If you have mild or moderate acne, you may have greasy skin and spots (whiteheads or blackheads) on your face, back and chest. Most spots will not cause any other symptoms. Sometimes, spots that have become inflamed (pustules, nodules and cysts) may be painful, tender to touch and your affected skin may feel hot.
Acne can usually be treated with over-the-counter creams and lotions. However, if your acne doesn't improve with self-help measures, or is affecting you emotionally, see your GP. If you’re uncertain whether or not you have acne, then speak to your pharmacist. Acne is easily recognisable by the distribution of spots on your body. Depending on how severe your acne is, your pharmacist or GP will recommend the most appropriate treatment.
There are many different types of treatment for acne.
By keeping your skin clean you can help to prevent spots forming. Gently wash spot-prone areas with a mild soap or an unperfumed cleanser in lukewarm water about twice a day. Try not to wash the affected areas more than this, or scrub too hard, as your skin needs a certain amount of oil to maintain its natural condition. Acne isn't an infection, so extra washing won't help. Take care not to scrub or pick acne, as this can make it worse, and make sure you remove all of your make-up at night. If your skin is dry (some acne creams can cause dry skin) you can use a fragrance-free, water-based emollient.
You may also be able to try an over-the-counter treatment that contains benzoyl peroxide (eg Oxy, Clearasil) – this has an antibacterial action and encourages your skin to shed its surface layer of dead cells. Together, these effects reduce the inflammation in existing spots and prevent new ones forming. You can buy these treatments from pharmacies and larger supermarkets.
Treatments containing benzoyl peroxide may cause your skin to become irritated (slightly reddened), especially to start with. This tends to settle down if you reduce the number of times you use it. You can then build up your use gradually.
Self-help treatments for acne take time to improve your skin noticeably, so it's important not to expect a big difference overnight. Your acne may only get better several months after you have been using the treatment regularly.
Creams and lotions
If your acne hasn't improved with self-help measures after about two months, see your GP. He or she may prescribe one of the following treatments.
- Azelaic acid. This is an antibacterial medicine usually used as an alternative to benzoyl peroxide, as it's less likely to make your skin as red, or peel as much.
- Antibiotic lotions, such as erythromycin or clindamycin. These can help control the P. acnes bacteria on your skin. You will usually be advised to continue with your treatment for two months. If your acne has not improved after this time, your GP may advise trying an oral treatment (a medicine you take by mouth).
- Retinoids such as tretinoin and isotretinoin. These are medicines based on vitamin A that work by unblocking your pores. Retinoids can make your skin more prone to redness, stinging and dryness in the sun. You shouldn't use retinoids if you're pregnant or breastfeeding as they can cause harm to your baby (teratogenic).
If you have moderate acne, your GP may prescribe an antibiotic such as oxytetracycline, erythromycin or doxycycline. He or she will advise you how many times a day you need to take your medicine, but you will need to stay on the course for a minimum of eight weeks. You may find it takes up to six months for your skin to improve and if your acne is severe, you may need to continue treatment for longer. You may also need to apply a cream or lotion containing benzoyl peroxide to increase the effectiveness of your antibiotic treatment.
If you're a woman and treatments with oral antibiotics haven't worked, your GP may advise taking an oral contraceptive pill, such as cyproterone acetate (eg Dianette). These medicines suppress the male hormones which are responsible for increasing sebum production and help make your skin less oily. You may find it takes up to three months for your skin to improve when you first start taking oral contraceptives. Generally, you will be given these together with other treatments to treat acne.
If you have severe acne, or acne that has proven resistant to other treatments, your GP may refer you to a dermatologist (a doctor specialising in skin conditions) for treatment with an oral retinoid (eg isotretinoin). These medicines are very effective at reducing the amount of sebum your skin produces.
If you're a woman, you should try to use two effective forms of contraception for at least one month before treatment, as well as during treatment, and for at least one month after stopping. This is because oral retinoids are teratogenic and could affect the development of an unborn baby. So for safety reasons, you will be asked to take regular pregnancy tests and will be limited to one month's supply of the medicine.
Oral retinoids usually cause dryness of your lips and occasionally nose bleeds and muscle pains. They are associated with a number of possible side-effects including low mood. If you have ever had low mood or depression in the past, you must let your dermatologist know before you start treatment. It's also recommended that you keep your alcohol intake to a minimum when you're being treated with isotretinoin.
You will have the opportunity to fully discuss all of these issues and ask any questions you may have with your dermatologist before you start treatment.
Light treatment is sometimes used to treat acne. Lights work by targeting the P. acnes in the sebaceous glands. Laser treatment may also be used to help with scarring caused by acne. For more information, speak with your dermatologist.
Contrary to popular belief, acne isn't caused by poor diet or bad hygiene.
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 to form. It's thought that this is one of the main reasons most teenagers develop acne during puberty. If you have acne, it doesn't necessarily mean that you have abnormally high levels of testosterone. It’s more likely that you have normal levels but that you’re more sensitive to its effects.
If you're a woman, hormonal changes during your menstrual cycle and pregnancy may trigger acne.
Acne can be hereditary. For example, if both your parents had acne you have an increased chance of having it too.
