A dermatologist can prescribe stronger medications, perform in-office procedures, and build a multi-step treatment plan that goes well beyond what’s available over the counter. If drugstore products haven’t cleared your skin after a few months of consistent use, a dermatologist has a significantly wider toolkit, from prescription topicals and oral medications to cortisone injections, chemical peels, laser therapy, and scar treatments.
Prescription Topicals That Work Faster
The biggest advantage a dermatologist offers is access to prescription-strength topicals. Over-the-counter products max out at low concentrations, but a dermatologist can prescribe stronger retinoids, higher-strength benzoyl peroxide combinations, and topical antibiotics. The American Academy of Dermatology recommends combining multiple topical mechanisms of action as a core strategy, something that’s difficult to do effectively on your own.
One of the most common prescriptions pairs benzoyl peroxide with either a retinoid (adapalene) or an antibiotic (clindamycin) in a single product. In clinical trials, 40% to 50% of patients using these combination products reported complete or near-complete improvement in their acne. A dermatologist can also prescribe clascoterone, a newer topical that blocks hormonal triggers for acne directly at the skin, and azelaic acid at prescription strength for both breakouts and post-inflammatory dark spots.
These prescription topicals typically show first results within 4 to 6 weeks, with full clearing closer to 8 to 12 weeks. Retinoids in particular build results gradually and can take up to 12 months for maximum improvement in both breakouts and skin tone. Your dermatologist will set expectations so you don’t abandon a treatment that’s actually working.
Oral Medications for Moderate to Severe Acne
When topicals alone aren’t enough, dermatologists can prescribe oral medications that attack acne from the inside. The most commonly prescribed oral antibiotics for acne include doxycycline, minocycline, and sarecycline. These reduce the bacteria and inflammation driving breakouts, and current guidelines recommend pairing them with benzoyl peroxide to limit antibiotic resistance. Dermatologists also aim to keep antibiotic courses as short as possible, transitioning you to topical maintenance once the acne improves.
For severe, treatment-resistant acne, isotretinoin remains the most powerful option available. It shrinks oil glands, reduces bacterial growth, and prevents clogged pores all at once. It requires close monitoring through regular blood tests and, for those who can become pregnant, strict pregnancy prevention measures. But for people with deep cystic acne that hasn’t responded to other treatments, it often produces long-lasting or permanent clearing.
Hormonal Treatments for Adult Acne
Hormonal acne, the kind that flares along the jawline and chin and worsens around your period, responds to a different class of medications. Combined oral contraceptives are one option, and the AAD lists them among recommended systemic therapies. Another is spironolactone, a pill originally designed as a blood pressure medication that also blocks the hormones triggering oil production.
Spironolactone is prescribed in doses ranging from 25 to 200 mg per day, though research suggests that even a low dose of 50 mg daily can be effective for hormonal acne. Dermatologists typically start low and increase gradually. Side effects can include more frequent urination (it’s a diuretic), breast tenderness, irregular periods, fatigue, and headaches. Because it can raise potassium levels, your dermatologist will monitor bloodwork, especially if you have kidney concerns. Spironolactone is only prescribed for women, as it can cause feminizing effects in men.
Cortisone Injections for Painful Cysts
If you’ve ever had a deep, throbbing cyst that won’t come to a head, a dermatologist can inject a small amount of a steroid directly into it. This is one of the fastest treatments available: the swelling, redness, and pain typically shrink within a few days. It’s a common same-day procedure for anyone with a painful nodule before a big event, or for cysts that keep recurring in the same spot. The AAD recommends these injections as an adjuvant treatment alongside other acne therapies.
Professional Extractions
Dermatologists and their trained staff can safely extract blackheads, whiteheads, and milia using sterile tools and proper technique. This matters more than it might seem. When you squeeze a pimple at home, the contents don’t always come out cleanly. They can rupture inward, spreading debris and bacteria deeper into the skin and triggering more inflammation and scarring. Inflammatory acne like pustules sometimes requires a sharp tool to open the surface before extracting, and milia (those hard, white bumps that look like whiteheads but won’t pop) typically need a blade-type instrument for removal. Both are best handled in a clinical setting.
Chemical Peels
Professional chemical peels use concentrations far higher than anything you can buy over the counter. While drugstore salicylic acid products typically contain 0.5% to 2%, a dermatologist can apply 20% to 30% salicylic acid in a controlled peel. These stronger peels penetrate deeper to unclog pores, reduce oiliness, and improve skin texture. A typical course involves multiple sessions spaced about two weeks apart. Your dermatologist can also use other peel formulations depending on your skin type and whether you’re dealing with active breakouts, dark spots, or both.
Light and Laser Therapy
For acne that doesn’t respond well to medications, dermatologists can offer light-based treatments. The most studied approach is photodynamic therapy, which involves applying a light-sensitizing agent to the skin and then exposing it to a specific wavelength of light. This targets the bacteria that cause acne and can also damage overactive oil glands. Red light is the most widely used because it penetrates deeper into the skin than blue light, reaching the oil-producing structures underneath.
Research on light therapy for acne is still evolving, and results vary. The AAD actually recommends against one specific combination (pneumatic broadband light with adapalene gel), so not all light devices are equally supported. Your dermatologist can advise whether light therapy makes sense for your specific situation or whether other options are likely to work better. Daylight-based versions of photodynamic therapy are also emerging as a potentially more tolerable option.
Acne Scar Treatments
Once active acne is under control, a dermatologist can address the scars left behind. The approach depends on the type of scarring you have.
- Microneedling: A device studded with tiny needles is rolled over the skin to stimulate collagen production underneath. It’s considered safe with minimal risk of skin discoloration, making it a good option for darker skin tones. Results are subtle and usually require repeat sessions.
- Laser resurfacing: Increasingly popular for acne scars, this technique removes or remodels damaged skin layers. It carries a higher risk of side effects for people with darker skin or a history of raised (keloid) scars.
- Subcision: For deep, tethered scars that create shadows or indentations, a dermatologist inserts a needle under the skin to release the fibrous bands pulling the scar downward. This allows the skin to lift and smooth out over time.
Many people benefit from a combination of these treatments rather than a single approach. Scar treatment is typically done in a series of sessions over several months, and your dermatologist will often recommend waiting until breakouts are well controlled before starting.
What to Expect at Your First Visit
A dermatologist will assess your acne type (comedonal, inflammatory, cystic, or a mix), its severity, and whether scarring is already present. They’ll ask about what you’ve already tried, how long you used it, and whether your acne seems connected to your menstrual cycle or other patterns. From there, they’ll typically start with a combination of topical prescriptions for mild to moderate acne, adding oral medications if needed for more severe cases.
The most important thing to know going in: acne treatment takes time. Dermatologists recommend giving any new regimen at least 8 to 12 weeks before judging results. Your skin may even look slightly worse before it improves, particularly with retinoids. Building a treatment plan with a dermatologist means you have someone adjusting your approach along the way rather than guessing on your own with products that may not be strong enough to make a difference.