For mild to moderate or moderate to severe acne, you'll usually start with a combination of topical treatments or antibiotic tablets combined with topical medications. For moderate to severe acne, you may need oral antibiotics to reduce bacteria. Usually, the first choice for treating acne is a tetracycline (minocycline, doxycycline) or a macrolide (erythromycin, azithromycin). A macrolide may be an option for people who can't take tetracyclines, including pregnant women and children younger than 8 years old.
A combination of antibiotic tablets and topical treatments is often the first treatment option for severe acne. If this doesn't work, a medication called isotretinoin may be prescribed. First-line treatment for moderate acne vulgaris includes a combination of benzoyl peroxide and a topical antibiotic (erythromycin or clindamycin), a topical retinoid, or both; benzoyl peroxide, an oral antibiotic and a topical retinoid; or benzoyl peroxide, oral and topical antibiotics and a topical retinoid. Alternative treatments to consider include a different combination of medications; changing the oral antibiotic; adding a combined oral contraceptive or spironolactone in women; or oral isotretinoin. You may not see the benefits of this treatment for a few months, so it may be helpful to use other acne medications for the first few weeks.
