In people with moderate or severe acne, topically applied medicines are usually not sufficient to treat acne effectively. In these cases, oral medications are prescribed. Usually, your doctor will start with an oral antibiotic pill.
These antibiotics work by treating the bacteria in the affected pores as well as by reducing the associated inflammation. Patience is needed while these pills take effect, usually 6 to 8 weeks later.
For women with acne, oral contraceptive pills (birth control pills) are often prescribed. These pills work by blocking acne-causing hormones and also require patience, taking up to 3 to 4 months to show effects.
Another pill that is occasionally used is spironolactone that works by blocking the hormones that cause oil glands to become overactive. In the most severe cases of acne when other pills don’t work, isotretinoin (Accutane®) is prescribed.
Isotretinoin is a derivative of Vitamin A and is a very potent treatment for acne. It works by shrinking the overactive oil glands in acne pores. Treatment usually takes several months but can lead to long-lasting improvement.
Isotretinoin has important possible side effects and is not appropriate for all patients. Only your doctor can determine if it is right for you.
Birth Control Pills as Treatment for Acne
Note: Our doctors work with your gynecologist when needed to plan your acne treatment using birth control pills.
By affecting the internal hormone balance, birth control pills work at the level of the sebaceous (oil producing) gland to reduce the production of the oily substance called sebum. When sebum production becomes excessive, a pore can become clogged and develop into a pimple (see Understanding Acne).
The optimal effects of oral contraceptive pills in clearing a woman’s complexion are not immediate. It usually takes several months for results to be seen. Sometimes, a woman may experience worsening of acne breakouts during the initial treatment period. With continued and consistent use, however, the acne flares usually decrease and clearing occurs after several months of use. It is important to remember that taking additional medications such as certain antibiotics together with oral contraceptives may decrease the effectiveness of the birth control pill in preventing pregnancy. Therefore, two forms of birth control should be used during such combination treatment.
Estrostep®, which contains norethindrone, Ortho-Tri-Cyclen®, which contains norgestimate, and Yaz®, which contains drospirenone are all used in the treatment of moderate acne vulgaris.
Estrostep and Ortho-Tri-Cyclen are both indicated for females of at least 15 years of age while Yaz may be used in those as young as 14 years old. For all three, treatment should not begin until the onset of menarche.
Other oral contraceptive pills such as Yasmin® and Alesse® have been shown to exhibit improvement in acne breakouts. However it is likely that many others would be beneficial in acne treatment.
Also, women over 35 years of age or those who smoke should not be given prescriptions for birth control pills due to the risk of blood clots, heart attacks and strokes. Also, women who have high blood pressure are also at risk of severe side effects from birth control pills.
If a woman is predisposed to migraine headaches, this may be worsened by a birth control regimen. Other potential side effects can also occur and these as well as all other considerations should be reviewed with your gynecologist before treatment is begun.
Finally, any woman taking birth control pills should be carefully monitored and receive routine examinations by a gynecologist.