Acne vulgaris
Chronic inflammatory disease of sebaceous glands. Presents with comedones, papules, and pustules. Moderate-to-severe cases require systemic antibiotics or isotretinoin.
ICD-10 L70.05 drugs
Also known as: Common acne, Acne
Drugs used for this condition
- ADoxycyclineFirst line · TetracyclinesFirst-line systemic antibiotic for moderate-to-severe acne per AAD 2024 guidelines. Dose is 100 mg once or twice daily for 3 months. Sub-antimicrobial dose of 40 mg modified-release (not registered in Russia) reduces inflammation without antibiotic pressure. Always combine with a topical retinoid and/or benzoyl peroxide to prevent resistance.
- BCyproterone acetateSecond line · Antiandrogen with progestogenic activityIn severe hormone-dependent acne in women, combined with ethinyl estradiol. AAD 2024 and AEDV 2023 set topical retinoids, benzoyl peroxide, and azelaic acid as first-line; hormonal therapy is second-line in acne with features of hyperandrogenism. Use is limited by meningioma risk (EMA 2020 warning) and thromboembolic events.
- BDrospirenone + ethinylestradiolSecond line · Combined oral contraceptives — antimineralocorticoid progestinPer AAD 2024, COCs with antiandrogenic progestins (drospirenone, cyproterone, dienogest) are second-line for acne in women when topical therapy and systemic antibiotics are inadequate. Effect develops over 3–6 months. Prescribed when contraceptive and acne indications coincide.
Marketing claims without evidence base
The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.
- DChlorophyll (chlorophyllin copper-sodium complex)Not recommended · Plant pigment; in supplements as natural chlorophyll (E140) and the water-soluble copper-sodium complex chlorophyllin (E141). In the European Union it is registered as a food colourant under Regulation (EC) 1333/2008. On iHerb, Amazon and in Spanish herbolarios «liquid chlorophyll» is sold as detox, a source of «liquid sunshine», anti-age, and an acne remedy. AEMPS does not register it as a medicine; AESAN classifies it as a complemento alimenticio without therapeutic indication. FDA has a single OTC-approved use – internal deodorant for ostomy, ileostomy, and incontinence (21 CFR 357.850, Derifil 100 mg)Chlorophyll has received strong TikTok marketing as a «natural acne remedy», especially «liquid chlorophyll drops» taken internally. The claim has a weak but non-zero base. The McCook open-label pilot (J Drugs Dermatol 2015) in 10 patients with mild-to-moderate facial acne used a chlorophyllin-copper gel topically twice daily for 3 weeks and reduced the inflammatory lesion count and pore size. The Stephens RCT (J Drugs Dermatol 2015) in 30 patients with photoaged skin used sodium-copper-chlorophyllin 0.066% gel twice daily for 8 weeks and improved wrinkle and pigmentation scores versus vehicle. These are small manufacturer-sponsored pilots without comparison to standard therapy. AAD Guidelines 2024 list as first-line acne treatment topical retinoids (adapalene, tretinoin), benzoyl peroxide, azelaic acid, and clindamycin combined with benzoyl peroxide; in moderate-severe disease – oral antibiotics (doxycycline, minocycline) or combined oral contraceptives in women; in severe nodulocystic acne – isotretinoin. Chlorophyllin appears in guidelines neither as first-line therapy nor as a proven alternative. Oral «liquid chlorophyll» for acne has not been studied in humans: systemic bioavailability is below 1% and the pigment does not reach the sebaceous gland. The «cleared in a week» effect in TikTok videos is explained by general hydration (a bottle of chlorophyll water), not direct action on the sebaceous gland. Topical chlorophyllin gel as a cosmetic is safe to try but not as a replacement for prescription therapy. In moderate-severe acne, see a dermatologist: months of delay with TikTok remedies lead to scarring and post-acne hyperpigmentation that are harder to treat later.
- DPantothenic acidNot recommended · Water-soluble vitamin B5Pantothenic acid in high doses (5–10 g/day) is marketed as an «acne treatment» based on a single uncontrolled publication (Leung 1995). The 2015 Cochrane review of complementary acne therapies found no high-quality RCTs supporting efficacy. AEDV 2021 does not mention pantothenic acid in its acne guideline; first-line is topical retinoids and azelaic acid, doxycycline for moderate disease, isotretinoin for severe. High-dose B5 causes diarrhoea and does not outperform placebo. If pantothenic acid was prescribed for acne, consider seeking a second opinion: a dermatologist for an evidence-based regimen.
How to read tiers A–F
Evidence tiers belong to the drug-indication pair, not to the drug as a whole: the same substance can be A for one condition and F for another.
- AStrong evidence – first or second line in international guidelines
- BRecommended in selected cases
- CStudy data contradict each other
- DBenefit not proven, no documented harm
- FDocumented harm, or risk without benefit