Oral antibiotics like tetracyclines or erythromycin are useful in moderate to severe acne. They also appear to have an anti-inflammatory effect independent of their antibacterial effect. Female patients who do not respond to oral antibiotics may benefit from hormonal therapy. Women placed on oral contraceptives containing hormones (like ethinyl estradiol and norgestimate) have demonstrated improvement in their acne. That is why if women patients are taking oral contraceptives, a change in estrogen and progestin combinations may be all that is necessary.
Severe acne not responsive to oral antibiotics, hormonal therapy, or topical therapy may be treated with the oral retinoid.
Even with so many available treatment options, patients should not have inappropriate expectations. In most cases, acne can be controlled, but not cured. Note that some of these treatments take time. Allow 2-4 weeks before discounting any acne treatment technique. Stress is an important exacerbating factor and stress management can be an important adjuvant to acne medication.
Prescription of medication should be supplemented with diet modification and decrease in cosmetic use. Studies have suggested that high-glycemic carbohydrates (bread, bagels, doughnuts, crackers, candy, cake, chips), those that substantially boost blood sugar levels, set off a series of hormonal changes that cause acne. Elevated blood sugar leads to increases in insulin production. This affects other hormones that can cause excess oil in the skin. Therefore low-glycemic diets, including fruits and vegetables, might offer a new treatment option for people with acne. Water helps the body flush out toxins and transport nutrients to the body. The recommended amount of water is at least half the bodyweight in ounces of water (a 140lb. individual should drink 70 ounces/day). While water alone will not eliminate acne it will greatly assist skin in remaining healthy and that will be one piece of the puzzle in fighting acne.
Moderate use of non-greasy lubricants and water-based cosmetics is usually well tolerated, but a gradual decrease in the use of cosmetics is encouraged as acne improves. Cream-based cleansers should be avoided. | 
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Cystic Acne
