Growing up, Julia suffered from hormonal cystic acne that “was deep and painful, and the under the skin pimples were impossible to pop.”
After struggling during her teenage years to find a solution that worked, she consulted with a dermatologist who recommended spironolactone. In just three weeks, her skin was already looking and feeling better. “Starting spironolactone is the best decision I’ve ever made,” she says. “It has had a dramatic effect on my confidence, not to mention that I no longer regularly feel the pain of cystic acne.”
Modern science is amazing, right? For the past six years, Julia’s prescription medication has given her freedom from cystic acne — but it did come with some downsides: “If you want it to keep working, you have to continue taking it."
Over a year ago, Julia took six months to wean herself off the medication safely in order to reduce the potential risks to her fertility. But as soon as the pandemic hit and she started wearing masks continually for her on-site work in construction, her acne resurfaced. Now, she’s back on the medication and grateful for the relief it provides.
Though her story is a promising one, not everyone experiences such immediate and effective relief for their skin issues. For some, it can take time and a little trial and error to find the right medication, which is why it’s so important to start the search by arming yourself with information.
When you know what the common dermatological prescriptions are, how they work, and what questions to ask to determine if they’re right for you, you are already on the path to finding the solutions you need.
What It Is: Spironolactone, often sold under the brand names Aldactone and CaroSpir, is a diuretic that comes as a pill or oral suspension (a medication that you dissolve in your mouth). It was originally created to treat conditions like high blood pressure, heart failure, and edema, but, because it works by blocking androgen hormones, it has also been used for over 30 years to tackle hormonal acne.
How It Works: Spironolactone works by slowing down your body’s production of androgen hormones (including testosterone and DHT). While your body needs androgens to function properly, producing too much of them can lead to an overproduction of sebum (oil), which can clog your pores and eventually cause acne. In addition to slowing down androgen production, spironolactone also prevents the androgens that are already present from causing unwanted side effects like acne, excessive hair growth, or hair loss.
Why You Might Be Prescribed It: Your dermatologist may prescribe spironolactone for the treatment of hormonal acne, PCOS-related hair growth, or alopecia-related hair loss. If you’ve recently gone off birth control and are experiencing hormonal acne, spironolactone may also be right for you.
You Should Keep in Mind: Everyone’s response to spironolactone is different — some may start to see an improvement in their acne or skin condition within a few weeks, while others may take longer to experience the benefits. Studies have shown that taking your daily dose at the same time every day can yield the best results, as can long-term use. Bottom line: the longer and more consistently you take spironolactone, the better outcome you’ll see.
Though spironolactone is considered a safe and effective acne treatment, it may not be right for everyone. Here are a few things to keep in mind:
Not safe for pregnancy: Stop taking spironolactone if you are pregnant or trying to become pregnant, as this medication can cause birth defects.
Sun sensitivity: You should be cautious when outside, even on overcast or winter days, as spironolactone can make your skin more prone to burning. When taking spironolactone, remember: sunscreen, sunscreen, sunscreen.
More frequent urination: Because this medication is a diuretic, trips to the bathroom may increase.
Watch your potassium intake: Avoid using potassium supplements or salt substitutes that contain potassium while taking spironolactone, as this can raise potassium levels in your blood and cause heart problems. Certain medications can also increase your levels when on spironolactone. These include: ACE inhibitors, Angiotensin II receptor blockers (ARBs), Digoxin (Lanoxin), Nonsteroidal anti-inflammatory drugs (NSAIDs), Cyclosporine, and Triamterene (Dyrenium). Though practices vary from clinician-to-clinician, most dermatologists will want to monitor your potassium levels via blood work every six months or so when taking this medication.
What They Are: Retinoids are a form of vitamin A that has been approved by the Food and Drug Administration (FDA) to treat acne, psoriasis, wrinkles, skin discoloration, and other skin conditions.
One of the most popular prescription retinoids for acne is Tretinoin, which can also be found under the brand names Atralin, Avita, Retin-A®, and Renova®. Adapalene (brand name Differin), is also commonly prescribed for the treatment of mild to moderate acne, while Acitretin (brand name Soriatane) and tazarotene (brand names Avage, Fabior, and Tazorac) are used to treat both acne and psoriasis.
Keep in mind that retinoids are similar, but not the same, as retinol. Both treat acne and other skin conditions, but retinoids refer to prescription medications while retinols are over-the-counter treatments often found in beauty products. As a result, retinoids often come in higher doses andare held to a higher standard of quality control.
How They Work: Put simply, retinoids work by speeding up your body’s production of new skin cells. Increased skin cell turnover helps to unclog pores, clear skin, even out pigmentation, minimize fine lines, and reduce or eliminate acne.
