The primary goals of acne treatment are to reduce and control active breakouts, preventing future flareups, and preventing scarring and discolorations using topical and oral medications and combination therapies.

For many patients with mild to moderate acne, topical medications are the first step in treatment. These therapies are applied directly to the skin and work by addressing clogged pores, excess oil production, inflammation, bacterial growth and regulating hormones.

• Benzoyl Peroxide: One of the most frequently used topical treatments is benzoyl peroxide, an antibacterial agent that reduces acne-causing bacteria and helps prevent clogged pores. It is available in a variety of concentrations and formulations, including gels, creams, and washes. Benzoyl peroxide can be used alone or in combination with other treatments to enhance efficacy.
• Topical retinoids: Topical retinoids such as tretinoin, adapalene, tazarotene and trifarotene are widely used and considered cornerstone treatments in acne management. These vitamin A derivatives promote healthy skin cell turnover, prevent clogged follicles, and improve skin texture. Retinoids also possess anti-inflammatory properties and help fade post-acne discoloration over time. It is, therefore, prescribed as part of the regimen for all types of acne, ranging from mild comedonal (black heads and white heads) acne to more significant inflammatory acne.
• Topical antibiotics: In cases where inflammation is more prominent, topical antibiotics such as clindamycin or erythromycin may be used. These medications reduce bacterial growth and inflammation. They are often combined with benzoyl peroxide for synergistic benefit. Recently, topical minocycline compounds have become available and are utilized frequently with great results for acne on the face and even the back and chest.
• Topical Dapsone: Topical dapsone treats acne through dual mechanisms of action: antimicrobial and anti-inflammatory effects. It inhibits the synthesis of dihydrofolic acid in bacteria, reducing the growth of Cutibacterium acnes, a key contributor to acne. Simultaneously, dapsone suppresses neutrophil activity and the production of inflammatory mediators like prostaglandins and leukotrienes, helping to calm redness and swelling in active lesions. When combined with benzoyl peroxide, its antimicrobial action is amplified. Used with retinoids, dapsone complements comedolytic activity by further reducing inflammation.
• Azelaic acid: Azelaic acid is a naturally occurring acid with antibacterial, anti-inflammatory, and skin-brightening properties. It is especially helpful in treating both acne and post-inflammatory hyperpigmentation, making it a popular choice for patients with darker skin tones prone to discoloration. It is also a safe treatment during pregnancy and breastfeeding making it a popular choice among child-bearing women.
• Spironolactone and Clascoterone: Topical spironolactone and Winlevi (clascoterone) are two exciting advancements in acne treatment, especially for hormonal acne. Unlike traditional therapies, these topicals target acne at the hormonal level—right where it starts. Both work by blocking androgen receptors in the skin, which reduces oil (sebum) production and calms inflammation, two major drivers of breakouts. Winlevi is FDA-approved and is often used once or twice daily, while topical spironolactone is compounded and often combined with active ingredients like dapsone and gaining popularity for its gentle, effective results. These treatments are especially helpful for women experiencing breakouts along the jawline or lower face, and they offer a promising option for clearer skin without the side effects of oral hormonal medications.
• Additional treatments: In addition to core acne treatments like retinoids, topical antibiotics, and dapsone, supportive therapies such as alpha hydroxy acids (AHAs), beta hydroxy acids (BHAs), and sulfur washes can play a powerful complementary role. AHAs like glycolic and lactic acid help exfoliate the skin’s surface, unclogging pores and improving texture, while BHAs such as salicylic acid penetrate deeper into the pores to dissolve excess oil and debris. Sulfur-based washes provide mild antibacterial and keratolytic effects, making them a great option for sensitive or oily skin types. When used alongside prescription treatments, these over-the-counter topicals can enhance results, speed up skin renewal, and support long-term acne management.

When acne is more persistent or widespread—especially when inflammatory or when on the back, chest, or jawline—or when topical treatments are not sufficient, oral medications may be recommended. These systemic therapies address deeper inflammation and hormonal factors contributing to acne.

• Oral antibiotics: Antibiotics such as doxycycline, minocycline, and sarecycline are commonly prescribed to reduce inflammation and target Cutibacterium acnes, the bacteria implicated in inflammatory acne. These medications are typically used short term to control flare-ups and are often paired with topical therapies to enhance long-term results and reduce antibiotic resistance.
• Oral contraceptives: For women with hormonal acne, particularly those experiencing breakouts around the lower face or jawline, hormonal therapies may be appropriate. Oral contraceptive pills containing estrogen and progestin can help regulate hormones that trigger excess oil production. Another medication, spironolactone, is often used off-label to block androgen hormones and reduce sebum production. It is especially effective in adult women with persistent, cystic acne. 
• Isotretinoin (oral retinoid therapy): For patients with severe, cystic acne or acne that has not responded to other therapies, isotretinoin—formerly known by the brand name Accutane—is considered the most powerful acne medication available. Isotretinoin works by shrinking the sebaceous (oil) glands, dramatically reducing oil production, preventing clogged pores, and reducing inflammation.

Treatment with isotretinoin typically lasts at least 6-8 months and requires regular monitoring, including blood tests and assessments for potential side effects. Because isotretinoin can cause birth defects if taken during pregnancy, patients capable of becoming pregnant must follow a strict risk management program, including using two forms of contraception. Despite these precautions, isotretinoin can offer long-lasting or even permanent remission of severe acne in many patients.

At Biscayne Dermatology, acne medication plans are often combined with in-office treatments to enhance results. Chemical peels, such as the Purify Precision Plus VI Peeland laser treatments may be used alongside prescription medications to reduce inflammation, kill bacteria, and improve skin texture.

Because acne is a multifactorial condition, combination therapy is often the most effective strategy. For instance, a patient might use a topical retinoid and benzoyl peroxide wash at home while receiving oral antibiotics or hormone therapy, depending on the type and severity of their acne.

Dr. Devorah Shagalov and the team at Biscayne Dermatology understand that no two cases of acne are alike. Each treatment plan is customized based on a detailed skin evaluation, medical history, and lifestyle factors. Patient education is also a key component of care, with guidance on how to use medications properly, what to expect during treatment, and how to care for the skin to prevent future breakouts.

Follow-up visits are scheduled to monitor progress, manage side effects, and adjust therapies as needed to ensure the most effective outcome. Whether a patient is struggling with teenage acne, adult-onset breakouts, or scarring from past lesions, Biscayne Dermatology offers comprehensive solutions grounded in medical science and delivered with personalized care.