Accutane. It’s a popular treatment for severe acne that doesn’t respond to other treatments.¹⁸

How it works: Isotretinoin inhibits sebaceous gland function and keratinization (aka, the buildup of dead skin cells). It can reduce the size of sebaceous glands and sebum production—helping to reduce excessive oiliness and, as a result, acne. It can take months for patients to see the results they’re looking for, but once they do, the results can be very impressive.

Isotretinoin does have some potential side effects—most common of which is dry lips, which is seen in as many as 90% of patients (so remember your lip balm). Dry skin (aka xerosis), dry mouth, dry nose, and sun sensitivity are also common side effects—so remember to use your sunscreen and a good hydrating lotion or moisturizer to combat dryness. Additional side effects include, but are not limited to:

• Itchiness

• Irritation

• Skin fragility

• Hair thinning

• Rash

Oral isotretinoin should not be used by pregnant women, as it can cause birth defects. Isotretinoin cannot be prescribed via telemedicine, so you’ll have to see an in-person dermatology provider to discuss whether isotretinoin is right for you.

Prescription topical treatments for acne

If your dermatology provider determines that an oral medication for acne isn’t right for you, they may prescribe a topical treatment for acne instead. Prescription treatments can be a great option for patients struggling with persistent acne. Here are two popular topical medications for the treatment of acne:

Tretinoin

Tretinoin—not to be confused by the aforementioned isotretinoin—is a topical treatment that’s a derivative of vitamin A. It’s a topical retinoid that boosts skin cell turnover, fights acne, and may help reduce the appearance of acne scars. Plus, it has anti-aging benefits!¹⁹ Your Curology provider may prescribe tretinoin as a part of your personalized prescription formula.

Clindamycin

Another popular prescription topical, clindamycin is a topical antibiotic that targets the bacteria that contribute to acne, helping to heal and prevent acne breakouts. In addition to fighting acne, it can also decrease swelling that comes along with it.²⁰ Your Curology provider can also prescribe this topical as a part of your personalized prescription formula to help you on your skincare journey.

Over-the-counter topical treatments for acne

Prescription topicals are great for tackling acne, but there are also over-the-counter treatments that can help.

Adapalene

Adapalene is a topical retinoid (aka, a derivative of vitamin A) that you might be familiar with, under its brand name, Differin. It helps to fight acne by boosting skin cell turnover—which reduces acne-contributing buildup.²¹ Although some forms of adapalene can only be used with a prescription, Differin is the only prescription-strength retinoid that you can get over-the-counter. 

Benzoyl peroxide

Benzoyl peroxide kills bacteria that contributes to the development of acne and reduces inflammation—so it’s great for fighting inflammatory acne.²² You can commonly find it in spot treatments, cleansers, and body washes.

Salicylic acid

Salicylic acid is a popular acne-fighting ingredient that you can find in many products, including cleansers and serums. It’s a beta hydroxy acid (or BHA) exfoliant—so it helps to clear pores and buffs away dead skin cells.²³ It’s a great option to help those with acne.

Custom skincare to fight persistent acne

Although acne is a common skin condition, treating it can be incredibly personal—after all, your skin, like you, is totally unique! Since 2014, Curology has provided dermatologist-designed solutions to skin concerns like acne, rosacea, and hyperpigmentation. With Curology, you’ll be paired with a licensed dermatology provider who can provide you with a personalized treatment plan (including a customized prescription formula) that can be adjusted as your skin changes.

Get your personalized skincare routine with Curology

Get your personalized skincare routine with Curology

Start your skin quiz

If you’re new to Curology, you'll start by completing a short questionnaire about your skin history and goals, submit a few selfies, and you’ll have a personalized skincare routine at your door in no time. Just be aware that any additional prescriptions may need to be picked up at a local pharmacy.

P.S. We did the research so you don’t have to:

1. American Academy of Dermatology Association. Skin Conditions by the Numbers. (n.d.). 

2. Andrea L. Zaenglein, et al. Guidelines of care for the management of acne vulgaris. Journal of the American Academy of Dermatology. (2016, May 1). 

3. American Academy of Dermatology Association. Acne: Who gets and causes. (n.d.).

4. Saikrishna Patibandla, et al. Spironolactone. StatPearls. (2022, July 4).

5. American Academy of Dermatology Association. Stubborn acne? Hormonal therapy may help. (n.d.).

6. Andrea L. Zaenglein, et al. Guidelines of care for the management of acne vulgaris. Ibid.

7. Reema S. Patel and Mayur Parmar. Doxycycline Hyclate. StatPearls. (2022, July 12).

8. American Academy of Dermatology Association. How long can I take an antibiotic to treat my acne? (n.d.).

9. Andrea L. Zaenglein, et al. Guidelines of care for the management of acne vulgaris. Ibid.

10. Yana Puckett et al. Prednisone. StatPearls. (2022, May 8).

11. Patrick M. Zito and Talel Badri. Acne Fulminans. StatPearls. (2021, November 15).

12. Alexander Hodgens and Tariq Sharman. Corticosteroids. StatPearls. (2022, May 8).

13. Zachary Sandman and Omar A. Iqbal. Azithromycin. StatPearls. (2021, October 17).

14. Simon Nazarian and Hossein Akhondi. Minocycline. StatPearls. (2022, February 10).

15. Timothy F. Herman and Muhammad F. Hashmi. Cephalexin. StatPearls. (2022, February 16).

16. Richard M. Rubenstein and Sarah A. Malerich. Malassezia (Pityrosporum) Folliculitis. J Clin Aesthet Dermatol. (March 2014).

17. Ameish Govindarajan et al. Fluconazole. StatPearls. (2022, June 21).

18. Hannah D. Pile and Nazia M. Sadiq. Isotretinoin. StatPearls. (2022, May 8).

19. Hilary E. Baldwin et al. 40 Years of Topical Tretinoin Use in Review. J Drugs Dermatol. (June 2013).

20. L E Becker et al. Topical clindamycin therapy for acne vulgaris. A cooperative clinical study. Arch Dermatol. (August 1981).

21. Leila Tolaymat et al. Adapalene. StatPearls. (2022, July 11).

22. James Q. Del Rosso. What is the Role of Benzoyl Peroxide Cleansers in Acne Management? J Clin Aesthet Dermatol. (November 2008).

23. Ashley Decker and Emmy M. Graber. Over-the-counter Acne Treatments. J Clin Aesthet Dermatol. (May 2012).

*Subject to medical consultation. Results may vary. Restrictions apply. See website for full details and important safety information.

Written by

Curology Team

Medically reviewed by

Nicole Hangsterfer, PA-C