Medication

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.
Dr. Schwarz, MD · Board-certified dermatologistLast reviewed August 23, 2026
A silver metal tube lying at an angle on a white background, white ribbed cap to the left, labeled Dapsone in black lettering with a plum-colored swoosh curving beneath the word.

Start here

When I see a patient on topical dapsone for acne, I know nothing else worked. It is one of our last-resort acne options.

— Dr. Schwarz, Board Certified Dermatologist

Key Facts

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Also calledAczone
Drug classTopical sulfone, anti-inflammatory
Applied asGel, 5% or 7.5%
Typical courseLong term while acne is active
Time to work4 to 12 weeks
Prescription onlyYes

What It Is

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Dapsone gel is a prescription acne gel. Dapsone itself is an old pill for leprosy and certain blistering skin diseases; the gel puts a small amount on the skin only, where it acts mainly as an anti-inflammatory. It is approved from age nine or twelve, depending on strength.

How It Works

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Dapsone calms the immune cells that make acne spots red and sore, mainly by blocking how neutrophils — a type of white blood cell — generate inflammation. It has some effect on bacteria, but the anti-inflammatory action is what helps acne.

People assume it is an antibiotic like clindamycin. It is not, and that matters — it does not appear to drive antibiotic resistance, so it does not need benzoyl peroxide alongside it for that reason.

Here is where Aczone acts in the skin, and what the others do instead.

About Aczone
Compare
Skin basics
BARRIEREPIDERMISDERMISPOREOILGLANDKILLS BACTERIAHARD TO GET INSTOPS PLUGS FORMINGUNCLOGS THE POREKILLS YEASTLOWERS OIL PRODUCTIONKILLS MITES

Aczone works on the bacteria growing in an inflamed pore. Less bacteria means less for the immune system to react to, which is what takes the redness and soreness out of a spot. Works more on the inflammation than the bacteria, which is why it suits inflamed acne rather than blackheads.

Dapsone gel crosses poorly on purpose. Blood levels stay far below those of the tablet, which is what makes the gel routine and the tablet a monitored drug.

Retinoids change how the lining of the pore sheds its cells, so the plug that starts a spot stops forming in the first place. That is why they prevent spots rather than treat the ones already there, and why the first weeks can look worse before they look better.

Salicylic acid dissolves in oil, so it gets down inside the pore rather than sitting on the surface, and loosens the plug of dead skin and sebum blocking the way out.

The yeast involved here lives on everyone's skin and only causes trouble when it overgrows in oil. This reduces it, which is why the flaking and itching settle and why it comes back if treatment stops for good.

This works upstream of the spot, on the gland itself. Less oil means fewer plugs, less for bacteria to feed on and less inflammation, which is why it changes the pattern rather than clearing one spot.

Everyone carries these mites in their follicles. In some people the immune system reacts to them, and reducing their number reduces the bumps and the redness that come with them.

The outer film of dead cells and oil. It holds water in and keeps irritants out, and it is thinner than a sheet of paper. Almost every dry, itchy, stinging skin problem starts here.

The outer layer, and the only one anything in a jar reaches. It renews itself constantly: a cell made at the bottom takes about a month to reach the surface and flake off. Most of what a skincare product does, it does here.

The living layer underneath, holding the blood vessels, the nerves and the collagen. It is where lasting change happens and it is hard to reach: most of what is sold for the skin never gets this far.

What It Treats

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Close-up of a cheek with inflamed acne. Raised pink-red bumps, a few with yellow-white heads, sit in a patch of redness, and the skin between them is dry and flaking.
Acne
Moderate evidence
Mild on the skin and tends to suit adult women with inflamed spots who cannot tolerate a retinoid. Applied at the same time as benzoyl peroxide it can temporarily stain skin orange, so space them apart.

Not the Best For

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Two skin close-ups side by side, labeled Whitehead (Closed Comedone) and Blackhead (Open Comedone)
Blackheads and whiteheads
Doesn't work
Dapsone works on inflammation. It settles red, tender spots well and leaves clogged pores alone.
Close-up of pink raised bumps, some with small white tips, on flaking skin
Very oily or severe acne
Doesn't work
It is a gentle option, best suited to mild or moderate inflamed acne. Widespread or deep acne generally needs a stronger plan.