Why You Might Be Prescribed Them: These medications are a popular solution among dermatologists to treat acne, psoriasis, and skin discoloration.
You Should Keep in Mind: As with most medications, retinoids are not right for everyone. Some things to keep in mind before using retinoids:
Increased dry skin: The most common side effect of retinoid and retinol use is dry skin, including itching, redness, and stinging. For this reason, it’s common for most people using retinoids to see their skin worsen before things get better. For most people, these symptoms will clear up within 12 weeks, after which their acne finally begins to clear and improve.
Not safe for pregnancy: Retinoids are not recommended if you are pregnant or trying to become pregnant, as they can lead to birth defects.
Don’t use with these acne treatments: It’s important to talk to your doctor about any OTC treatments you may be taking before starting retinoids. Generally, doctors don’t recommend using additional topical skin products that contain peeling agents (benzoyl peroxide, resorcinol, salicylic acid, or sulfur). Other products you may want to avoid include hair removal products and skin products that are extra drying or abrasive.
Sun sensitivity: You should be cautious when outside, even on overcast or winter days, as retinoids can make your skin more prone to burning. In addition to protecting your skin by wearing a hat and using sunscreen whenever possible, opt to apply or use retinoids at night.
What It Is: Isotretinoin is a prescription-strength medication used to treat severe acne that has not responded to other therapies, including antibiotics. Isotretinoin can also be found under the brand names, Accutane, Amnesteem, and Claravis.
How It Works: Similar to retinoids, isotretinoin is a derivative of vitamin A. It works by decreasing the size of the glands that produce sebum (or oil). When too much sebum is secreted — which can be caused by a hormonal imbalance — it can result in severe acne.
Why You Might Be Prescribed It: Isotretinoin is most often prescribed for the treatment of severe acne that has not responded to a full course of oral antibiotics. This medication can also be prescribed to treat psoriasis.
You Should Keep in Mind: Isotretinoin is a powerful medication and is not recommended for everyone. Here are some of the side effects, risk factors, and contraindications to consider:
Side effects: Isotretinoin can have potentially severe side effects that include depression and risk of suicide, stomach problems, night blindness, headaches, muscle aches and pains, and dry or itchy skin.
Not safe for pregnancy: Isotretinoin poses an extremely high risk of severe birth defects during pregnancy—including cleft lips, ear and eye defects, and mental retardation—as excess vitamin A can disrupt genetic control of body shape (axial patterning) during an embryo’s development. Patients using isotretinoin are required to have a negative pregnancy test before any medication is given out and are cautioned against getting pregnant during the course of treatment. For this reason, women of reproductive age are also required to sign up for a pregnancy risk program called iPLEDGE™ before filling their prescription.
Mandatory risk management: All people receiving isotretinoin must participate in an FDA-approved risk management program, including regular monitoring appointments with their doctor to screen for any severe side effects.
Sun sensitivity: You should be cautious when outside, even on overcast or winter days, as isotretinoin can make your skin more prone to burning. In addition to protecting your skin by wearing a hat and using sunscreen whenever possible, opt to apply or use retinoids at night.
Alcohol and other interactions: Studies show that drinking excessively can reduce the efficacy of isotretinoin. In addition to watching your alcohol intake, medications you should avoid when taking isotretinoin include any over the counter treatment that has salicylic acid, drugs that treat epilepsy, oral antibiotics (specifically tetracyclines), and vitamin A and supplements containing vitamin A.
4. Oral Contraceptives
What They Are: For decades, oral contraceptives have been a popular acne treatment among dermatologists. There are currently three hormonal birth control pills on the market that the FDA has approved for use in women who suffer from acne: Ortho Tri-Cyclen, Yaz, and Estrostep.
How They Work: Combined oral contraceptives, as this version of the pill is known, use a combination of progestin (a synthetic form of the hormone progesterone) and estrogen to calm the monthly hormonal spike that comes with a normal cycle and lower the amount of androgens in your body, which in turn reduces oil production and acne.
Why You Might Be Prescribed Them: If you suffer from mild to severe acne, are at least 14 or 15 years of age, and have started your period, your doctor or dermatologist may prescribe the pill.
You Should Keep in Mind: It may take several weeks or months for your acne to improve after you begin hormonal birth control. For this reason, some people continue using other acne medications when they first start their prescription. It may also take several months to find the right brand that works for you with the least number of side effects.
Some things to consider before taking combined oral contraceptives:
Side effects: The pill can have some side effects including weight gain, mood changes including depression, migraines, and breast tenderness. It can also cause an increased risk of blood clots, so if you smoke or have any history of heart problems or blood clotting disorders, this might not be the right solution for you.
