Acne: medications and paying cash

Overview

Acne begins when oil and dead skin cells clog hair follicles. Some clogged pores stay as blackheads and whiteheads; others become inflamed spots and, in more severe acne, deep nodules and cysts that can scar. Hormones, genetics, some medicines and friction from masks or helmets all play a part. Treatment takes six to twelve weeks to show its effect, and maintenance prevents relapse.

Topical retinoids such as tretinoin and adapalene, which is sold over the counter, unclog pores and are the foundation. Benzoyl peroxide kills acne bacteria without causing resistance and is combined with any antibiotic, because topical clindamycin or erythromycin used alone breeds resistant bacteria. Oral doxycycline or minocycline is added for moderate inflamed acne, for no more than three or four months, always with a topical. For women, combined oral contraceptives and spironolactone reduce hormonal acne; some contraceptives are FDA-approved for acne in women who also want contraception, but acne is not an FDA-approved use for spironolactone, so the prescriber decides.

Isotretinoin often clears severe acne for good. Because it causes severe birth defects, it is dispensed only under the iPLEDGE program: prescriber, pharmacy and patient must be registered, people who can become pregnant need monthly negative pregnancy tests and two forms of contraception, and each fill is limited to thirty days and must be picked up within a short window.

Choosing between the options when you pay cash

Tretinoin, clindamycin gel, doxycycline and spironolactone are available as generics, and benzoyl peroxide is sold over the counter; quotes for the same tube or bottle can differ between pharmacies. The fixed combination gels, such as clindamycin with benzoyl peroxide or adapalene with benzoyl peroxide, are convenient single products; ask the prescriber whether using the two parts separately, with the benzoyl peroxide bought over the counter, would suit you, and compare quotes both ways.

For isotretinoin, the pharmacy must be registered with iPLEDGE and able to fill on the day the prescription is authorized; price matters, but a pharmacy that reliably stocks your strength and handles the program without delay matters more, since a missed window means starting the monthly steps again.

Medicines at a glance

How the medicines in this group are supplied and usually taken. Each guide has the full details.

• Tretinoin
  Cream (Retin-A, Renova and generic), Gel (Retin-A, Atralin and generic), Microsphere gel in tubes or pumps (Retin-A Micro and generic)
  Generic: Yes · Once a day
• Doxycycline
  Tablets: hyclate (Acticlate, generic), Capsules: hyclate or monohydrate (Monodox, generic), Delayed-release tablets (Doryx MPC, generic)
  Generic: Yes · See the guide
• Clindamycin
  Capsules (Cleocin HCl and generic), Granules for oral solution (Cleocin Pediatric and generic), Topical gel (Cleocin T, Clindagel and generic) and lotion (Cleocin T and generic)
  Generic: Yes · Three or four times a day
• Spironolactone
  Film-coated tablets (Aldactone and generic), Oral suspension (CaroSpir and generic)
  Generic: Yes · Once a day
• Isotretinoin
  Capsules (generic, Amnesteem, Claravis, Zenatane), Capsules (Absorica and its generics), Capsules (Absorica LD)
  Generic: Yes · Twice a day
• Adapalene
  Gel (over the counter: Differin and store brands), Gel (prescription), Cream (prescription)
  Generic: Yes · Once a day
• Azelaic Acid
  Gel, 15 percent (Finacea and generics), Foam, 15 percent (Finacea Foam), Cream, 20 percent (Azelex)
  Generic: Yes · Twice a day
• Minocycline
  Capsules, Tablets, Extended-release tablets (acne)
  Generic: Yes · Every 12 hours
• Norgestimate/Ethinyl Estradiol
  28-day packs (21 active and 7 inert tablets), Monophasic, triphasic and lower-dose triphasic packs
  Generic: Yes · See the guide
• Drospirenone/Ethinyl Estradiol
  28-day packs, 24 active and 4 inert tablets (Yaz type), 28-day packs, 21 active and 7 inert tablets (Yasmin type)
  Generic: Yes · See the guide
• Tazarotene
  Cream (Tazorac and generic), Gel (Tazorac and generic), Lotion (Arazlo)
  Generic: Yes · Once a day

Medications

Which of these is right for a given person is a decision for the prescriber. The guides explain what each drug is, how it is supplied, and why its cash price varies between pharmacies. No page on this site shows a price; prices come from pharmacies responding to your actual prescription.

Questions worth asking

• Which treatment step am I on, and how long before we judge it?
• Could I use the two generic parts instead of a combination gel?
• How long should I take an oral antibiotic, and what replaces it afterward?
• Would spironolactone or a combined pill help my acne?
• If isotretinoin is suggested, which pharmacies near me are registered with iPLEDGE?

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