Oral vs Topical Acne Medications - Which Is Best For You?

What are the most common oral and topical medications for acne, and how can we understand them?

All of the recommendations\ we're going to discuss are prescription only which means you need to get them prescribed to you. These suggestions are not things you can buy over the counter. There are specific services though such as Apostrophe that allows you to get an online consultation with a dermatology care provider. You could also go into a doctor’s office or a medical clinic to discuss what’s going on with your skin and body.

What is the difference between topical and oral acne medication? 

Let’s speak about the main differences between oral and topical medications. Cassandra is going to share with you the top four ingredients /medications in each category. There are antibiotics, spironolactone, oral contraceptives, and vitamin A also known as tretinoin. Antibiotics include ingredients like erythromycin, tetracycline, minocycline, or doxycycline.  

How do antibiotics work?

Antibiotics work by being an “anti-bacterial” component. Antibiotics kill bacteria and stop them from being able to spread, and they need to be worn with sunscreen. Cutibacterium lives naturally in the skin, but if it eats too much oil, our skin will get clogged. When oil and debris has a hard time escaping, this causes pimple on our face. Antibiotics can be a helpful option, but they often cause digestion issues and an upset stomach. Antibiotics can also be used to treat a wide variety of other bacterial infections in the body, and if they’re prescribed to you, always take the full dose. If you only take a part or a half, you could be making your body to be antibiotic resistant. 

What is spironolactone?

There are very few places to get spironolactone, but if you can find it, it could be wonderful. Spironolactone is known as a diuretic. It’s a water pill, and it makes some people urinate. Similar to antibiotics, it can be used for a multitude of things. As opposed to birth control, spironolactone can be used in both men and women.

As a bonus,  spironolactone can be used for hair loss, but it depends on what your physician says. It’s so important to speak to a doctor or dermatologist. If you are prescribed it, spironolactone works by binding to specific receptors. It binds to the 5 alpha dihydrotestosterone receptor. When it binds to the receptors, it doesn’t allow your body’s natural sex hormones such as testosterone and other androgens to bind. 

A lot of time androgens and testosterone are contributing factors to acne because they can cause more oil to be produced in your skin which the acne bacteria feeds off of. Spironolactone is normally used to treat hormonal acne specifically for women, but as mentioned before, the topical formula can be used for both men and women which makes it fantastic. As opposed to antibiotics and retinoids, spironolactone tends to have fewer side effects such as redness and irritation.

Topical antibiotics

Antibiotics like clindamycin or erythromycin can be used topically. Topical antibiotics use hair follicles and pores to get into the skin, and they hang out where the bacteria is present. They go in there like a trojan horse and kill the bacteria so the bacteria can’t populate or reproduce anymore. This allows your acne flares to calm down. 

Antibiotics can be irritating or drying for some people, and that’s why it’s important to make sure you understand how to use them. Speak to your provider, and get what works for you. Cassandra got a topical prescription from Apostrophe, and it contained antibiotics. She also got a topical prescription that contains spironolactone. The prescription Cassandra most recently received from Apostrophe was a blend of tretinoin, spironolactone, and tranexamic acid. Tranexamic acid can be used for things like hyperpigmentation, but it’s not known to be taken orally for acne. The process of receiving this formula was easy. When you go onto Apostrophe, you upload photos of your skin, you speak about what you need, and you get a blend. 

Oral Tretinoin (Vitamin A)

Tretinoin is known as vitamin A. You might even know it as Accutane from the pill form. But, it can be used topically as well. The brand name Accutane was taken off of the market because there were quite a few lawsuits. But, tretinoin can make a significant difference for those that need it. It can be very harsh; but, it can also be very wonderful. Oral tretinoin works by telling all of your body’s oil glands to stop producing as much oil. So, yes, it can work for people who have very oily skin and acne. But, it can also help people who have a very oily scalp and oily hairline. It shrinks the oil glands in your skin so they produce much less oil. Acne bacteria feeds off of the oil so tretinoin starves the bacteria out.

Unfortunately, when taken orally, tretinoin can be a very difficult medication to be on.  If you have a uterus and are of childbearing age, you need to make sure you’re on two types of birth control. Tretinoin can also feel painful once applied to the skin. It can make your lips peel. It can make your skin feel, and it can make your lips extremely dry. But for the right person, it can be amazing when prescribed properly.

Topical tretinoin

Topical tretinoin can be used with fine lines, wrinkles, rosacea, or pigmentary spots. Basically, retinoids work by binding to the RAR and RxR receptors inside of your cells. They tell your skin cells to produce more of themselves. This is called “epidermal growth factor.” 

Epi means top and dermal means skin. Retinoids speed up the process of shedding your skin’s top layer which can cause a little bit of redness and peeling. And if you get a retinoid that is prescription strength, you’re getting tretinoin, the highest potency. Retinol or retinal is not nearly as potent as prescribed retinoic acid aka retinoin. Cassandra has an Apostrphe formula that combines spironolactone and tretinoin, and it’s specifically made to help with adult, female hormonal acne. 

Oral contraceptives

Birth control works by changing the body’s hormones so that your body does not have the hormones to support the growth of a baby. There’s no one-size-fits-all when it comes to using birth control for acne. Sometimes birth control is used to prevent the body from getting pregnant. Other times, people are prescribed birth control to help with painful conditions such as endometriosis where basically the uterine lining of the body doesn’t grow in the uterus where it’s supposed to.

Birth control can do many things, but because birth control normally controls estrogen and progesterone, it can also have an impact on what’s going on in the skin. A lot of acne is caused by hormonal changes in the body, and this causes an overproduction of oil, making our skin more livable for the acne bacteria.

So, if the right birth control is given, it can prevent these conditions. There are many different types of birth control, and some, specifically progesterone-based birth control, can make acne worse. This is why it is so important to speak to an OBGYN, dermatologist, or an endocrinologist. So, you can understand how your body operates, what your body needs, and what you can do. For men or people with XY chromosomes, birth control is not always an option, and that’s why spironolactone is another wonderful option for hormonal acne. It can be taken orally and topical, and it can be used by both males and females.

OTC medications

There are medications like benzoyl peroxide, salicylic acid, and sulfur.  But, because they’re not prescriptions, we’re not going to speak about them in this article.

It can be difficult to get a doctor’s appointment or go to one, and that’s why Cassandra loves Apostrophe. Cassandra loves how the process flows. They make it easy to upload photos, and they have other things like Latisse which is for eyelash growth. 

To Cassandra, Apostrophe is the number one custom skincare prescription space online for acne. Some people have a hard time getting this internationally. This is available in 49 states. Apostrophe truly stands out because nobody else has spironolactone or things like Latisse for eyelash growth. They even have options for men’s hair loss.

When using an acne treatment, make sure that you’re taking photos to see clear progress. Apostrophe even stores your photos. Cassandra hasn’t tried Latisse. Overall, Apostrophe is wonderful for people who want to take skincare into their own hands and understand how their prescriptions work.

Use code: CASSANDRABANKSON at Apostrophe to get your first visit for $5 and $5 off on your first order.