Systemic treatments
• Systemic antibiotics: Systemic antibiotics, such as the tetracycline group of antibiotics,
are usually effective for treating acne. They contain anti-inflammatory agents and help
fight P acnes. However, bacteria have become resistant to these agents. To reduce the
resistance, antibiotics should be combined with benzoyl peroxide.
• Hormonal therapies: Some hormonal therapies are effective in treating acne vulgaris.
Birth control pills increase the level of the sex-hormone-binding globulin. This causes the
testosterone circulating in the body to fall, which reduces the production of sebum.
• Isotretinoin: Isotretinoin is a systemic retinoid that is effective in treating severe and
recalcitrant acne vulgaris. It normalizes the epidermal differentiation and, at the same
time, reduces the quantity of sebum excreted by the sebaceous glands up to 70%. Also, it
is anti-inflammatory and reduces the number of P acnes. In severe cases, isotretinoin is
recommended to be used with steroids at the start of therapy.