If you have mild or moderate acne, you may have greasy skin and spots (such as blackheads) on your face, back, chest and shoulders. Red or yellow spots (pustules) can form if your skin becomes inflamed (swollen). Sometimes, spots that have become inflamed (pustules, nodules and cysts) may be painful, tender to touch and hot. In very severe acne, cysts may join together to form larger, deeper inflamed areas (acne conglobata), but this is rare.
If you think you have acne, and it’s affecting how you live your life, see your pharmacist or GP.
Your GP will ask about your symptoms and may examine you. They may also ask you about your medical history. Your GP will usually be able to diagnose acne based on your symptoms. This is because acne is easily recognisable by the pattern of spots on your body.
If your acne is severe, your GP may refer you to a doctor who specialises in treating conditions that affect the skin, called a dermatologist.
Acne isn’t caused by having poor hygiene, so extra washing doesn't make it better. Gently wash spot-prone areas as normal with a mild soap or an unperfumed cleanser and water no more than twice a day. If possible, try not to wear lots of make-up. If you do wear make-up, make sure you remove it all at night.
There’s no need to scrub your skin forcefully or use exfoliating skin care products. Scrubbing or picking your skin can make it worse. If your skin is dry (some acne creams can cause dry skin) you can use a fragrance-free, water-based moisturising cream.
Over-the-counter treatment containing benzoyl peroxide (eg PanOxyl) may help. These treatments are antibacterial and so reduce the amount of Propionibacterium acnes (P. acnes) bacteria on your skin. You can buy these treatments from pharmacies and larger supermarkets. There’s not much proof that other types of over-the-counter acne treatments are helpful.
Treatments containing benzoyl peroxide may cause your skin to become irritated (slightly reddened). This tends to settle down if you reduce the number of times you use them. You can then build up your use gradually.
Over-the-counter treatments like benzoyl peroxide for acne take time to improve your skin noticeably, so don’t expect a big difference overnight. Your acne may only get better several weeks after you have been using the treatment regularly.
Take care not to get any of your treatment on your clothes. If treatments containing benzoyl peroxide accidentally get onto your clothes, they will cause the colour to fade.
Creams and lotions
Your GP may prescribe one of the following treatments.
- Benzoyl peroxide creams or gels.
- Azelaic acid. This is an antibacterial medicine usually used as an alternative to benzoyl peroxide. It's less likely to make your skin as red, or peel as much.
- Antibiotic lotions or gels, such as clindamycin or erythromycin. These can help to reduce inflammation (swelling) by controlling the levels of natural P. acnes bacteria on your skin.
- Topical retinoids such as tretinoin and isotretinoin. It may take some time before the effects of these medicines are noticeable. Retinoids can be slightly irritating to your skin, but this should settle over time.
You may also become more sensitive to sunlight, so make sure you use plenty of sunscreen if you’re going out in the sun. You shouldn't use retinoids if you're pregnant as they can cause harm to your baby.
If you have moderate or severe acne, your GP may prescribe an antibiotic such as oxytetracycline, erythromycin or doxycycline. They will advise you how many times a day you need to take your medicine and for how long. Most people who try this treatment find their acne gets much better within six months. You may also be given a cream or lotion (explained above) to use at the same time.
If you're a woman and also need contraception, your GP may advise taking an oral contraceptive pill to treat your acne. Contraceptive pills suppress the male hormone testosterone, which is responsible for increasing sebum production. This means they can help make your skin less oily. Generally, you’ll be given these alongside other treatments for acne.
If you have severe acne and antibiotics have not helped, your doctor may suggest that you take a medicine called co-cyprindiol. This works as a type of contraception. It reduces the levels of male hormones in your body. Taking oral contraceptives can increase your risk of getting blood clots. Your doctor will discuss the risks and benefits of this treatment with you.
Your doctor may advise you to take an oral retinoid medicine called isotretinoin. This reduces the amount of sebum your skin produces. Be aware that your acne may worsen before it begins to improve. Isotretinoin can cause dry lips and skin, headaches, nose bleeds and pain in your joints. It may also cause more serious problems such as liver problems, raised cholesterol levels and rarely, low mood (depression). If you’ve had depression in the past, let your dermatologist know before you start treatment. Although rare, there’s a small chance you may have an allergic reaction to isotretinoin. You’ll be advised to have regular blood tests to check for any problems, for example, with your cholesterol levels.
