When do I need oral medication for acne? Grade 1 mild is treated with topical medication only. grade 2 mild or above requires topical medication with oral medication. To put it plainly, oral medication is not needed when there are only papules and pimples, just topical topical treatment is sufficient. If there are inflammatory papules, pimples, and pustules, you need to add anti-inflammatory drugs orally to the topical application. If, in addition to the above skin manifestations, there are nodules and cysts, it is necessary to add anti-keratosis medications, such as vincristine capsules, vincristine tablets, and isotonic acid soft capsules.