Oral Acne Medications: How They Work and When to Consider Them

Why Consider Oral Acne Medications?

You might be a candidate for an oral medication if:

• You’re dealing with severe acne, including nodular acne or persistent acne vulgaris.
• You're experiencing painful, cystic breakouts.
• Your acne leaves scars or post-acne marks.
• Your breakouts are hormonal (i.e. flaring around your period or showing up along the jawline).
• Topical treatments haven’t helped enough.

Oral options can offer system-wide support, helping regulate oil production, reduce inflammation, and stop new breakouts from forming.

 

Oral Acne Medication Options

Here’s a rundown of the different oral acne medication options available. 

1. Oral Antibiotics

Best for: Moderate to severe inflammatory acne (papules, pustules, cysts)

How they work: Oral antibiotics like doxycycline or minocycline reduce acne-causing bacteria (C. acnes) and calm inflammation in the skin. They’re commonly used in antibiotic therapy for moderate acne with topicals like benzoyl peroxide or retinoids.

What to expect:

• Results usually appear within 6-12 weeks
• Must be taken consistently and exactly as prescribed
• Often combined with topical treatments (topical antibiotics or topical retinoids) to prevent bacterial resistance

Common side effects:

• Upset stomach or nausea (take with food)
• Increased sun sensitivity
• Yeast infections
• Long-term use can lead to risk of antibiotic resistance
  
  

Tip: Oral antibiotics are one of several treatment options for inflammatory acne. Talk to a healthcare provider to weigh the possible side effects and find the best treatment for your acne type

 

2. Spironolactone

Best for: Hormonal acne (acne that typically appears on the jawline, chin, and lower cheeks) 

How it works: Spironolactone is a medication that blocks androgens—hormones like testosterone that trigger oil overproduction in the skin. Because these effects of androgens often intensify around the menstrual cycle, spironolactone helps reduce hormonal fluctuations that lead to breakouts. 

What to expect:

• Results usually take 3-6 months
• Often paired with topical treatments for faster improvement
• May also reduce oiliness and increase skin clarity over time

Common side effects:

• Increased urination (it’s a diuretic)
• Breast tenderness or menstrual irregularities
• Dizziness or lightheadedness
• Possible drop in blood pressure
• Can increase potassium levels (requires occasional blood work)

Not for: individuals assigned male at birth, pregnant people, or those with kidney issues or low blood pressure 

Good to know: Spironolactone is one of the most widely prescribed medications for adults assigned female at birth with persistent hormonal acne. If your breakouts follow a monthly pattern or are localized to the jawline and chin, spironolactone might be the right fit.

 

3. Oral Contraceptives (Birth Control Pills)

Best for: Hormonal acne in individuals assigned female at birth of reproductive age who also need contraception

How they work: Certain oral contraceptive pills are FDA-approved not only for contraception but also as an effective treatment of acne in individuals experiencing hormonal changes.

FDA-approved birth control pills for acne include:

• Ortho Tri-Cyclen®
• Yaz®
• Estrostep®

What to expect:

• Results may take two to three cycles (around 3 months)
• Can help reduce monthly flare-ups
• May also improve skin texture and oil control

Common side effects:

• Nausea or bloating (especially early on)
• Mood changes or headaches
• Breast tenderness
• Increased risk of blood clots (especially for smokers or those over 35)

Not for: People with clotting disorders, a history of migraines with aura, or certain cardiovascular risks. If you’re considering birth control for acne, your healthcare provider can explain the risk of side effects.

Tip: For many, combining birth control with topical ingredients like azelaic acid or salicylic acid yields the best results.

 

4. Isotretinoin (Accutane)

Best for: Severe, cystic, or treatment-resistant acne

How it works: Oral isotretinoin (formerly sold under the brand name Accutane) is a powerful treatment derived from retinoic acid—often reserved for severe forms of acne. It dramatically shrinks oil glands, reduces inflammation, prevents clogged pores, and changes the skin environment to make it less hospitable to acne-causing bacteria.

What to expect:

• A typical course lasts 4-6 months
• Often results in long-term or even permanent remission
• May cause an initial “purge” or flare-up in the first few weeks

Common side effects:

• Dryness everywhere (lips, eyes, nose, skin)
• Sun sensitivity
• Nosebleeds
• Joint pain
• Mood changes (rare, but discuss any mental health history with your provider)
• Temporary increases in cholesterol or liver enzymes (requires monthly blood work)
• Severe birth defects risk if taken during pregnancy—must follow iPLEDGE guidelines, which include regular pregnancy tests

Important: You’ll need to commit to monthly dermatologist visits, lab tests, and strict contraception (or abstinence) while on this drug.

Tip: Use ultra-hydrating, non-comedogenic skincare and SPF daily while on isotretinoin. Barrier support is essential.

 

Which Oral Acne Medication Is Right for You?

Here’s a quick breakdown based on acne type:

 

Final Thoughts: Talk to a Derm First

Oral acne medications can be a great solution for some—but they’re not one-size-fits-all.

• Your medical history matters

• Your acne pattern matters

• Your lifestyle and preferences matter

Whether you’re treating mild acne, comedonal acne, or navigating more complex types of acne, the right oral medications can support your skin’s healing process. A board-certified dermatologist can help identify which option is best based on your unique skin, health, and goals.