Prescription Topical Treatments for Acne

If over-the-counter acne products haven’t delivered the results you hoped for, it may be time to consider prescription topical acne treatments. Dermatologist-prescribed creams and gels are often recommended for stubborn, moderate, or severe breakouts and they work in more targeted, powerful ways.

These treatments can reduce inflammation, kill acne-causing bacteria, unclog pores, and help fade post-acne discoloration. The right choice depends on your skin type, acne severity, and whether you’re also dealing with sensitivity or hyperpigmentation.

Here’s what you need to know.

Azelaic Acid

Azelaic acid is a prescription cream or gel used for mild to moderate acne. It’s sold under brand names like Azelex and Finacea.

How it works:

• Reduces Cutibacterium acnes (formerly Propionibacterium acnes)

• Normalizes the shedding of dead skin cells

• Decreases inflammation

One major bonus? Azelaic acid can help fade post-inflammatory hyperpigmentation (PIH) the dark marks left behind after acne heals. This makes it especially helpful for people with darker skin tones, who are more prone to discoloration.

It’s generally well tolerated and often recommended for sensitive skin.

Topical Retinoids

Topical retinoids are vitamin A derivatives that are considered one of the most effective acne treatments available. Dermatology guidelines frequently list them as first-line therapy for acne.

They work by:

• Increasing skin cell turnover

• Preventing clogged pores

• Reducing the formation of comedones (blackheads and whiteheads)

Common options include:

• Tretinoin (Retin-A, Retin-A Micro)

• Tazarotene (Avage, Tazorac)

• Adapalene (Differin)

Retinoids are effective for mild to severe acne and also offer anti-aging benefits, including improvement in fine lines and uneven texture.

Important note: Many people experience a temporary acne “purge” during the first few weeks. Mild redness, peeling, and dryness are common but typically improve with consistent use.

Tip for sensitive skin:

• Start with a pea-sized amount

• Apply every other night at first

• Use a moisturizer regularly

• Always wear sunscreen, as retinoids increase sun sensitivity

Topical Antibiotics

Topical antibiotics treat acne by stopping the growth of acne-causing bacteria and reducing inflammation.

Common prescriptions include:

• Clindamycin

• Erythromycin

They’re typically used for moderate to severe inflammatory acne.

However, due to concerns about antibiotic resistance, dermatologists rarely prescribe them alone. Instead, they’re usually combined with benzoyl peroxide or a retinoid. In fact, guidelines recommend limiting topical antibiotic use to about 12 weeks when possible.

Using them in combination:

• Reduces bacterial resistance

• Improves effectiveness

• Allows for lower antibiotic doses

Topical Combination Medications

Combination treatments contain two or even three active ingredients in one product. This simplifies your routine while targeting acne from multiple angles.

They may:

• Kill bacteria

• Reduce inflammation

• Prevent clogged pores

• Increase cell turnover

Popular options include:

• Acanya (clindamycin + benzoyl peroxide)

• Epiduo (adapalene + benzoyl peroxide)

• Onexton (clindamycin + benzoyl peroxide)

• Ziana (clindamycin + tretinoin)

In 2023, the FDA approved Cabtreo, the first triple-combination topical gel containing clindamycin, adapalene, and benzoyl peroxide for patients 12 and older.

Research shows combination therapies improve adherence and often produce better outcomes than single-ingredient treatments.

Special Considerations for Sensitive Skin

If your skin reacts easily, prescription acne treatments may initially cause:

• Dryness

• Peeling

• Redness

• Mild burning or stinging

To minimize irritation:

• Introduce one product at a time

• Use gentle, fragrance-free cleansers

• Apply a non-comedogenic moisturizer

• Avoid harsh scrubs or exfoliants

If irritation persists or worsens, consult your dermatologist adjustments in strength or frequency can often solve the issue.

Do You Need a Prescription?

You may benefit from prescription topical acne treatments if:

• OTC treatments haven’t worked after 8–12 weeks

• You have painful cystic acne

• You’re developing scarring

• You experience persistent hyperpigmentation

• Breakouts significantly impact your confidence or daily life

Acne affects up to 85% of people between ages 12 and 24, and adult acne especially in women remains common into the 30s and beyond. Prescription treatments can make a significant difference when tailored to your skin’s needs.

Prescription topical acne treatments offer powerful, targeted solutions for stubborn breakouts. Whether you need a retinoid, azelaic acid, or a modern combination gel, a dermatologist can help build a plan that works with your skin not against it.

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