Oral antibiotics. Isotretinoin (Roaccutane). Topical retinoids. Benzoyl peroxide. Anti-acne pill. These five treatments represent 90% of what conventional medicine has offered against acne since the 1980s. They have saved genuinely severe situations. They have also left many patients with side effects — and a majority of relapses after stopping.
For ten years, research on microbiome and skin inflammation has renewed the understanding of acne. Here is the honest state of these treatments.
Important note: this is not an article against conventional medicine. In some severe cases these treatments remain relevant. This is an article to understand when they are useful, when less so, and why a complementary approach exists.
1. Oral antibiotics (tetracyclines)
Mechanism: 3–6 month courses. Reduce C. acnes + anti-inflammatory effect at low dose.
What works: rapid reduction of inflammation, effective on moderate to severe forms.
What is problematic: relapse after stopping in 60–80% of patients, documented bacterial resistance, lasting gut dysbiosis, photosensitisation.
Verdict: justified in severe acute inflammatory acne. Debatable in moderate cyclic acne.
2. Isotretinoin (Roaccutane / Curacne)
Mechanism: vitamin A derivative. Massively reduces sebum production, regulates keratinisation. The most effective treatment available.
What works: long-term remission in 60–70% of patients.
What is problematic: significant physical side effects (extreme dryness, hair fragility, joint pain), hepatic impact requiring monthly bloodwork, major teratogenicity (contraception mandatory in women of childbearing age), documented neuropsychiatric effects (depression, suicidal thoughts), relapse in 1/3 of patients.
Verdict: justified in severe nodulocystic acne with major psychological impact. Debatable in moderate acne or when other approaches have not been tried.
3. Topical retinoids (adapalene, tretinoin)
Mechanism: regulate follicle keratinisation, moderate anti-inflammatory effect.
What works: effective on comedonal acne, well studied for 40 years.
What is problematic: skin irritation (dryness, redness, flaking) in early weeks, photosensitisation (SPF mandatory), weakened skin barrier, incompatible with pregnancy, effect lost on stopping.
Verdict: justified in acne with a comedonal component. Debatable on sensitive or already weakened skin.
4. Benzoyl peroxide
Mechanism: powerful antibacterial.
What works: fast antibacterial action, no resistance, effective in targeted local application.
What is problematic: strips the skin barrier (tight, red, flaking skin), bleaches fabric, does not distinguish good from bad bacteria (kills the entire skin microbiome), rebound effect on stopping, moderate photosensitisation.
Verdict: justified for an isolated occasional pimple, short term. Debatable in daily prolonged use.
5. Anti-acne contraceptive pill
Mechanism: antiandrogens.
What works: contraception + effect on skin in some patients.
What is problematic: limited efficacy (15–30% improvement on average in rigorous studies), systematic relapse after stopping with major rebound (especially Diane 35), increased thromboembolic risk, mood effects, possible libido decrease.
Verdict: justified if real need for contraception + severe hormonal acne. Debatable for acne alone.
What all these treatments have in common
They target a symptom or a specific mechanism — never the deep causes of adult acne: microbiome, systemic inflammation, gut-skin axis, global hormonal balance. That is why relapse on stopping is almost systematic. The symptom is suppressed without repairing the terrain that produces it.
The modern approach: treat the terrain, not the symptom
Recent research converges on a simple conclusion: durable adult acne is treated with a holistic approach that rebalances the terrain. The 4 pillars: gut microbiome (varied diet, reduction of ultra-processed foods, targeted supplementation if needed); skin microbiome (gentle cleansers that preserve the hydrolipid film); supported hormonal balance (sleep, stress management, moderate exercise); restored skin barrier (daily hydration, regenerating night care).
The Zactigis approach: IN & OUT
Our SkinLine range is built on this philosophy:
IN — Deep action via SkinCTRL. Lactoferrin supplement supporting the gut microbiome, hormonal balance through the gut-skin axis, and foundational immunity. Made in Switzerland.
OUT — Complete topical routine: phase-appropriate cleansing (SkinSoap, SkinFoam, SkinNet), targeted treatment of risk zones (SkinPure, SkinMat), nocturnal regeneration (SkinNight).
This combination gives the best results over time — not to make a pimple disappear in 3 days, but to build a durable balance.
Our 3-month SkinCTRL course covers the biological duration needed for genuine change. The Complete Routine Pack brings together the 5 fitting topical products.
Should all medical treatments be abandoned?
No — especially not without medical advice.
If you are currently on treatment: do not stop without consulting your dermatologist. Discuss a progressive transition.
If you are considering a medical treatment: have I tried a holistic approach (IN + OUT + lifestyle) for at least 6 months? Is my situation severe enough to justify the side effects? Am I ready to accept the documented risks? Do I have a post-treatment exit strategy to avoid relapse?
If you prefer to test a holistic approach first: legitimate for moderate acne. Allow 3 to 6 months for honest evaluation.
Summary
- Classic treatments target symptoms, not deep causes — hence the relapses
- They remain relevant in severe cases but with serious side effects
- The modern approach rebalances the terrain: microbiome, inflammation, hormonal balance, skin barrier
- A holistic approach (IN + OUT + lifestyle) delivers durable results over 3–6 months for moderate acne
- Always consult a professional before stopping or changing an ongoing medical treatment
