Aczone vs Birth Control Pills

Aczone: An anti-inflammatory gel for red, tender acne. It is not a retinoid and not a standard antibiotic, so it suits skin that cannot tolerate either. Birth Control Pills: Birth control pills containing estrogen and a progestin. Four are FDA-approved for acne, and they work by lowering the amount of active testosterone in the blood.

Reviewed by Dr. Schwarz, Board-Certified Dermatologist

An illustrative blister pack and white sleeve labeled Birth Control Pills.

Which one?At a glance What it treats Diagrams How you take it Results Side effects Safety Cost When you stop Questions

Which one is right for you?

Choose Aczone if…

Choose for red, tender acne when skin can't tolerate a retinoid or you want to avoid a standard antibiotic.

Inflamed spots rather than blackheads
Sensitive skin that reacts to retinoids
You want a morning step that sits well under makeup

Choose Birth Control Pills if…

Choose for hormonal acne along the jaw and chin when you also want contraception and have no clot risk factors.

Breakouts that track your cycle
You want contraception anyway
You don't smoke and have no clot or migraine-with-aura history

Often combined

Can you take them together?

These work on different causes: the pill lowers hormone-driven oil while Aczone calms inflamed spots. They are often used together for hormonal acne.

At a glance

● Aczone

● Birth Control Pills

Type

Topical anti-inflammatory (dapsone gel)

Combined hormonal pill (estrogen + progestin)

What it does

Calms red, tender acne spots

Lowers active testosterone, so less oil

Best for

Inflamed acne

Hormonal acne in people who also want contraception

Prescription

Yes

Yes in most states

Form

Gel, 5% or 7.5%

Tablet

How often

7.5% once daily; 5% twice daily

One tablet daily

Course length

Ongoing

Time to results

4–12 weeks

About 3 months

Main side effect

Mild dryness

Nausea, breast tenderness, spotting

Blood tests

None for the gel

None; blood pressure checks

Pregnancy

Check with your clinician

Not used in pregnancy

Cost

Moderate; generic available

Low; generic, often no copay

What it treats

Compare uses by strength of evidence. Evidence level describes confidence in a benefit, not its size.

Evidence level

Aczone

Birth Control Pills

Strong evidenceMost established uses

Acne

Reduces inflamed breakouts in large trials.

Acne

Reduces hormonal breakouts.

Moderate evidenceSome supportive research

—

Hirsutism

Slows unwanted hair growth.

Visible sebum shine and natural pores on the nose and cheek.

Oily Skin

Lowers oil production.

Limited evidenceEarly or small studies

Redness and fine superficial vessels across a light-skinned cheek and nose.

Rosacea

Small studies show fewer bumps.

—

Little evidence

dark keratin plugs in dilated pores on the nose and adjacent left cheek, with the face turned to the person’s right on light skin.

Blackheads

Weaker on clogged pores than retinoids.

—

Not effective

Acne Scarring

Doesn't change scars.

Acne Scarring

Doesn't change scars.

Can make it worse

—

Flat tan patches with soft irregular edges across the forehead and upper cheek of an adult with light skin, the surface completely smooth.

Melasma

Hormones can trigger or darken melasma.

How it works

Aczone. Dapsone gel helps calm inflammatory acne. 1. May calm neutrophil activity: Can reduce some inflammatory actions of these immune cells. 2. May reduce inflammatory oxidants: Can limit release of tissue-irritating molecules. 3. Reduces inflamed acne spots: Red bumps and pimples can improve over time. — Open full-size diagram
Diagram explanation and sources
May calm neutrophil activity: Can reduce some inflammatory actions of these immune cells. May reduce inflammatory oxidants: Can limit release of tissue-irritating molecules. Reduces inflamed acne spots: Red bumps and pimples can improve over time.
The acne mechanism is unknown. Neutrophil and oxidant explanations are proposed based on experimental studies, not established as the cause of topical clinical benefit.
Source 1 · Source 2 · Source 3

Birth Control Pills. Combined pills can reduce hormone-driven acne. 1. Reduces ovarian androgens: Combined hormones lower androgen production by the ovaries. 2. Binds more testosterone: Estrogen raises SHBG, leaving less testosterone free to act. 3. Turns down oil stimulation: Less available androgen means less oil-gland stimulation. 4. Reduces acne over time: Hormone-driven breakouts can gradually improve. — Open full-size diagram
Diagram explanation and sources
Reduces ovarian androgens: Combined hormones lower androgen production by the ovaries. Binds more testosterone: Estrogen raises SHBG, leaving less testosterone free to act. Turns down oil stimulation: Less available androgen means less oil-gland stimulation. Reduces acne over time: Hormone-driven breakouts can gradually improve.
This refers to combined estrogen-progestin pills, not progestin-only contraception. Estrogen effects include suppression of ovarian androgen production and increased SHBG, reducing free testosterone. Specific formulations and clinical responses differ.
Source 1 · Source 2

How you take it

Treatment plan

When to Apply: Clean dry skin, whole affected area. The 7.5% gel once a day, the 5% gel twice, usually in the morning so the night is free for a retinoid.

How to Start: Full strength from day one. It dries clear and sits well under makeup and sunscreen.

If It Irritates: Uncommon — usually mild dryness a moisturizer settles. With benzoyl peroxide at the same moment it can turn skin temporarily orange-brown, which is harmless and avoided by using the two at different times of day.

If It’s Not Working: Give it twelve weeks. There is no step up in strength, so the next move is adding or changing a drug.

