The good news is that a whole range of therapeutic solutions are currently available to combat acne. When talking to your doctor, you should therefore provide him with all relevant details that may help him determine a strategy.

With the advice of a pharmacist and doctor, everyone should be able to find a solution to eliminate all types of blemishes: blackheads, whiteheads, red spots, cysts, etc.

Oral acne medications are available by prescription only. Depending on the type of acne (comedonal acne, inflammatory acne, cysts) and its severity, the doctor may prescribe an oral treatment, often in combination with topical treatments containing antibiotics, hormones or retinoids.

The use of oral antibiotics alone is declining, due to antimicrobial resistance phenomena and their negative effects on the skin microbiome. However, these treatments remain appropriate in certain cases, in combination with other active ingredients, although doctors seldom prescribe them for longer than three months.

They have few side effects overall but are often photo-sensitising. You should therefore apply an effective sun protection product if exposed to the sun when taking this type of treatment.

Woman taking medication

Hormones and acne

In combination with progesterone, oestrogen exerts hormonal action, in the same way as certain birth control pills with similar effects. With a high risk of thrombosis (blood clot), these are now reserved for certain women and are no longer prescribed as first-line therapy. A gynaecologist’s opinion is needed.

Hormonal treatments require an in-depth discussion with a doctor beforehand, since the risk of thrombosis is high, especially for smokers and for women with a family history of vascular disorders.

 

Isotretinoin and acne

A synthetic derivative of vitamin A, this molecule is reserved for severe acne and more specifically for cases of cysts and nodules, with a large inflammatory component.

It can only be prescribed by dermatologists, under strictly controlled conditions, although general practitioners are authorised to write repeat prescriptions.

 It should only be prescribed when all other treatment types have failed or when there is a high risk of scarring. Oral isotretinoin is highly effective in treating acne but has a long list of side effects, in particular extreme dryness of the skin and mucous membranes.

 

Side effects of oral acne treatments

  • Antibiotics generally have few side effects. However, they can trigger a phenomenon of antimicrobial resistance and promote the development of undesirable resistant bacteria such as Staphylococcus aureus. Their comprehensive antibacterial action also destroys the “good” bacteria of the skin microbiome and by modifying its environment, they create an imbalance whose consequences for acne are still unknown although the effects may be devastating. Lastly, the substances used in antibiotics can irritate and dry out the skin. In this case, a compensating moisturising treatment is essential.
  • Isotretinoin directly influences sebum production and causes sometimes extreme and often uncomfortable dryness. The start of treatment should go hand in hand with the application of effective compensating moisturising products for the skin of the face and lips. Sometimes it is also necessary to lubricate the eyes with specific solutions, since this dryness affects all mucous membranes, hair and nails. During treatment, the skin becomes thinner and thus more sensitive to the sun: once again, anti-UV protection is absolutely necessary. Lastly, oral isotretinoin can have effects on the liver, and liver function tests are prescribed on a regular basis throughout the duration of treatment. Also bear in mind that it can only be prescribed for patients using effective contraception and taking monthly pregnancy tests.