Oral Treatments

Oral Antibiotics

Who are they for?

Oral antibiotics are usually used in combination with a topical treatment to treat moderate to severe acne. They are only available on prescription from a healthcare professional.

How do they work?

Oral antibiotics help control acne by curbing the growth of bacteria and reducing inflammation.

What are the different types?

Tetracycline based antibiotics are the most commonly type of antibiotic prescribed for acne. These include: oxytetracycline, lymecycline, minocycline and doxycycline.  Women who are pregnant or breastfeeding should not use tetracycline antibiotics but can take an antibiotic called erythromycin.

How are they used?

Antibiotics capsules or tablets should be taken by mouth every day. Some should not be taken at the same time as food, so follow the instructions carefully.  It will usually take about six weeks to notice a significant improvement in your acne symptoms. Depending on how well you react to the treatment, a course of oral antibiotics can last between four to six months.  Treatment is usually stopped after six months to reduce the risk of antibiotic resistance.

What are the side-effects?

Side-effects of tetracyclines include:

  • nausea
  • vomiting
  • diarrhoea.

Tetracyclines can make the skin sensitive to sunlight and UV light.Antibiotics may also make the oral contraceptive pill less effective during the first few weeks of treatment particularly in cases where nausea and diarrhoea occur, so you will need to use an additional method of contraception, such as a condom, during this time.

The most common side-effects of erythromycin are nausea and mild stomach pain; taking erythromycin with food should help to reduce the severity of these side-effects

Isotretinoin - known as Roaccutane and Accutane (in US)

Who is it for?

Isotretinoin (Roaccutane and Accutane) is for people with severe acne. It can only be prescribed by a dermatologist (an expert in treating skin conditions) and not by your GP.

How does it work?

Isotretinoin works by reducing the production of sebum, preventing dead skin cells from plugging hair folliclesand reduces inflammation.  Isotretinoin is very effective. After a course of treatment, acne completely or almost completely disappears in most patients. If given early isotretinoin can help to prevent the scarring that can occur with severe acne.

How is it used?

Isotretinoin is taken in tablet form and most people take a four to six-month course. You may find that your acne gets worse during the first seven to 10 days of treatment.

What are the side-effects?

The down-side of isotretinoin is that it can have very serious side-effects.

Taking isotretinoin carries a very high risk of causing serious birth defects if taken during pregnancy

  • If you are a woman of childbearing age, you will only be prescribed isotretinoin after having a negative pregnancy test. You will then need to have regular pregnancy tests throughout your treatment with isotretinoin.
  • Women are advised to use two separate, effective forms of birth control at the same time for one month before starting treatment with isotretinoin, during the entire course of treatment and for one month after stopping the drug.
  • It is very important to contact your dermatologist immediately if you think you might be pregnant, either during isotretinoin treatment or in the first month after treatment.
  • You should ask your doctor when it is safe to get pregnant after you have stopped taking isotretinoin.

Common side-effects of isotretinoin include:

  • Inflammation, dryness and cracking of the skin and lips. This can usually be relieved with a moisturiser and lip balm
  • The inside of your nose may become dry, leading to mild nosebleeds. Applying a thin layer of petroleum jelly to the inside of your nose should help
  • Headaches - these are more common on higher doses
  • Skin rash, mild itching and a slight peeling of the skin
  • Inflammation of your eyelids (blepharitis)
  • Inflammation and irritation of your eyes (conjunctivitis)
  • Back, muscle and joint pain. This is usually worse during and after exercise
  • Changes in liver function
  • Skin fragility - it is advisable to avoid hair removal, waxing, peeling and laser therapies

Evidence suggests that having severe acne itself increases the risk of depression and suicide.  Only individuals with severe acne are likely to receive treatment with isotretinoin, it remains unclear whether there is any higher risk due to the isotretinoin. You should contact your GP or dermatologist immediately if you are on isotretinoin and:

  • you have a sudden mood change, such as anxiety or depression or, if you are already depressed,  your depression worsens
  • you have aggressive or violent thoughts or tendencies
  • you start to think suicidal thoughts
  • you begin to act in ways that are quite different to your usual behaviour