Timing matters: It’s important to take your oral contraceptive at the same time every day to help increase its efficacy.
Negative drug interactions: Some medications, including certain antibiotics, can reduce the pill’s efficacy at preventing pregnancy.
What They Are: Antibiotics refer to a class of oral and topical medications that are used to reduce bacteria and/or treat bacterial infections. For many dermatologists, the first-line antibiotic of choice is tetracycline, which is often prescribed as minocycline (also known by the brand name Minocin) and doxycycline (Monodox, Targadox).
For people who can’t take a tetracycline—including pregnant women and children under 8 years old—your dermatologist might recommend a macrolide instead, like erythromycin or azithromycin.
How They Work: Antibiotics work to prevent the growth of new bacteria that cause acne and to kill bacteria that may be already present on your skin. By getting rid of the bacteria, you can reduce the number of pimples that pop up, as well as the resulting scarring and improve the overall look and health of your skin.
Why You Might Be Prescribed Them: If you have moderate to severe acne, your dermatologist may prescribe an antibiotic to help tackle any bacteria that may be part of the root cause of the issue.
You Should Keep in Mind: Oral antibiotics should not be used for a prolonged period as they can lead to antibiotic resistance. Benzoyl peroxide is often recommended for use along with topical antibiotics in order to decrease the risk of resistance.
Use caution if pregnant or breastfeeding: Not all antibiotics are considered safe for use during pregnancy and breastfeeding, so speak with your doctor first before taking them.
Sun sensitivity: You should be cautious when outside, even on overcast or winter days, as antibiotics can make your skin more prone to burning. In addition to protecting your skin by wearing a hat and using sunscreen whenever possible.
6. Topical Steroids
What They Are: Topical steroids are one of the most commonly prescribed treatments for all types of eczema and are also used in the treatment of psoriasis.
How They Work: Steroids are naturally produced by our bodies to help regulate the growth and functioning of cells and organs. In topical steroids, a synthetic form of this chemical is added to creams and lotions to help reduce skin inflammation and itching.
Why You Might Be Prescribed Them: If you are suffering from the dry, itchy, sometimes painful skin flare-ups that come with eczema, your dermatologist may prescribe a topical steroid to help bring you relief. These creams come in a variety of potencies depending on the severity and location of your skin irritation.
You Should Keep in Mind: If you follow the guidelines for how long topical steroids should be used, side effects are uncommon. But there are a few things to keep in mind:
Apply to affected areas only: Topical steroids should only be applied to the areas with eczema and should not be used on delicate skin like your eyelids.
Keep treatment short: This medication is generally only recommended for short courses of treatment, typically 7 to 14 days, while an eczema flare-up is occurring. Prolonged use of topical steroids can have suppressive effects on hormone levels, so you want to ensure that you are following the guidelines.
7. Topical Calcineurin Inhibitors
What They Are: Topical calcineurin inhibitors (CNIs), which are often prescribed under the names tacrolimus (or Protopic) and pimecrolimus (or Elidel), are another type of medication used to treat moderate to severe eczema symptoms. CNIs are most often prescribed in cases where a topical steroid hasn’t been effective.
How They Work: Eczema is an inflammatory reaction that occurs when your immune system overreacts to an allergen or something in the environment. CNIs work by altering this immune system response and disrupting the skin inflammation that it produces.
Why You Might Be Prescribed Them: If your eczema has not responded well to other treatments, your dermatologist may prescribe CNIs as the next option. They may also be recommended if your eczema flare-ups occur on more delicate skin, including your neck, eyelids, or vaginal area, where topical steroid use is not advised.
You Should Keep in Mind: It is particularly important to follow your doctor’s instructions with CNIs — don’t apply them too often or use too much at one time. A few other things to keep in mind:
Don’t mix with topical steroids: CNIs and topical steroids may be used at the same time on different parts of the body, but they should not be used together on the same flare-up.
Sun sensitivity: Too much natural sun exposure or any artificial UV light (aka tanning beds) is a bad idea while on CNIs, which can increase your skin’s sensitivity and make you more prone to sunburns.
Initial burning or itching is common: Many patients have reported some mild burning or itching when they first begin using CNIs, but this side effect generally disappears within a week.
Not advised during pregnancy: Research is scarce on the safety of CNIs during pregnancy, so it is generally not recommended.
What It Is: Cyclosporine (under the brand names Neoral, Gengraf, and Sandimmune) is another type of calcineurin inhibitor (CNI), but it is usually prescribed in pill form and is used by dermatologists to treat severe psoriasis.
How It Works: While topical CNIs work to suppress the immune system from the outside, cyclosporine does the same on the inside. By interrupting an overactive immune response, it can prevent your body from attacking its own cells and causing psoriasis.
