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Updated on November 13, 2011


Acne is a skin condition affecting 40- 60 million people in America, and 3 out of every 4 teenagers. In spite its prevalence, acne remains a condition that is largely undertreated and often misunderstood. According to some studies only 11% of individuals with acne will see a physician about it. Many will attempt to treat their acne with over-the-counter products, but up to 40% will do nothing at all. Myths abound about acne. Some mistakenly believe it is a personal hygiene issue. Others think that greasy foods or chocolate have been proven to cause acne. The fact is that acne is actually a far more complex condition than we tend to realize. The true causes of acne include follicular hyperkeratinization, neutrophil pathology, t-cell defects and hormonal imbalances. No wonder we find it easier to just say it is caused by chocolate! Easier…yes…but not correct.

Due to the fact that many patients are reluctant to seek the advice and help of a physician or dermatologist, I am offering the following article to assist patients in speaking with their doctor. Sometimes it is easier to talk about something when you feel a bit more informed about the treatments. Therefore this article will briefly review the currently available prescription topical treatments for acne. Oral therapies, of which there are several, will be covered in a separate article.

Prescription topical (meaning creams, ointments, gels, etc) treatments for acne can be generally divided into 3 broad categories. Within each of these categories there are a variety of available prescription drugs which I will list. These 3 categories are:

· Topical Antibiotic Preparations for Acne

· Topical Retinoids for Acne

· Miscellaneous Topical Products (non-antibiotics and non-retinoids)


1. Benzoyl Peroxide is probably the most popular antibiotic approach to treating acne. Antibiotics for acne work, in part, by interfering with the replication of a bacteria known as p. acnes. Benzoyl peroxide is available in a variety of over-the-counter products, and is one of the ingredients in the popular "Proactiv" product for treating acne.

Prescription Acne Medications with Benzoyl Peroxide Include:
• Benzac (various formulations and strengths)
• Inova (contains vitamin E also)
• Pacnex (various formulations of liquids and pad)
• Neobenz Micro

2. Clindamycin is another popular prescription acne cream ingredient. All products contain 1% Clindamycin

Prescription Acne Medication with Clindamycin as the active ingredient:
• Cleocin-T (available as a solution, lotion, Gel or swab)
• Clindagel
• Clindamax
• Evoclin

3. Erythromycin is another topical antibiotic often used to treat acne. Most of the “brand name” products have been discontinued (e.g. Erygel) since they have all become available generically. One brand name product still available is called Akne-Mycin.

4. Antibiotic Combinations are a popular approach. These products combine 2 antibiotic ingredients in a single cream, gel or solution.

Prescription acne antibiotic combination products include:
• Acanya (combines benzoyl peroxide and clindamycin)
• BenzaClin (combines benzoyl peroxide and clindamycin)
• Duac CS (combines benzoyl peroxide and clindamycin)
• Epiduo (combines benzoyl peroxide and adapalene – see below for info on adapalene)
• Benzamycin (combines benzoyl peroxide and erythromycin)
• Ziana (combines clindamycin and tretinoin – see below for a discussion of tretinoin)


Since acne is due to a complex combination of causes, it is logical that a variety of products (targeting different causes) would be developed. Tretinoin is the result of such research and development. Tretinoin is a derivative of vitamin A and has been studied for its benefits in treating acne since the 1960’s. Tretinoin came to the prescription market in the late 1990’s in the form of Retin-A, which, according to the manufacturer, continues to be the most prescribed drug by dermatologists today. Since then other products with ingredients “similar” to tretinoin have been developed.

Prescription Acne Topical Products which contain Retinoids:
• Atralin
• Retin-A
• Retin-A Micro
• Differin (active ingredient is called adapalene)
• Tazorac (active ingredient is called tazarotene)
• Tretin-X


Rounding out this review of topical products for acne are those products that do not fit neatly into either of the previous 2 categories. These products contain ingredients for which the exact mechanism of action has not been fully determined.

Aczone (active ingredient = dapsone). Note, the use of any benzoyl peroxide product in addition to Aczone will cause a temporary yellowing of the skin at the site of application. Aczone is applied twice daily.

Azelex (contains Azelaic acid). After thoroughly washing the skin, Azelex cream is massaged into the affected areas twice daily. Results are typically seen within 4 weeks.

Klaron Lotion (active ingredient sodium sulfacetamide). Applied twice daily.


