# Acne That Requires Prescription Treatment
Acne is a common skin condition that affects people of all ages, but not all cases are the same. While many people can manage mild acne with over-the-counter products, some individuals develop severe acne that requires prescription medications to treat effectively.
Understanding what causes acne to become severe enough to need prescription care can help you recognize when it’s time to see a dermatologist.
## What Makes Acne Severe
Acne develops when several factors work together to create the right conditions for breakouts. The exact cause of acne is not fully understood, but research has identified genetic, hormonal, and environmental factors that contribute to or worsen the condition. Contrary to common myths, acne is not caused by poor hygiene, diet, or stress.
The basic process involves your skin producing too much oil, dead skin cells clogging pores, and bacteria infecting these clogged areas, leading to inflammation and breakouts. When this process becomes severe and doesn’t respond to standard treatments, prescription medications become necessary.
## Hormonal Acne and Prescription Treatment
For many people, especially women, hormones play a major role in acne development. Hormonal imbalances can result from conditions like polycystic ovarian disease (PCOS), birth control methods, pregnancy, or menopause. When hormones are out of balance, they can increase the production of androgens, which are male hormones that boost oil production in the skin and clog pores.
Hormonal acne often appears along the jawline and in the T-zone area of the face. When this type of acne doesn’t respond to topical treatments, doctors may prescribe spironolactone, a medication that blocks the effects of androgen hormones in women. This prescription medication works by slowing down your body’s production of these hormones, reducing excess oil production and preventing breakouts.
## Severe Nodular Acne
The most serious form of acne is severe nodular acne, which is resistant to conventional treatments like systemic antibiotics and topical medications. This type of acne causes large, painful bumps and can lead to permanent scarring if left untreated.
For severe nodular acne that doesn’t respond to standard therapy, doctors prescribe isotretinoin, an oral retinoid medication. Isotretinoin is a powerful medication that was FDA-approved in 1982 specifically for treating this severe form of acne. The medication works by reducing sebaceous gland size and sebum production, essentially shrinking the oil glands in your skin. It is taken daily at doses between 0.5 to 1.0 mg per kilogram of body weight.
## When to Seek Prescription Treatment
According to dermatology guidelines, prescription treatment should be considered for patients with severe acne or those who have not responded to standard treatments including oral and topical therapies. Additionally, patients who experience significant emotional distress from their acne or who show signs of scarring should be evaluated for prescription medications.
If you have moderate to severe acne, it’s important to seek medical care from a dermatologist to avoid further complications and permanent skin damage. Your doctor will review your complete medical history, allergies, and current medications before prescribing any treatment to prevent drug interactions.
## Other Prescription Options
Beyond isotretinoin and spironolactone, dermatologists have other prescription tools available. Tretinoin, a topical vitamin A derivative, encourages skin cells to shed faster and more evenly, helping prevent the clogged pores that cause breakouts. Clascoterone is the first FDA-approved topical antiandrogen, working locally on the skin to target acne-causing hormones without affecting hormones throughout the rest of the body.
For older adults who develop acne, low-dose systemic isotretinoin may be beneficial for some patients, though treatment typically emphasizes gentler options first.
## Important Considerations
Treatment effectiveness takes time. It may take several weeks to see improvement from prescription acne medications, so patience is essential. Your dermatologist may recommend a combination of treatments working together for the best results.
It’s crucial to follow your doctor’s instructions carefully and never stop taking prescribed acne medication without consulting your healthcare provider first. Some medications, particularly antibiotics, can become less effective over time due to bacterial resistance, which is why your doctor might adjust your treatment plan.
If you are pregnant, planning to become pregnant, or breast-feeding, inform your doctor before starting any acne treatment, as some medications can cause serious birth defects.
## Sources
https://www.ncbi.nlm.nih.gov/books/NBK525949/
https://www.goodrx.com/spironolactone/spironolactone-for-acne-how-does-it-work
https://www.tuftsmedicine.org/about-us/news/acne-over-30
https://www.pharmacytimes.com/view/the-educated-patient-clearing-up-acne