Forms

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One form only
It dries clear, and generic versions exist.
A white cream tube lying on its side on a white background, with a plain white label reading Aczone Gel and a blue swoosh beneath it.
The only form
Gel
There is no cream or lotion version.

Strengths

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Once-daily 7.5% is usually the better choice, because people keep using it.

WeakestStrongest
5%7.5%
Twice a day
5%
The original.
Once a day
7.5%
The usual choice now, and easier to stick with.

Basics

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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.

Sample Routine

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Here is where Aczone sits in a day, and what goes around it. Pick what you are treating and what your skin is like, and the rest of the routine changes to suit.

What to Expect

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Weeks 1 to 4Weeks 4 to 8After 12 weeks
Weeks 1 to 4
Red, tender spots calm down. Blackheads and whiteheads look unchanged.
Weeks 4 to 8
Fewer new inflamed spots.
After 12 weeks
If inflamed acne has not improved, move on. Judge it on red spots only — it was never going to fix clogs.

What to Avoid

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  • Benzoyl peroxide at the same moment It leaves a temporary orange tint on skin and facial hair. Use them hours apart and it does not happen.

Monitoring

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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.

If You Stop

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No rebound, no taper. Inflammation returns to its old level, and red spots come back within weeks to a couple of months.

Cost

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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.

Ask Your Doctor

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Oral dapsone at the same time
Unless a specialist has planned it.
An allergy to dapsone or sulfones
The only absolute barrier for the gel.
If you get a spreading rash or blisters
Anywhere on the body.
If you feel breathless or look pale
Or your lips look blue-tinged. Rare, and needs same-day care.

How It Compares

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A white metal tube lying at an angle on a white background, white ribbed cap to the left, labeled Clindamycin in black lettering with a teal swoosh curving beneath the word.Diagram: how Clindamycin works in the skin
Clindamycin
Worse
similar target, but an antibiotic, so resistance is a concern and it must be paired with benzoyl peroxide.
Three acne wash tubes on white: Differin Deep Cleanser, CeraVe Acne Foaming Cream Cleanser and PanOxylLabeled cutaway diagram of a single skin pore. The epidermis is drawn as a brick-textured layer across the top and the dermis in pink below it, with a yellow oil gland at the base of the pore. Three callout lines point into the pore: decreases dead cells in pore near the opening, kills bacteria at the cluster of bacteria deep in the shaft, and decreases inflammation in the surrounding dermis.
Benzoyl peroxide
The same
cheaper and effective, but more drying and it bleaches fabric.
Five azelaic acid tubes and bottles on white, most marked 10 percent, from Peach Slices, Paula's Choice, Facetheory, The Ordinary and NaturiumLabeled cutaway diagram of a single skin pore, headed Azelaic Acid. The epidermis is a brick-textured band across the top and the dermis is pink below it, with a yellow oil gland at the base of the pore and a small cluster of bacteria inside it. Three callout lines point in: decreases dead cells in pore and kills bacteria are drawn in dark navy as main effects, and decreases inflammation is drawn in gray as a lesser one.
Azelaic acid
Different job
also gentle, also helps dark marks, and works on clogs as well as inflammation.
Topical retinoids
The same
stronger overall and the backbone of acne treatment, but far more irritating.
Dapsone gel's case is tolerability, not power.
Different job

Myths

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  • "You need a G6PD test first." Not for the gel. A study of 64 people with G6PD deficiency using dapsone gel 5% found no sign of red cell breakdown, clinical or laboratory. The blood test belongs to the oral drug.
  • "The orange tint is permanent." It comes from applying it at the same moment as benzoyl peroxide, it affects skin and facial hair rather than staining anything for good, and it washes out.
  • "You cannot combine it with anything." It is routinely used with a retinoid or benzoyl peroxide — just not at the same moment as benzoyl peroxide.
  • "You have to avoid certain foods, alcohol or the sun." None of those affect the gel. It is not a photosensitizer, so your usual sun care is enough.

Questions Patients Ask

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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.

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.

Will it clear my blackheads?

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

Is it an antibiotic?

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

References

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