While treating acne with topical creams may help, it may also be necessary to consider replacing certain prescription medications which might be contributing to the acne problem. The following are a few prescription medications know to sometimes cause or worsen acne:

  • Tazodone (used for depression or insomnia)
  • Haloperidol (an antipsychotic)
  • Lithium (for bipolar disorder)
  • Estrogens
  • Anabolic steroids (for testosterone deficiency)
  • Phenytoin, Lamotrigine (for seizure disorders)
  • Isoniazid (an antibiotic used for tuberculosis)


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    • pharmacist profile imageAUTHOR

      Jason Poquette 

      5 years ago from Whitinsville, MA

      Hi Laura,

      I understand your concern and the problem. Ideally you should start with an OTC product. Wash your face daily (or twice daily) with a hypo-allergenic cleanser/soap. Not more than that. Use a benzoyl peroxide product on the actual spots. Be sure to use only oil-free water-soluable cosmetics. If these approaches don't work, contact your MD for a further evaluation and more options like the ones in this article.

    • profile image


      5 years ago

      When i was younger I used a acne gel and it gave a some dark spots in my skin well my cheeks n now am embarrassed to even show my skin now the acne is back but it's only 4-6 pimples but they are huge n they hurt a lot any thing that can help me I will appreciate it

    • pharmacist profile imageAUTHOR

      Jason Poquette 

      6 years ago from Whitinsville, MA

      Hi Cami,

      Isotretinoin is reserved for more severe non-responsive acne. I suspect your dermatologist will want to try a few more things before going down that road with you. Best wishes!

    • profile image


      6 years ago

      Hi I use doxycycline but I'm thinking about going on isotretinon because the doxycycline has stopped working I started to take it when I was 11 and now I'm thirteen do you think I should try isotretinon? I only get break out on my for head and an occasional pimple here and there on my chin and nose

    • pharmacist profile imageAUTHOR

      Jason Poquette 

      6 years ago from Whitinsville, MA

      magnifique100 - oral contraceptives have helped many women manage their acne problem, and YES - write a Hub about the company! :)

    • magnifique100 profile image


      6 years ago

      I've struggled with acne myself until I went on birth control and started using products from Institut Esthederm. Maybe I can write a hub about the Institut Esthederm company. :)

    • adawnmorrison profile image


      6 years ago from The Midwest

      Speaking from my own experience - I struggled with acne from nine years of age and used a number of prescriptions, both topical creams and oral antibiotics all through high school. Finally, my freshman year of college, I underwent accutane therapy, which was 6 months of agony, but my acne finally seemed to respond, though I still had occasional outbreaks. I noticed during all three of my pregnancies and while breastfeeding that my complexion was absolutely pristine. After I weaned my youngest child, my acne came back with a vengeance - obviously a hormonal imbalance! I refused hormonal birth control, so my doctor prescribed Differin cream, and I have had the best results ever with it. Keep after your doctor until you find what works for you, and don't waste too much time on over-the-counter remedies that aren't working.

    • pharmacist profile imageAUTHOR

      Jason Poquette 

      7 years ago from Whitinsville, MA


      Happy to provide some helpful information. Thank you for the kind words. Sounds like your daughter has a pretty awesome mother! :) Take care!

    • pharmacist profile imageAUTHOR

      Jason Poquette 

      7 years ago from Whitinsville, MA

      Tabiee - I can do better than that. I wrote a Hub for you:

    • gailalovesbijou profile image


      7 years ago from Wyomissing, PA

      Thank you for this informative hub, pharmacist! Voted up, useful, and bookmarked for future reference. My 16-year-old daughter sometimes has outbreaks. She's had success with a topical benzoyl peroxide cream, but every once in a while nothing seems to work. Recently had her apply colloidal silver solution, and that seemed to really help. I will consult this next time nothing seems to work. :)

    • Tabiee profile image


      7 years ago from Pakistan

      Actually hydroquinine is used in whitening creams I want to ask is it safe to use?

    • Tabiee profile image


      7 years ago from Pakistan

      yeah I do have

    • pharmacist profile imageAUTHOR

      Jason Poquette 

      7 years ago from Whitinsville, MA

      Hi Tabiee,

      If you have a specific question about these, feel free to ask. Thanks!

    • Tabiee profile image


      7 years ago from Pakistan

      I wish you can write something about hydro quinine, kojic acid and likes

    • lucybell21 profile image

      Bonny OBrien 

      7 years ago from Troy, N.Y.

      Wow really detailed. One of the girls I work with has acne that she can't seem to get rid of. Nice hub.

    • MBerg22 profile image


      7 years ago from Colorado Springs, CO

      I hate my acne! I am 31 and still trying to deal with it, even after taking accutane in my early 20s. So frustrating. Thanks for the information. Great hub!

    • MurciélagoHeart profile image


      7 years ago from San Francisco

      What an in depth analysis, great hub, voted!


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