Treatments for severe acne

Treatment for Moderate to Severe Inflammatory Acne

People with moderate to severe inflammatory acne may be treated with prescription topical or oral medicines, alone or in combination.

Prescription Topical Medicines

Several types of prescription topical medicines are used to treat acne. They include:

Antibiotics – help stop or slow the growth of bacteria and reduce inflammation


Vitamin A derivatives (retinoids) – unplug existing comedones (plural of comedo), allowing other topical medicines, such as antibiotics, to enter the follicles. Some may also help decrease the formation of comedones. These drugs contain an altered form of vitamin A. Some examples are tretinoin (Retin-A2), adapalene (Differin), and tazarotene (Tazorac)


Others – may destroy P. acnes and reduce oil production or help stop or slow the growth of bacteria and reduce inflammation. Some examples are prescription strength Benzoyl peroxide, sodium sulfacetamide/sulfur-containing products, or Azelaic acid (Azelex).

Like OTC topical medicines, prescription topical medicines come as creams, lotions, solutions, gels, or pads. Your doctor will consider your skin type when prescribing a product. Creams and lotions provide moisture and tend to be good choices for people with sensitive skin. If you have very oily skin or live in a hot, humid climate, you may prefer an alcohol-based gel or solution, which tends to dry the skin. Your doctor will tell you how to apply the medicine and how often to use it.

For some people, prescription topical medicines cause minor side effects, including stinging, burning, redness, peeling, scaling, or discoloration of the skin. With some medicines, such as tretinoin, these side effects usually decrease or go away after the medicine is used for a period of time. If side effects are severe or don't go away, notify your doctor.
As with OTC medicines, the benefits of prescription topical medicines are not immediate. Your skin may seem worse before it gets better. It may take from 4 to 8 weeks to notice improvement.