The type of medication used to treat acne depends on the severity of the condition. Mild to moderate acne is treated with topical medications such as retinoids, benzoyl peroxide, salicylic acid and topical antibiotics. Topical retinoids are the foundation of treatment. They are a derivative of vitamin A and work to unclog pores and prevent whiteheads and blackheads from forming. They may cause an initial irritation of the skin in the first 2-4 weeks. This is a common reaction and can be managed by moisturizing the skin, using sunscreen and increasing the dose of the retinoid gradually. My personal choice is Adapalene (Differin) because it is non-photosensitizing (doesn't cause irritation with sun exposure) and it can be used in the mornings. Other retionids include Treinoin (Retin-A) and Tazarotene (Tazorac) which is reserved for oily skins.
In general, if the topical retinoid alone is not sufficient, then a combination of the retinoid with a topical antibiotic (newly approved Ziana Gel) or a combination of benzoyl peroxide with a topical antibiotic (Duac or Benzaclin) may be given for a broader coverage. I prefer Duac because it does not need to be refrigerated and it can be applied once a day which improves compliance.
Oral agents are used to target moderate to severe acne. These include antibiotics, isotretinoin (Accutane), birth control pills, testosterone blockers and corticosteroids. Antibiotics are the most commonly used of these options. They include tetracycline, doxycycline, minocycline, and erythromycin. Each of these has its own set of side effects. The choice of the antibiotic depends on the tolerance of side effects as well as the cost with doxycycline and tetracycline being the least expensive and minocycline being the most expensive. Antibiotics are generally given for 3-6 months and are then tapered off.
Almost all birth control pills can help reduce acne for the majority of women. They are especially useful for premenstrual flares of acne. My preferred oral contraceptive for acne is Yasmin because it helps to block the affect of androgen on the sebaceous (oil producing) hair follicles. Other pills are Demulen 1/50, Orhto-Tri Cyclen, Orhto-Cyclen, Ortho-Evra, Mircette, Brevicon, and Modicon. All of these are higher estrogen, lower androgen potency pill.
Please note that Depo-Provera, a long acting progesterone contraceptive, is often associated with acne. It needs to be avoided in patients with acne.
Severe acne with scarring may be treated with Accutane. Patients should not get pregnant during treatment with this medication because it can cause birth defects. The treatment is 20 weeks long and the major side effects are dryness of the lips. The patient should also be monitored for depression and for abnormalities in liver or cholesterol by routine blood tests.
Once the acne is controlled, there are several methods available to improve the scarred areas. These include fillers, chemical peels, dermabrasion, or laser resurfacing. These procedures may be done by a dermatologist or a plastic surgeon.
References: please see above links.