Oral Acne Treatment

Oral treatments are used when acne is moderate to severe, widespread or inflammatory, or when topical therapy alone has not achieved enough control. They are almost always used together with topical treatments rather than on their own, to improve results and reduce the chance of relapse.

There are two main types of oral acne treatment: oral antibiotics and hormonal therapy (the combined oral contraceptive pill). Both are prescribed for defined periods, with regular review to check response and side effects.

General principles

• Oral treatments are not first-line for mild acne
• They are always combined with topical therapy
• Antibiotic courses are time-limited
• Once the skin has improved, maintenance is usually topical only

This approach lowers the risk of antibiotic resistance and gives better long-term results.

Oral antibiotics

Oral antibiotics reduce acne by suppressing acne-causing bacteria and calming inflammation in the skin. They work best for inflammatory acne, particularly when lesions are widespread or involve the chest and back.

Which antibiotics are used?

Duration and review

• Usually prescribed for up to 3 months, then reviewed
• If improving but not fully clear, treatment may be extended to a maximum of 6 months
• Once the acne has cleared, antibiotics are stopped and topical maintenance continues

Long-term or repeated antibiotic courses are avoided wherever possible.

Important safety information

• Oral antibiotics are not used during pregnancy or breastfeeding
• They are generally avoided in children under 12
• Tell your GP straight away if you develop:
  • Persistent headaches
  • Visual changes
  • Severe gastrointestinal symptoms

Hormonal treatment (combined oral contraceptive pill)

Hormonal therapy may suit women with persistent or recurrent inflammatory acne, acne that flares with the menstrual cycle, or acne where contraception is also needed. It works more slowly than antibiotics but can give sustained improvement.

How it works

Combined oral contraceptives reduce acne by lowering circulating androgens and reducing oil (sebum) production. They are effective for inflammatory acne in women.

Choosing the right pill

• Combined oral contraceptives are preferred — progestogen-only pills may worsen acne
• Pills containing progestogens with low androgenic or anti-androgenic activity are generally favoured
• In Ireland the combination of cyproterone acetate with ethinylestradiol is licensed for severe acne, but requires careful assessment of risks and benefits

What to expect

• Improvement is gradual — it may take 3–6 months
• For faster control it is often combined with topical treatment or a short antibiotic course

Risks and considerations

• Combined pills slightly increase the risk of blood clots
• Your individual risk factors are assessed before prescribing
• You will be counselled on the benefits, risks and alternatives, and reviewed regularly

Combining oral and topical treatment

Oral treatments work best alongside Epiduo® (adapalene + benzoyl peroxide) or another non-antibiotic topical therapy. Once the oral treatment stops, ongoing topical therapy is essential to prevent relapse. See our topical treatment guide.

What to expect overall

• Improvement takes time and early response may be gradual
• Taking treatment consistently is essential
• Relapse is common if maintenance therapy is stopped

When to come back for review

• Little or no improvement after 3 months
• Side effects
• Acne causing scarring or psychological distress
• Acne still severe despite oral therapy

In these situations, treatment with isotretinoin (Roaccutane®) may be appropriate.

Key messages

• Oral treatments are for moderate to severe acne
• Antibiotic courses are time-limited and carefully reviewed
• Hormonal therapy is effective in women but works slowly
• Long-term control depends on ongoing topical maintenance

See also: Acne Clinic · Topical treatment · Oral treatment · Roaccutane · Fees