Why You Might Be Prescribed It: You are a candidate for cyclosporine if you have severe psoriasis and an otherwise healthy immune system, and if other treatments like topical steroids haven’t worked.
You Should Keep in Mind: In some people, cyclosporine can provide rapid relief from their symptoms, but others may not see improvements for a few weeks. A few other things to keep in mind:
Not safe with compromised immune system: If you currently have a weak immune system or have ever had the condition, consult with your doctor as cyclosporine works to suppress your immune system, and it may not be safe for you.
May decrease efficacy of vaccines: Some vaccines do not mix well with this medication, so make sure you talk to your doctor if you are due for an injection.
Not safe for pregnancy: Cyclosporine is not safe to take if you are pregnant or breastfeeding.
Many Contraindications: Cyclosporine does not play well with many other medications and supplements. Make sure to get a full list from your doctor, but some common ones include aspirin, ibuprofen, and antibiotics.
Watch your potassium: Because cyclosporine can increase your potassium levels, you will need to watch your potassium intake while on this drug. Potassium-rich foods including bananas, tomatoes, and carrots, should be consumed in limited quantities. Grapefruit should also not be consumed in any form while on this medication. For this reason, your doctor may want to monitor your potassium levels via regular blood work.
9. Mirvaso & Rhofade
What They Are: The gel Mirvaso (brimonidine) and the cream Rhofade (oxymetazoline) are FDA-approved topical medications specifically used to treat the redness that comes with rosacea.
How They Work: Both medications belong to a class of drugs called alpha-agonists that work to constrict blood vessels, which can dramatically reduce facial redness.
Why You Might Be Prescribed Them: If you struggle with redness and flushing brought on by rosacea, your doctor may put you on Mirvaso or Rhofade to provide relief.
You Should Keep in Mind: These topical treatments are temporary, so regular and consistent use is required to see prolonged results. They should also never be applied to the mouth or eyes. A few other things to keep in mind:
May be expensive: Both of these medications can be costly and are often not covered by insurance.
Rebound flushing with Mirvaso: Some patients have reported rebound flushing, or intense skin redness, at the end of the day when the Mirvaso gel has worn off. This side effect is not as widely experienced with Rhofade.
Drug interactions: These topical prescriptions can decrease the effectiveness of any medication prescribed to lower blood pressure. They should also be used with caution by anyone on monoamine oxidase inhibitors (MAOIs), which are prescribed for depression, as the two medications used together can increase your risk of high blood pressure.
What Is It: Latisse is an FDA-approved liquid medication used to encourage eyelash growth.
How It Works: Latisse is applied regularly along the lash line of the upper eyelid and is thought to work by lengthening the amount of time eyelash follicles stay in their growth phase, helping to encourage longer, thicker, and darker eyelashes.
Why You Might Be Prescribed It: If you have sparse eyelashes or want to encourage increased growth and fullness, your doctor may prescribe Latisse.
You Should Keep in Mind: Latisse is meant to be used on the upper eyelid only, and results can take up to two months to take effect. Once you stop using Latisse, your eyelashes will eventually return to their regular length and appearance. If you have healthy eyes, Latisse is generally safe to use. But a few side effects to keep in mind.
Eye irritation: Latisse can cause some eye irritation, including itchy, red, eyes.
Eye Discoloration: This medication can also cause your eyelids to darken, a symptom that may go away after you stop using Latisse. In more serious cases, it can also cause the darkening of iris pigmentation, which is not reversible.
What Is It: Vaniqa® is a cream that is FDA-approved for use in slowing the growth of unwanted facial hair.
How It Works: This topical cream works by blocking an enzyme in the skin that is needed for hair growth. This helps to slow the production of new facial hair and to lighten its appearance. However, it does not remove unwanted hair or cause the existing hair to fall out.
Why You Might Be Prescribed It: If you have PCOS-related hirsutism or pesky patches of hair growth on your face, your doctor may prescribe Vaniqa®.
You Should Keep in Mind: Vaniqa® may take several weeks of twice daily use before you begin to see results. A few other factors you should know:
Don’t apply directly after hair removal: You need at least a five-minute buffer between any hair removal activities (shaving, plucking, or waxing) and application of the cream.
Use caution if pregnant or breastfeeding: Because no studies have been done on possible side effects during pregnancy, it is recommended that you discuss continuing use of Vaniqa® if you are pregnant or breastfeeding.
Beginning a new medication can be a big decision, requiring you to weigh the potential for relief with any side effects it may bring. We believe every woman should be armed with all the information she needs to know what questions to ask her doctor and to consider what treatments are right for her health.