Acne Vulgaris – Oral Medications

Antibiotics – Overview

Oral antibiotics are used in the management of moderate to severe acne. They work primarily by their antibacterial and anti-inflammatory effects. They work more rapidly than topical preparations to improve your acne.

Over time the P. acnes bacteria can become resistant to the antibiotic being used to treat it. When this occurs, the acne is not controlled and another treatment agent can be prescribed.

The main oral anitibiotics used are:





Acne Vulgaris – Oral Medications

Birth Control Pills (BCP)

BCPs contain estrogen, which regulates menstruation, and prevent ovulation. BCP’s improve acne by reducing ovarian androgen secretion and blocking the androgens from stimulating the sebaceous glands to produce excess sebum. BCPs that help to control acne are the ones that contain a combination of estrogen and progestin.  Commonly used brands include:

Diane 35®





Acne Vulgaris – Oral Medications


Class: Retinoid

Route: Given in gelatin capsules for oral administration.

Typical Dosage: 10-mg, 20-mg, and 40-mg capsules. Most patients start with 0.5 mg/kg/d for the first month, then they increase to 1 mg/kg/d to a maximum of 2 mg/kg/d if needed. Treatment usually continues for 20 weeks.

Clinical Indications: Isotretinoin is a very effective drug against acne. Most people who have taken isotretinoin have had a dramatic reduction in their acne with prolonged results only after one course of isotretinoin. Because isotretinoin can cause serious side effects, it should only be considered when the following types of acne exist:

People must have severe disfiguring nodular acne that has not responded to standard therapies.

Inflammatory acne with scarring that has failed conventional treatment

Acne with significant psychological distress

Moderate to severe acne with frequent relapses

Special Notes:

Blood tests including cholesterol profile, complete blood count, and liver function tests must be performed before initiating treatment. These tests will be repeated during the course of treatment as isotretinoin can cause changes in the liver and cholesterol levels.

Females on isotretinoin must be on two methods of birth control such as condoms, birth control pill, intra uterine devices, diaphragm, tubal ligation, abstinence, or hysterectomy.

Some people may initially get worse before they get better when they first start to use isotretinoin. However, most will see an improvement after the first month of therapy which continues during the course of the treatment.


Wax epilation and skin resurfacing procedures should be avoided during therapy and for at least 6 months afterwards.

Patients should avoid prolonged exposure to UV rays and sunlight.

Decreased tolerance to contact lenses may be experienced by some patients.

Vitamin supplements containing vitamin A must also be avoided.

Women must not be pregnant or become pregnant or breastfeed while taking isotretinoin due to the drug causing severe birth defects. These include skull abnormalities, heart defects, cleft palate, deafness and central nervous system defects. Women of childbearing age must be using an effective method of birth control.

Treatment with tetracycline and isotretinoin shouldn’t be given at the same time because the combination has been associated with brain swelling (pseudotumor cerebri)

Do not donate blood during treatment or for one month after stopping treatment.

Mechanism of Action: Isoretinoin is the only acne treatment that works on all four factors that predispose a person to acne – excess oil production, clogged skin pores, P. acnes and inflammation.

Mild side effects include:

Dry lips: Lips can become chapped, cracked and dry in majority of people taking the drug. Often lip balm helps overcome this problem. Chapstick or Vaseline Petroleum jelly usually works.

Dry eyes: This is often more of a concern in contact lens wearers. You may need to stop wearing them temporarily. As well the frequent use of artificial tears in the affected eye will help with dry eyes.

Dry Skin: You may notice dry and scaly skin on hands and forearms. Moisturizing creams will assist with this problem.

Nosebleeds: They can occur when the nasal lining dries out. They often can be stopped with direct pressure on the nose. Nosebleeds can be prevented by using nasal lubricants such as Vaseline Petroleum Jelly.

Aches and pains: Usually stiffness of large joints and of lower back can occur. They are often mild and self limited. Tylenol can be used for the pain.

Sun sensitivity: A sun screen with a SPF or at least 20 should be used daily. As well it is important to stay out of the sun as much as possible while on isotretinoin.

Thinning hair: This occurs less commonly; however, it usually does not persist after the treatment course. Hair usually will grow back when the treatment has been completed.

Rare side effects include:

Depression, or suicidal thoughts. There is concern of a possible link between isotretinoin and depression. However, depression is a common problem in adolescents, the individuals who most frequently take the drug. As well, the stress of having severe and disfiguring acne can also contribute to mood changes. Therefore, it becomes difficult to determine whether isotretinoin is in fact causing depression. Studies have also revealed that patients are emotionally better after being on the medication because their acne has improved. Currently, it is still unclear as to whether isotretinoin causes an increased risk of depression. If you are showing signs of depression or any psychiatric disturbances while on this drug, it should be stopped and you should notify your physician.

Allergic Reactions: These can present as hives, trouble breathing or swollen face or mouth. Urgent medical attention is required if any of these symptoms are experienced.

Changes in vision: One may experience decreased night vision and must be careful while night driving. This side effect usually does not persist after treatment.

Headaches: Benign intracranial hypertension is a rare side effect of isotretinoin. It can result in increased pressure of fluid in the brain. If ongoing persistent headaches occur while on isotretinoin, you should alert your physician.

Hearing Impairment: This usually does not persist after treatment.