When it comes to prescription acne treatments, retinoids (both topical and the oral version, Accutane) along with antibiotics are the most often talked about. However, there are several other effective prescription acne medications that can help clear your complexion, either when used solo or as part of a broader treatment protocol. Here, dermatologist Julie Harper, M.D., founding director of the American Acne and Rosacea Society and an Acne Store advisory board member, weighs in on five of the most common acne prescriptions.

1. Oral contraceptives

To treat acne in women, dermatologists often take the hormonal route, with birth control pills being one of the most-commonly prescribed medications for acne, says Harper. There are currently four that are FDA-approved to treat acne: Ortho Tri-Cyclen, Estrostep Fe, Beyaz, and Yaz. Still, Harper says it’s likely that any birth control pill will help, so long as it’s a combination pill that contains both estrogen and progestin (progestin-only pills can actually make acne worse, she notes). Obviously, these are only a viable choice for women who don’t want to get pregnant, and it’s also worth noting that any hormonal treatments aren’t the fastest option. “It takes anywhere from three to six months to see effects,” says Harper. 

"To treat acne in women, dermatologists often take the hormonal route."

2. Spironolactone

A blood pressure medication that’s used off-label to treat acne, spironolactone is an androgen receptor inhibitor that, like birth control pills, addresses the hormonal component of acne, says Harper. It doesn’t contain estrogen, but instead works by inhibiting male hormones, such as testosterone, from stimulating oil production. While not FDA-approved for acne, it’s safe and well-tolerated, and something that women can stay on for years, Harper says. (However, due to a risk of birth defects, women who are pregnant or are trying to become pregnant, shouldn’t take it.) Harper especially likes it for adult women who need long-term treatment, and she stresses that it’s a good alternative to antibiotics, which people shouldn’t stay on for extended periods of time. And while only women can take spironolactone, Harper says that a topical anti-androgen medication, clascoterone cream, that even men can use is now available, a major win given that all acne—in both men and women—is hormonal.

3. Dapsone

Known by the brand name Aczone, this is a topical anti-inflammatory drug, says Harper. “It’s well-tolerated, cosmetically elegant, and doesn’t cause dryness or other irksome side effects,” she adds. Based on your type and severity of acne, your doctor may or may not pair dapsone with other topical or systemic treatments.

4. Azelaic acid 

“Topical azelaic acid addresses two of the four factors that contribute to acne—it helps keep the follicle from getting plugged and is also anti-inflammatory,” says Harper. But what’s particularly noteworthy about azelaic acid is its ability to also help lighten hyperpigmentation. This makes it ideal for acne patients who have darker skin and are more prone to post-inflammatory hyperpigmentation, as well as anyone who has acne scarring and dark marks. Plus, it’s also one of the few prescription acne treatments that can safely be used during pregnancy, Harper adds.

5. Benzoyl peroxide

Benzoyl peroxide is found in both over the counter and prescription-strength acne treatments and works by oxidizing acne-causing bacteria, killing it in a way that doesn’t contribute to bacterial resistance in the same way that antibiotics do, explains Harper. She’s quick to point out that there’s no real difference between the OTC and Rx versions, except for the fact that benzoyl peroxide is often compounded with other ingredients like topical antibiotics or retinoids in prescription acne-fighting products. Like azelaic acid, benzoyl peroxide can also be used to treat acne in pregnant women.