If you’re a woman you’ll need to use contraception while taking this medicine. This is because isotretinoin could affect the development of an unborn baby. You’ll also have a monthly review meeting to chat about how your treatment is going. You’ll have the opportunity to discuss these and other issues with your dermatologist and ask questions before you start treatment.
New treatments that involve therapy with light or lasers are being developed. Light therapy isn't usually offered as treatment for acne, because doctors aren't sure how well it works yet. Research into how well these therapies work is still on-going. Before these therapies are offered as treatments, more scientific proof is needed to show how useful they are.
For more information on light treatment, speak with your dermatologist.
There are lots of myths about what causes acne. You may be surprised to know that acne isn't caused by having a poor diet (such as eating lots of chocolate) or bad hygiene. In fact, washing too much can make it worse. It’s also not likely to be caused by stress.
During puberty, both men and women produce more of the male hormone testosterone. This increases the production of sebum in your skin, causing it to become greasy and encouraging spots. It's thought that this is one of the main reasons most teenagers develop acne during puberty. But if you have acne, it doesn't always mean that you have high levels of testosterone. Instead, your body may be more sensitive to the effects of testosterone.
If you're a woman, hormonal changes just before your period may trigger acne. Newborn babies can sometimes get acne in the first few months of life.
There’s a chance that acne can run in families. For example, if both your parents had acne you have an increased chance of having it too.
Other causes of acne may include:
- conditions such as polycystic ovary syndrome and Cushing's syndrome
- oily cosmetic products
- medicines, such as anabolic steroids, steroid creams and ointments, and lithium
Acne usually clears up as you get older. If you have more severe acne, you might get scarring. This can be permanent but usually improves over a long time.
- Scarring. Up to one in five people with acne have noticeable scarring. If you pick and squeeze your spots, you increase the chance of developing scars. Scars can be narrow ‘ice pick’ scars or broader ‘pock marks’. These are firstly purple in colour before fading to a whitish colour. Rarely, ‘keloid’ (firmer lumpy) scars may develop on your skin.
- Hyperpigmentation (your skin becomes darker in the areas affected by acne). This is usually only noticeable if you have a dark skin tone.
- Psychological problems. Acne may have a psychological effect on you, for example making you feel depressed or anxious. It can also affect your self-confidence, for example if people comment on your acne. Talk to your GP if your acne is making you start to feel low.
Does sunlight help acne?
There’s no proof that sunbathing or UV light help acne. It’s important that to remember that damage from the sun’s rays can increase your chance of getting skin cancer.
Unfortunately, there’s no proof that sunbathing or UV light help treat acne. However, repeated sunbed use and too much exposure to sunlight can increase your risk of getting skin cancer. Because of this, UV-based therapies aren't recommended for treating acne.
Some acne medicines increase sensitivity to sunlight. If you’re using a prescribed acne medicine, read the patient information leaflet and follow any advice on sun exposure and sunbed use.
You should never allow your skin to burn in the sun and should always use sunscreen. Talk to your GP or dermatologist for more advice.
I've heard oral retinoids work well as treatments for acne. Can they be prescribed for me?
Acne can often be treated with creams, lotions and antibiotics. If you have severe acne, or acne that hasn't got better with these treatments, you may be offered treatment with an oral retinoid medicine called isotretinoin.
Isotretinoin can work very well as treatment for acne. It works by reducing the amount of oil that your skin produces. It is also anti-inflammatory (reduces swelling). It can only be prescribed by a dermatologist (a doctor who specialises in skin conditions).
Isotretinoin is only usually prescribed if:
- you have severe acne, especially if it's causing nodules or cysts
- your skin is scarring
- your acne hasn't responded to previous courses of antibiotics
If you’re taking isotretinoin, you may develop some mild side effects, such as dry skin. There’s a chance you may develop more serious side-effects, but this is rare. See the treatment section to learn more about these. Because of its side-effects, isotretinoin is only used when other treatments haven’t worked. Your dermatologist might not prescribe it if you have a history of mental illness.
- British Association of Dermatologists
020 7383 0266
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- Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed date (online version)
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- Hyperandrogenism. DermNet NZ. www.dermnetnz.org, published Feb 2014
- Acne vulgaris. Medscape. www.emedicine.medscape.com, published 27 October 2014
- Squamous cell carcinoma of the skin. PatientPlus. www.patient.co.uk/patientplus.asp, published 12 August 2014
- Isotretinoin capsules. EMC. www.medicines.org.uk, published 10 April 2013
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- Personal communication, Dr Michael Arden-Jones, Associate Professor, Southampton University, 10 March 2015
- British Association of Dermatologists
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