Stronger, evidence-based options for persistent, inflammatory, or scarring acne.
If acne is not improving with a consistent routine and over-the-counter actives, prescription treatment can be the turning point. Prescription therapies work by targeting the main drivers of acne — pore plugging, inflammation, acne bacteria imbalance, and oil-gland activity — with higher-strength or more specific medications.
At The Skin Doctor, we use prescription treatment responsibly: clear diagnosis first, then a staged plan with realistic timelines, careful monitoring, and a long-term maintenance strategy. (1,2)
When Prescription Treatment Is Worth Considering
Prescription therapy is often appropriate if you have:
- moderate to severe inflammatory acne
- painful deeper lesions (nodules)
- acne affecting the trunk (chest/back) that is hard to treat topically
- acne causing marks or scarring
- acne affecting confidence or quality of life
- acne persisting after 8–12 weeks of consistent OTC treatment
If you prefer to start with Over The Counter pharmacy medicines and cosmeceuticals first, see: OTC Acne Treatments Explained
Mild Acne: Prescription Topicals Are the Foundation
For mild acne, topical therapy is usually the primary treatment. Most patients do best with a topical retinoid as the backbone of the routine, plus an antimicrobial if inflammation is present. (1,2)
Topical retinoids (vitamin A creams/gels)
Examples include:
- Tretinoin (eg Retrieve®, Stieva-A®)
- Adapalene (eg Differin®, and also found in combination products like Epiduo®)
- Tazarotene (eg Zorac®)
- Trifarotene (eg Aklief®) – my favourite because it’s a modern, first-in-class retinoid with focused receptor targeting (RAR-γ) and often causes less irritation than older retinoids
- Isotretinoin topical (brand availability varies by country)
Why they work:
- prevent the microcomedo (the earliest acne lesion)
- reduce blackheads/whiteheads
- have anti-inflammatory effects over time (1,2)
How to use them properly:
- apply a thin layer to the whole acne-prone area (not spot treatment)
- introduce slowly if sensitive (e.g., every second or third night at first)
- support the skin barrier with a non-comedogenic moisturiser (1)
For truncal acne (back/chest), trifarotene has robust clinical trial data for both face and trunk. (9)
Benzoyl Peroxide and Antibiotics: The Rules That Prevent Resistance
Benzoyl peroxide (BPO)
BPO is antibacterial and comedolytic, and importantly, bacterial resistance to BPO has not been identified. (1)
Lower strengths often work just as well with less irritation:
- 2.5% was equivalent to 5% and 10% for inflammatory lesions in controlled trials. (3)
Common examples:
- benzoyl peroxide gels/washes in 2.5%–10% (brand availability varies)
Topical antibiotics (clindamycin)
Topical antibiotics can reduce inflammatory lesions, but should not be used alone. They should be paired with benzoyl peroxide to improve efficacy and reduce resistance risk. (1,2)
Common examples:
- Clindamycin (eg Dalacin T®)
- Combination clindamycin + benzoyl peroxide (eg Duac® in some countries; local availability varies)
A large trial of a fixed combination of clindamycin 1% + tretinoin 0.025% showed superior lesion reductions compared with either agent alone. (5)
Combination Products: Often Best for Adherence
Many patients do better with fewer steps. Fixed-combination gels can:
- simplify routines
- improve adherence
- improve outcomes compared with monotherapy (1,4)
Common examples:
- Adapalene 0.1% + benzoyl peroxide 2.5% (eg Epiduo®)
- Tretinoin + clindamycin (combination gels vary by country)
One large trial of adapalene 0.1% + benzoyl peroxide 2.5% showed greater total lesion reduction than either agent alone, with early improvement seen quickly. (4)
Additional Prescription Topicals (Selected Patients)
Dapsone gel (5% or 7.5%)
Most helpful for inflammatory acne, especially when skin is sensitive or reactive.
Common examples:
- Dapsone 5% gel (eg Aczone®)
- Dapsone 7.5% gel (market availability varies)
Randomized trials show dapsone gel provides statistically significant reductions in inflammatory lesions compared with vehicle and is generally well tolerated. (6,7)
Important practical note:
- don’t apply dapsone at the same time as benzoyl peroxide, as temporary yellow/orange discoloration can occur. (1)
Topical clascoterone 1% cream
A topical androgen receptor inhibitor for acne.
Common examples:
- Clascoterone 1% (eg Winlevi®; availability varies in Australia, can sometimes get through Chemist Warehouse)
Two phase 3 trials showed higher treatment success versus vehicle with a favourable safety profile. (8)
Topical minocycline (foam)
A topical antibiotic option for moderate to severe acne in some markets – it’s not available as a commercially made product in Australia, but can be compounded by a pharmacist (off label).
Example:
- Minocycline 4% foam (eg Amzeeq® in USA)
Moderate to Severe Acne: Systemic Therapy May Be Needed
If acne is inflammatory, widespread, painful, or scarring, topical therapy alone is often not enough.