The pack is the dose.

Starting dose: One active tablet daily, begun where in the cycle your prescriber says.
Going up: No increase. If acne has not responded by six months, change the formulation or add another drug.
Usual dose: One tablet daily at about the same time.
Total course: As long as contraception and acne control are both wanted.

Monitoring

No routine blood tests for the gel. Unlike dapsone tablets, you do not need G6PD testing first, because so little is absorbed.

You can stay on this for years, and nothing accumulates. Review is clinical, at about twelve weeks and then yearly.

Blood pressure and a careful history come before the first prescription: migraines, past clots, smoking, family history. Blood tests are not routinely needed.

People stay on this for years, and what drifts is risk, not the drug. Clot risk is highest in the first year and after restarting, and rises with age, weight, smoking and immobility. Blood pressure is rechecked periodically, and the decision is revisited around age 35.

When to take it

Not covered in this guide yet

One tablet daily at the same time, with food if it causes nausea. Backup contraception covers the first week unless you start at a set point.

If you miss a dose

Not covered in this guide yet

Take it as soon as you remember, even if that means two in a day. For more than one, follow the pack instructions and use backup contraception. Missed pills affect pregnancy protection far more than acne.

When you’ll see results

Approximate windows, not promises.

● Aczone

● Birth Control Pills

Weeks 1 to 4

Weeks 1 to 4Red, tender spots calm down. Blackheads and whiteheads look unchanged.

Weeks 1 to 4Nausea, breast tenderness and spotting between periods. Acne may briefly worsen.

Weeks 4 to 8

Weeks 4 to 8Fewer new inflamed spots.

After 12 weeks

After 12 weeksIf inflamed acne has not improved, move on. Judge it on red spots only — it was never going to fix clogs.

After 12 weeksThe fair judgment point, though improvement often runs to six months. Nothing changed by then means a different formulation or drug.

Weeks 4 to 12

Weeks 4 to 12Oiliness drops and inflamed spots become less frequent.

Side effects

Sorted by what to do about them.

Aczone

Birth Control Pills

Common

Mild dryness or oiliness
Orange tint if used with benzoyl peroxide at the same time

Common

Nausea, usually gone by month three
Breast tenderness
Spotting between periods

Tell your doctor

Irritation that doesn't settle

Tell your doctor

New or severe headaches, especially with vision changes
Low mood that does not lift

Stop and get care

A spreading rash or blisters
Breathlessness, pale skin or blue-tinged lips

Stop and get care

Pain, swelling or warmth in one calf
Sudden breathlessness or chest pain
Sudden weakness, numbness or trouble speaking

Safety and who should avoid it

Pregnancy

Ask first

Discuss with your clinician.

Stop

Not taken in pregnancy.

Breastfeeding

Ask first

Discuss with your clinician.

Avoid early

Estrogen can reduce milk supply; progestin-only methods are preferred early on.

Children

9 and older

Approved from age 9 (7.5%) or 12 (5%).

After periods start

Used in teens once periods are established.

Monitoring

None routine

Unlike dapsone tablets, no blood tests.

Blood pressure

Checked before and a few months in.

Key interactions

Check

Benzoyl peroxide at the same time (orange tint); oral dapsone.

Check

Rifampin, St John's wort and some anti-seizure drugs reduce how well it works.

Other cautions

Avoid

Allergy to dapsone or sulfones.

Avoid

Smoking at 35+, past blood clots, migraine with aura, uncontrolled blood pressure, breast cancer, liver disease.

Cost and getting it

Getting it and cost

Generic dapsone gel comes in both strengths and costs far less than it used to, though still more than generic clindamycin or benzoyl peroxide. Some plans want prior authorization, usually after a retinoid.

Most combined pills are generic and cheap, and many plans cover contraception with no copay. The branded acne-approved versions cost more with no advantage. Availability without a prescription varies by state.

When you stop

Comes back?

Yes. Red spots come back within weeks to a couple of months.

Often, and acne can flare in the first few months after stopping.

Taper needed?

No rebound and no taper.

No.

After the last dose

Inflammation returns to its old level.

Fertility returns within a cycle or two. Have the next acne step in place first.

Common questions

Aczone:Why did my face turn orange?

Benzoyl peroxide and dapsone applied together can leave a temporary orange-brown tint on skin and light-colored facial hair. It washes off and is harmless. Use them hours apart.

Aczone:Do I need a G6PD test first?

Not for the gel. That belongs to dapsone tablets, where far more of the drug reaches the bloodstream.

Aczone:Will it clear my blackheads?

No. It works on inflammation. Blackheads need a retinoid.

Aczone:Is it an antibiotic?

No. It is a sulfone with anti-inflammatory action, which is why resistance is not the same concern.

Birth Control Pills:Which pills actually help acne?

Combined pills, which contain estrogen. Four are FDA-approved for acne; many others work similarly. The mini-pill, implant and hormonal coil can make acne worse.

Birth Control Pills:Will my acne get worse first?

Sometimes, in the first month or two. It settles.

Birth Control Pills:Does my acne antibiotic stop the pill working?

Rifampin does. Doxycycline and the other acne antibiotics do not.

Birth Control Pills:How risky are blood clots really?

The increase is real, but absolute risk stays low in healthy non-smokers, and pregnancy itself carries a higher clot risk. It rises sharply with smoking after 35, a family history of clots, and migraine with aura.

Birth Control Pills:What happens to my skin when I stop?

Acne commonly flares for a few months. Plan the next step before you stop.

Dermapedia on YouTube