Prescription vs. OTC: When to See a Dermatologist for Acne

Not all acne can be managed with store-bought remedies. As a rule of thumb, mild acne (occasional whiteheads, blackheads, or small pimples) can usually be treated with OTC products. Moderate-to- severe acne – including numerous inflamed papules, deep nodules/cysts, or widespread breakouts – often requires a dermatologist’s help. You should consider seeing a doctor if: your acne is painful or cystic; it covers a large area (e.g. most of face, chest, back); it fails to improve after consistent OTC treatment (about 3 months); or it’s causing scarring or emotional distress. The American Academy of Dermatology echoes this: deep, painful acne anywhere generally needs professional care. Why Choose a Dermatologist: A specialist can tailor a regimen that OTC cannot match. Dermatologists can prescribe stronger and combination therapies that address acne’s root causes. For example, they can prescribe prescription retinoids (like tretinoin, tazarotene, or stronger adapalene) which are more potent than OTC strengths. Topical prescriptions often combine a retinoid with an antibiotic or benzoyl peroxide to maximize results. They may also suggest azelaic acid creams (20%) for inflammatory lesions and post-acne discoloration. Importantly, a doctor can also assess whether your acne is linked to hormones (in which case birth control pills or spironolactone may help) or other health factors. Prescription Treatments: – Topical Options: Prescription retinoids clear pores, similar to OTC adapalene but often stronger . Topical antibiotics (like clindamycin or erythromycin gels) reduce bacteria and inflammation, usually used with benzoyl peroxide to prevent resistance. Oral antibiotics (tetracyclines like doxycycline or minocycline) tackle inflammation and bacterial overgrowth from inside. Azelaic acid (Finacea/Azelex 15– 20%) is a Rx cream that fights acne bacteria and pigment. Dapsone gel (7.5–5%) is another Rx anti- inflammatory.

• Hormonal Treatments: For women with hormonal acne, low-dose birth control pills (certain brands

approved for acne) or spironolactone (an androgen blocker) can dramatically improve breakouts by reducing oil production and hormone-driven acne.

• Oral Isotretinoin (Accutane): For severe, scarring, or treatment-resistant acne, isotretinoin is very effective

(often clearing acne that failed other treatments). It reduces oil gland size and sebum production. Because of its potency and side effects (dryness, birth defects, etc.), it requires specialist supervision.

• Procedures: A dermatologist might also perform procedures – injections of corticosteroids into cysts for

fast relief, chemical peels, laser therapy, or manual extraction – none of which are available OTC. When to See a Dermatologist: If you’ve tried good OTC care for at least 2–3 months without seeing improvement, it’s time to see a dermatologist. Also see a doctor sooner if acne is severe (many painful nodules or large cysts), is causing dark spots or scars, or if it’s affecting your confidence or mental health. Adolescents whose acne flares dramatically or with unusual pattern (e.g. on trunk) may need evaluation. Essentially, if home regimens aren’t working or if your acne is worsening, professional help ensures faster , more complete treatment and can prevent permanent scarring. In summary, OTC acne treatments (like benzoyl peroxide, salicylic acid, and OTC retinoids) are great for mild to moderate acne . But prescription therapies offer stronger and combination approaches for harder cases. Knowing when to upgrade is key: persistent, widespread, or cystic acne – or acne that deeply affects you – should be treated by a dermatologist. A specialist can evaluate your skin, possibly order tests (e.g. hormone levels), and prescribe the optimal medications. Working together with a dermatologist often leads to clearer skin and prevents long-term damage that could occur from untreated severe acne.

Related reading