Reviewed by Katelyn Hagerty, FNP
Written by Our Editorial Team
Step into your local drugstore and you’ll come across countless cleansers, serums, lotions and masks all promising the same thing: fewer acne breakouts and clearer, smoother skin.
Unfortunately, not all acne products are equally effective. While light acne breakouts are usually easy to get rid of with over-the-counter acne treatments, many products that are great for milder forms of acne are almost totally ineffective against severe or persistent pimples.
If you’re unlucky enough to have difficult-to-treat acne, you might have tried many of these acne treatments before, only to give up after several months of little or to progress.
Luckily, options are available. Behind the pharmacist’s counter, you’ll find a large range of acne medications designed to deal with stubborn breakouts, including severe forms of acne such as nodular acne and cystic acne.
We’ve shared these stronger, more effective acne medications below, along with information on how each treatment works to get rid of acne and promote clear skin.
Before we get into specific acne medications, it’s important to quickly go over the basics of how acne develops on your skin.
Acne forms when your pores, or hair follicles, become clogged or plugged. Most clogged pores are caused by the accumulation of sebum, which is a type of natural oil that’s produced by your skin, and dead skin cells.
Sebum is important for keeping your skin hydrated and healthy. It’s released by your sebaceous glands and forms part of your skin’s protective barrier.
Your skin needs sebum to maintain itself, but when too much sebum is produced, your skin may start to become overly oily.
Dead skin cells form as a byproduct of your skin’s process for maintaining itself, which is known as epidermal turnover.
Approximately every 40 to 56 days, your epidermis (the outer layer of your skin) replaces its old cells with new ones. As they’re replaced, the old cells form a layer of dead, cornified cells that’s referred to as the stratum corneum.
Like sebum, dead skin cells are an important part of your skin’s protective barrier. However, as cornified cells build up on the surface of your skin, they can mix with sebum and cause clogged pores and acne breakouts to develop.
Acne can vary hugely in severity. The mildest type of acne is comedonal acne. Blackheads and whiteheads are two common types of comedonal acne that can develop on your face and other parts of your body.
More severe forms of acne, such as papules, pustules and inflammatory acne, begin to develop when bacteria is able to multiply inside clogged pores.
As acne-causing bacteria such as Propionibacterium acnes (P. acnes) and others grow, the wall of the pore can rupture, causing redness, swelling and discomfort.
The most powerful and effective acne medications work by targeting one or more of the causes of acne, whether it’s sebum production, skin cell accumulation, skin inflammation or the growth of acne-causing bacteria.
Others work at a higher level by regulating your production of hormones that contribute to acne breakouts.
By doing this, these medications don’t just provide relief from acne — they also help to stop acne breakouts from coming back in the future.
Tretinoin is a topical medication for acne. It’s available as a lotion, cream or gel and belongs to a class of medications referred to as retinoids, which are derived from vitamin A.
Tretinoin works by increasing your skin’s cellular turnover, resulting in the creation of fresh skin cells at a faster rate. This promotes the peeling of dead skin cells and prevents clogged pores and acne breakouts from developing.
Dermatologists have prescribed tretinoin for decades as a safe, reliable acne treatment. Thanks to the countless studies that have found that it’s effective at treating acne, it’s been referred to in scientific literature as a “mainstay” of therapy for acne vulgaris.
You can purchase tretinoin under a variety of brand names, including Retin-A®, Atralin®, Avita® and Altreno®. It’s also available as a generic medication.
One interesting quality of tretinoin is that it’s not just good for treating acne — it’s also one of the most effective medications available for preventing wrinkles, age spots and other common signs of skin aging.
Since it’s affordable, safe and easy to use, tretinoin is a great starting point if you’re looking for a reliable medication to deal with acne breakouts.
The results aren’t instant — on average, it takes a few months to see significant improvements — but when it’s used consistently, tretinoin is highly effective.
Tazarotene (sold as Tazorac®, Fabior® and Avage®) is another topical retinoid that’s prescribed to treat acne, psoriasis and as an anti-aging treatment.
As an acne medication, tazarotene isn’t as well known as tretinoin. However, numerous studies have found that it’s an effective treatment for acne breakouts, particularly breakouts that involve comedonal forms of acne such as blackheads and whiteheads.
If you have acne that’s infected and inflamed, topical retinoids alone may not be enough to bring it under control.
Enter topical antibiotics. These medications work by preventing the bacteria that cause inflamed acne, such as P. acnes, from multiplying on the surface of your skin.
Several topical antibiotics are used to treat acne, but one of the most powerful and effective is a lincomycin antibiotic called clindamycin.
Clindamycin not only helps prevent acne-causing bacteria from growing — it also reduces the swelling that can occur with inflammatory acne. This helps to reduce pain and discomfort while getting rid of acne breakouts.
Another topical antibiotic used to treat acne is erythromycin, which is often prescribed as a combination treatment with benzoyl peroxide.
