Prescription oral medication works on an internal level to do one of two things: inhibit the enzyme that leads to blemish-causing actions or to reduce the bacteria in pores.
Spironolactone is a diuretic that was originally intended to treat high blood pressure, hyperaldosteronism (when the body produces too much of the hormone aldosterone) and low potassium levels. As an acne treatment, spironolactone is known to block dihydrotestosterone, which basically means it works to block the follicular enzymes (5-a reductase) from reacting with androgen receptor sites. When there is an overproduction of testosterone, or there is a testosterone sensitivity, it can cause increased resistant adult breakouts, especially nodules and cysts on the chin and jawline.
Often used to combat hormonally based acne—painful nodules and cysts along the jawline, chin and lower part of the face—spironolactone should be taken in low doses, and probably indefinitely, too, to keep breakouts from returning. But a low dose is considered safe.
Birth control pills can also help regulate hormone levels by absorbing the extra testosterone making it less likely to bind with the receptors that relay messages of increased oil production. For those who don’t want to take an oral contraceptive, spironolactone acts similarly.
A wide variety of oral and topical antibiotics are prescribed to treat acne, including tetracycline, erythromycin, minocycline, doxycycline and clindamycin. Many factors come into play when choosing the antibiotic, including a patient’s age, allergies and if they are pregnant or nursing. Seattle, WA, dermatologist Dr. Jennifer Reichel explains that minocycline is often her first choice, because “It’s an easy once-a-day dose and it’s well tolerated by most patients.”
Antibiotics decrease the number of bacteria present in the pores. In addition, they help hinder the inflammatory response once a pore is clogged, thus reducing the telltale redness and swelling associated with blemishes. Kansas City, MO dermatologist Dr. Audrey Kunin says, “No matter the therapy, it takes six to eight weeks to see improvement.”
Beverly Hills, CA, dermatologist Stuart Kaplan, MD, often recommends more aggressive acne prevention with oral antibiotics, since healed pimples may leave dark spots (post-inflammatory hyperpigmentation) on pigmented skin, which are more difficult to treat than dark spots in lighter skin. Solodyne is an FDA-approved oral antibiotic specifically dosed to treat mild to severe cystic acne.