If acne persists even after you’ve tried topical treatments, a dermatologist at NYU Langone may recommend oral medications—those taken by mouth—that can effectively combat blemishes by killing bacteria on and within the skin, or by regulating the hormone changes that lead to breakouts.
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These medications are available by prescription only, and your dermatologist can recommend the proper dosage based on your symptoms. Often, your dermatologist prescribes mediation for an initial period of three to six months, then examines your skin to assess how well treatment is working. At that time, your dermatologist determines whether to continue or adjust treatment.
Oral antibiotics are sometimes prescribed to treat acne blemishes that are rooted deep in the pore, including nodules and cysts. Bacteria that cause an infection beneath your skin can lead to these blemishes. Antibiotics kill these bacteria, reducing inflammation and redness and allowing pores to clear.
Typically, antibiotics start to clear skin in four weeks, and treatment can last for months. However, there is the risk that acne bacteria develop a resistance to antibiotics, and blemishes may reappear. Research shows that using benzoyl peroxide creams in addition to antibiotics may reduce the risk of developing antibiotic resistance. Dermatologists, therefore, may recommend that you use these medications simultaneously.
Birth control pills containing estrogen have been shown to reduce the effect of androgens, which are hormones that increase oil production in pores and cause blemishes to form. Estrogen may be an effective treatment option for women, in particular for those who experience acne breakouts during their menstrual cycles. If you get red, inflamed blemishes on your lower jawline or chin at the same time each month, clogged pores due to hormones are likely the culprit.
Women who are in the early stages of menopause may also experience a flare-up of acne in response to hormonal changes. Taking birth control pills is often an effective treatment option for these women.
Birth control pills must be taken daily and can result in skin improvement within three to four months.
For more severe forms of acne, your doctor may prescribe isotretinoin, a retinoid that is taken by mouth. Retinoids clear clogged pores by reducing the amount of oil that skin glands produce and killing the bacteria that reside there. This medication was previously manufactured under the brand name Accutane® but is now available in generic form.
It may take several months of using oral isotretinoin to see improvements in your skin, and dermatologists recommend waiting for at least two months before assessing the results. Treatment with isotretinoin has been shown to clear acne, even in people whose blemishes—including nodules and cysts—have been resistant to treatment before. However, this medication can cause side effects, including increased sun sensitivity and dry skin, and it may not work for everyone.
Isotretinoin can cause birth defects if taken by a woman while pregnant. As a precaution, the U.S. Food and Drug Administration has created the I-Pledge registration system that requires every female taking isotretinoin to be on two forms of birth control throughout treatment. Your dermatologist at NYU Langone helps you to complete the registration process and file the paperwork.
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