Oral antibiotics (time-limited)
Used to reduce inflammatory acne when needed, typically alongside topical retinoids and benzoyl peroxide to maintain results and minimise resistance. (1,2)
Common examples:
- Doxycycline (eg Doxy®, Vibramycin®)
- Minocycline (eg Minomycin®)
Hormonal therapy (women)
If the pattern is hormonal (jawline/chin flares, cyclical breakouts), treatments such as combined oral contraceptives or spironolactone may be appropriate after assessment.
Common examples:
- Spironolactone (eg Aldactone®)
- Combined oral contraceptives (brand varies; chosen based on medical suitability)
Oral isotretinoin
For severe acne, scarring acne, or acne causing significant psychosocial burden, isotretinoin is one of the most effective options and is strongly recommended in guidelines when indicated. (1,2)
Common examples:
- Isotretinoin (eg Roaccutane®, Oratane®)
It requires:
- strict pregnancy prevention requirements
- monitoring and follow-up
- a structured maintenance plan after completion (1,2)
Maintenance Therapy: How We Keep Acne Under Control
Acne is often suppressed rather than “cured” — maintenance prevents relapse.
Topical retinoids are the preferred maintenance option, because they prevent microcomedones and reduce relapse rates after stopping antimicrobials. (1)
Pregnancy and Breastfeeding Considerations
Topical retinoids and oral isotretinoin are avoided in pregnancy. A meta-analysis provides reassurance after inadvertent first-trimester exposure to topical retinoids, but does not support intentional use during pregnancy. (10)
If you are pregnant or planning pregnancy, your treatment plan must be adjusted safely — we can guide this in consultation.
Your Next Step
If you’re ready for a clear plan that targets your acne type and prevents long-term scarring:
Book an Acne Consultation (Main cosmetic Automed booking page)
About Us
Frequently Asked Questions
How long do prescription treatments take to work?
Most acne treatments take 6–12 weeks for meaningful improvement. Early improvement can occur, but long-term control requires consistency. (1,2)
Do I have to go straight to isotretinoin?
No. Many patients improve with topical retinoids, benzoyl peroxide combinations, hormonal therapy (if appropriate), and time-limited antibiotics.
Why can’t I use topical antibiotics alone?
Because antibiotic monotherapy increases resistance risk. Pairing with benzoyl peroxide improves efficacy and reduces resistance. (1,2)
What if my acne is mostly on my back?
Truncal acne often needs specific planning because topical application is harder. We may use washes, simplified regimens, or systemic therapy sooner depending on severity. Trifarotene has strong evidence for both facial and truncal acne. (9)
References
1.Zaenglein AL, Pathy AL, Schlosser BJ, et al. Guidelines of care for the management of acne vulgaris. J Am Acad Dermatol. 2016;74(5):945–973.e33. https://pubmed.ncbi.nlm.nih.gov/26897386/
2.Zaenglein AL, Thiboutot DM. Acne vulgaris guidelines and evidence-based management. J Am Acad Dermatol. 2016. https://pubmed.ncbi.nlm.nih.gov/26897386/
3.Mills OH Jr, Kligman AM, Pochi P, Comite H. Comparing 2.5%, 5%, and 10% benzoyl peroxide on inflammatory acne vulgaris. Int J Dermatol. 1986;25(10):664–667. https://pubmed.ncbi.nlm.nih.gov/2948929/
4.Thiboutot DM, et al. Adapalene-benzoyl peroxide fixed-dose combination gel for acne: efficacy and safety. J Am Acad Dermatol. 2007. https://pubmed.ncbi.nlm.nih.gov/17655969/
5.Leyden JJ, et al. Clindamycin/tretinoin hydrogel combination versus monotherapy and vehicle in acne vulgaris. J Am Acad Dermatol. 2006. https://pubmed.ncbi.nlm.nih.gov/16384759/
6.Draelos ZD, et al. Dapsone gel, 5% for acne vulgaris: two randomized studies. J Am Acad Dermatol. 2007. https://pubmed.ncbi.nlm.nih.gov/17208334/
7.Thiboutot DM, et al. Dapsone gel 7.5% for acne: phase 3 efficacy and safety. J Drugs Dermatol. 2016. https://pubmed.ncbi.nlm.nih.gov/27847545/
8.Hebert A, et al. Clascoterone cream, 1%, for acne vulgaris: two phase 3 trials. JAMA Dermatol. 2020. https://pubmed.ncbi.nlm.nih.gov/32320027/
9.Tan J, et al. Trifarotene 0.005% cream for facial and truncal acne (phase 3 trials). J Am Acad Dermatol. 2019. https://pubmed.ncbi.nlm.nih.gov/30802558/
10.Kaplan YC, et al. Pregnancy outcomes following first-trimester exposure to topical retinoids: systematic review and meta-analysis. Br J Dermatol. 2015;173:1132–1141. https://pubmed.ncbi.nlm.nih.gov/26215715/