To target acne from several angles, your healthcare provider may prescribe an antibiotic with a topical retinoid, such as tretinoin, adapalene or tazarotene.
This helps to lower bacterial growth while also stopping acne lesions from forming in the first place.
If you have hormonal acne, your healthcare provider may recommend using the birth control pill to stop your breakouts and clear your skin.
While birth control might seem like an unusual type of medication for treating acne, there’s real research behind it. In fact, several oral contraceptive pills are widely used as hormonal therapy for women with stubborn, difficult-to-treat acne.
The pill treats acne by reducing the number of androgens, or male sex hormones, produced by your body.
Because androgens stimulate sebum production, using the birth control pill can make your skin less oily, reducing your risk of dealing with persistent acne breakouts.
Currently, the FDA has approved three birth control pills as hormonal treatments for acne: Yaz, Estrostep and Ortho Tri-Cyclen, as well as their generic equivalents.
Like all forms of hormonal birth control, these pills require a prescription. We offer birth control pills online, including generic forms of several birth control pills approved to treat acne, after an online consultation with a physician.
It’s important to note that the pill can cause side effects, some of which can be more common in the first few months of use. It’s also worth noting that the acne prevention effects of the pill may take a few months, meaning you shouldn’t expect clear skin overnight.
Spironolactone is a medication that’s used to treat high blood pressure. It’s also used off-label as a treatment for stubborn hormonal acne breakouts.
As an acne treatment, spironolactone works by reducing the amount of androgen hormones in your body. This helps to cut down on sebum production, making your skin less oily and prone to acne breakouts.
Like other acne medications, the effects of spironolactone aren’t immediate. You’ll usually need to take this medication for two to four months before you’ll be able to see improvements in your skin’s appearance and texture.
Because of its effects on hormone levels, spironolactone isn’t safe for use during pregnancy. In order to use it as an acne treatment, your healthcare provider may require you to use a reliable form of birth control.
If you have moderate or severe acne that doesn’t seem to improve with topical medication, your healthcare provider may prescribe an oral antibiotic.
Oral antibiotics work by stopping acne-causing bacteria from growing on the outermost layer of your skin, as well as inside your pores.
They’re usually prescribed in combination with a topical retinoid such as tretinoin or an over-the-counter treatment like benzoyl peroxide.
Common oral antibiotics prescribed to treat acne include doxycycline (see doxycycline dosage for acne), tetracycline, minocycline, azithromycin, erythromycin, trimethoprim/sulfamethoxazole, cephalexin and others.
If you’re prescribed an oral antibiotic, it’s important to closely follow the instructions provided by your healthcare provider.
Make sure to take your medication for the entire treatment period, even if you notice your acne improving early.
You may need to use antibiotics for three to four months before it’s okay to go back to your previous acne treatment plan.
If you have severe acne, your healthcare provider may suggest using isotretinoin to bring your breakouts under control.
Isotretinoin, which was previously sold as Accutane®, is a highly powerful acne medication. It’s used to treat severe forms of acne, such as cystic acne.
For many people, isotretinoin can clear even the most severe acne breakouts and provide lasting acne-free skin.
Dermatologists often prescribe isotretinoin when other acne medications have failed to properly clear breakouts.
Although isotretinoin is effective, it often causes side effects. Many people develop dry skin and chapped lips while using this medication, as well as other side effects such as irritated eyes, dry mouth, nosebleeds and increased sensitivity to sunlight.
Isotretinoin isn’t safe for use during pregnancy. If used by pregnant women, it may cause severe birth defects.
To stay safe while you’re using isotretinoin, you’ll need to check in with your healthcare provider on a regular basis and take part in iPLEDGE — a program to prevent pregnancy among women who use isotretinoin to treat acne.
Chemical exfoliants are topical medications that work by peeling away the outermost layers of your skin. They’re used in chemical peeling procedures provided by dermatologists and plastic surgeons.
By removing the outermost layer of dead skin cells, chemical exfoliants can improve acne and acne scars, reduce the appearance of fine lines and wrinkles, even out skin tone and even get rid of mild forms of scarring and sun damage.
While the highly concentrated versions of these chemicals used for peeling procedures are only available to dermatologists, you can find less concentrated versions in many cleansers, serums and other products available over the counter.
You may want to consider a chemical peel if you have severe or stubborn acne that doesn’t get better with other treatments.
Acne can range in severity from occasional breakouts of comedonal acne to severe, persistent acne that requires professional attention.
If you have mild or moderate acne, you’ll likely be able to control your breakouts with a reliable facial cleanser and other over-the-counter products.
However, if your acne is more severe, it’s best to talk to your healthcare provider about using a stronger form of treatment.
This could mean a topical treatment such as tretinoin, or a systemic option such as isotretinoin or oral antibiotics.
You can get prescription medication for acne by talking to your healthcare provider, meeting with a dermatologist or accessing acne treatments online.
Kate Hagerty is a board-certified Family Nurse Practitioner with over a decade of healthcare experience. She has worked in critical care, community health, and as a retail health provider.