Treatment for moderately severe acne usually includes tablets or capsules, which are usually prescribed for at least 3–6 months.
Examples of antibiotics include doxycycline and erythromycin. They work by killing germs (bacteria) that contribute to the cause of acne. They also reduce inflammation. Antibiotics are ideally used in combination with a topical retinoid or benzoyl peroxide. Antibiotics can lead to antibiotic resistance and so, in most cases, they should not be used long term.
The combined oral contraceptive pill containing ethinylestradiol and an antiandrogenic progesterone (cyproterone or drospirenone) can improve acne in women by reducing sebum secretion (which is controlled by androgens). Hormone therapy examples include Ginet.
These may be helpful if you have breakouts around the time of your period, polycystic ovary syndrome or acne around your neck and lower face. At least 3–6 months is needed to work out whether it is effective for you.
There is an increased risk of blood clots in women taking cyproterone acetate with ethinylestradiol, particularly during the first year of use. Read more about the combined oral contraceptive pill and hormonal contraceptives and blood clots(external link).
Isotretinoin greatly reduces the amount of oil (sebum) made by your sebaceous glands. It works very well and usually clears spots even in severe cases. Isotretinoin is not suitable for women who are planning a pregnancy or if there is a chance you may become pregnant. It is harmful to your unborn baby, so contraception should be used if you could become pregnant and are taking isotretinoin. Read more about isotretinoin.