Other less common causes of acne may include:
- conditions such as polycystic ovary syndrome and Cushing's syndrome
- cosmetic products, particularly some types of greasy moisturisers
- medicines, such as steroid creams and ointments, used for eczema, and some medicines to treat epilepsy
Most people have a mild form of acne that usually clears up after their teenage years, but sometimes more severe complications may develop if you have moderate or severe acne.
- Scarring. Up to two in 10 people with acne have scarring that is socially noticeable. If you pick and squeeze your spots, you increase the chance that you will develop scars. Scars can be narrow 'ice pick' scars or broader ‘pock marks.’ These are initially purple in colour before fading to a whitish colour. Rarely, 'keloid' (lumpy, painful and itchy) scars may develop on your chest and back.
- 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 cause you to have low self-esteem or feel angry about the appearance of your skin, especially if you have scarring. Talk to your GP if your acne is making you feel particularly low.
Does sunlight help acne?
Sunlight may help some people with acne, but this isn't predictable and in most cases it has little benefit. The risk of getting skin cancer as a result of damage from the sun's rays far outweighs any improvements to acne.
Some people may find that sunlight improves their acne in the short term, but there aren't thought to be any long-lasting benefits.
Although some studies have suggested artificial ultraviolet (UV) light therapy can slightly improve acne, these haven't been conclusive and are being investigated further. However, as there is strong and clear evidence that repeated sunbed use and excessive exposure to sunlight increases your risk of getting skin cancer, UV-based therapies aren't recommended as a treatment for acne. Some acne medicines can increase sensitivity to UVB light or sunlight. If you’re taking medicine that has been prescribed by your doctor, particularly topical or oral retinoids or oral tetracyclines, you shouldn't expose yourself to sunlight for long periods of time.
Talk to your GP or dermatologist for more advice. You should never allow yourself to burn if you're in the sun and should always use sunscreen.
I've heard oral retinoids are very effective at treating acne. Can I be prescribed them?
Acne can usually be controlled with creams, lotions and antibiotics. However, severe acne, and acne that has not responded to other treatments, may sometimes be treated with retinoid tablets. Oral retinoids can only be prescribed by a dermatologist (a doctor who specialises in skin conditions).
Oral retinoids can be very effective at treating acne. They work by reducing the amount of oil that sebaceous glands produce, as well as acting as an anti-inflammatory and reducing the presence of the Propionibacterium acnes bacteria on your skin.
Oral retinoids are only 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 oral and topical antibiotics
- your acne is causing you psychological problems
However, oral retinoids have many unpleasant and potentially serious side-effects. The most common side-effects are dry skin, nosebleeds, headaches and muscle aches. Oral retinoids can cause damage to unborn babies and therefore if you're female you will need to use an effective form of contraceptive. Some people taking oral retinoids have reported mood changes, such as depression, anxiety, aggressive behaviour or suicidal thoughts, but these are rare. For this reason, an oral retinoid is only used as a last resort and your dermatologist may not prescribe it if you have a history of mental illness.
What's the best way to apply benzoyl peroxide for acne?
You should apply products that contain benzoyl peroxide once or, if necessary, twice a day. Benzoyl peroxide is available in several different formulations. You may find some formulas suit you better than others.
Benzoyl peroxide is available to buy over the counter on its own as a cream, a gel or a wash. It's worth trying different types and seeing which works best for you. For example, you may find some formulas, such as the wash, are better suited to treating the spots on your chest or back. Others (eg creams or gels), may be easier to apply on your face.
Before you apply the benzoyl peroxide treatment, you should wash your face with a mild soap and lukewarm water and leave it to dry for 20 minutes. It's important to dry your skin properly before applying the treatment as otherwise these products can cause a surface layer to form on your skin, which later peels. You should then put the treatment on all areas affected by acne, not just on the places where you have spots. Don't use too much – for example, a pea-sized amount of cream should be enough to cover your face. You should treat areas that have cleared of acne until the whole area has settled down. You may need to repeat this once or twice a day.
Benzoyl peroxide may cause your skin to become irritated (slightly red, itchy and scaly) when you first use it. However, if you reduce the number of times you use it, but apply regularly, the irritation should improve. Alternatively, you may need to use a lower strength treatment.
Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.
- British Association of Dermatologists
020 7383 0266
- Acne vulgaris. Prodigy. www.prodigy.clarity.co.uk, published June 2009
- Acne vulgaris. eMedicine. www.emedicine.medscape.com, published 28 June 2012
- Acne vulgaris. The Merck Manuals. www.merckmanuals.com, published August 2008
- Acne. British Association of Dermatologists. www.bad.org.uk, published July 2012
- Joint Formulary Committee, British National Formulary. 64th ed. London: British Medical Association and Royal Pharmaceutical Society of Great Britain; 2011: 739–43
- Referral advice. National Institute for Health and Clinical Excellence (NICE), 2001. www.nice.org.uk
- Magin P, Pond D, Smith W, et al. A systematic review of the evidence for ‘myths and misconceptions’ in acne management: diet, face-washing and sunlight. Family Practice 2004; 22:62–70. doi:10.1093/fampra/cmh715
- British Association of Dermatologists
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