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Acne

Expert reviewer Dr Anton Alexandroff, Consultant Dermatologist
Next review due December 2022

Acne (acne vulgaris) is a common skin condition that causes spots, and it can vary from mild to severe. There isn’t a cure for acne but there are treatments that can help to ease your symptoms.

An image showing the skin

About acne

Acne can affect the skin on your face, back, shoulders and chest. Acne can cause different types of spots:

  • dark spots called ‘blackheads’
  • light-coloured ‘whiteheads’
  • inflamed spots that look like red bumps (papules), or are yellow in colour (pustules)
  • spots that contain fluid called cysts

Acne is very common in teenagers and young adults − about nine in 10 have had acne at some point. It's less common in later life but adults can get acne too. And newborn babies can sometimes get acne in their first six months.

Acne isn't contagious, so you can't catch it or pass it on to other people.

Causes of acne

Acne is caused when excess sebum (a natural oil) and dead skin cells block your hair follicles. Changes in your hormones cause your skin to produce more sebum during your teenage years. As a result, your skin becomes greasy and spots develop. Sometimes, a bacterium called Propionibacterium acnes (P. acnes) that usually lives harmlessly on your skin can grow inside your hair follicles. It can contribute to inflammation (swelling) in spots.

There’s a chance that acne can run in families. Other causes of acne or links to it may include:

  • conditions such as polycystic ovary syndrome
  • medicines, such as corticosteroids, medicines for epilepsy and lithium (sometimes used in treatment for depression)
  • hormonal changes – in women, hormonal changes just before your period may cause acne to flare up, and if you’re pregnant, you might get acne in your first trimester

Symptoms of acne

The main symptom of acne is spots on your face, chest, back, and shoulders, although you might not have them on all these areas. Acne can affect just your face, or just your chest or back.

The spots can be non-inflamed or inflamed. Blackheads and whiteheads are non-inflamed spots. Inflamed spots include red bumps and lumps, yellow pus-filled spots or fluid-filled cysts. In very severe acne, cysts may join together to form larger, deeper inflamed areas, which is called acne conglobata.

Your skin may look greasy and the spots may feel hot and tender to touch.

You may get one type of spot or a mixture of the different types. The severity of acne can vary from person to person but the following is a guide.

  • Mild: you mostly have non-inflamed spots.
  • Moderate: you have more spots that are a mixture of inflamed and non-inflamed spots.
  • Severe: you have a lot of inflamed spots and cysts that are widespread on your skin and there are some scars.

Diagnosis of acne

If you think you have acne, go and see a pharmacist. They can recommend over-the-counter treatments to try. If your acne is severe or over-the-counter treatments haven’t worked, see your GP.

Your GP will ask about your symptoms and examine you, and will ask you about your medical history. Your GP will usually diagnose acne based on your symptoms because acne is easy to recognise by the pattern of spots on your body. There are different types of acne and the most common is acne vulgaris. Your doctor will be able to tell you which type you have and what the best treatment is.

If your acne is severe, your GP may refer you to a dermatologist (a doctor who specialises in treating conditions that affect the skin).

Self-care for acne

There are a number of things you can do to help acne, which include the following.

  • Try not to pick or squeeze your skin as this can make acne worse and lead to acne scars.
  • If you smoke, try to quit as you’re more likely to develop acne scars since smoking leads to an increased risk of scarring in general.
  • Gently wash spot-prone areas with a mild soap or an unperfumed cleanser and lukewarm water. Acne isn’t caused by poor hygiene, so extra washing or scrubbing doesn't make it better; it will just make acne worse. You don’t need to wash your skin more than twice a day.
  • It’s better for your skin not to wear make-up. But if it makes you feel more confident to do so, choose make-up products that are water-based and oil-free. Also, look on the label and choose products that are non-comedogenic or non-acnedemic (these shouldn’t cause blackheads, whiteheads, or acne). Completely remove your make-up at night.
  • If your skin is dry (some acne creams can cause dry skin), use a moisturiser made for acne-prone skin.
  • If you need to shave your face, choose shaving products that are moisturising. Shave downwards, following the direction of the hair growth.
  • Use products (moisturisers, shaving gels and cleansers) that are designed especially for acne. Speak to your pharmacist for advice about these.

Over-the-counter medicines that you can buy from a pharmacy include the following.

  • Benzoyl peroxide (eg Brevoxyl). This is an antibacterial treatment that reduces the amount of P. acnes bacteria on your skin. Take care not to get any of your treatment on your clothes as products containing benzoyl peroxide may bleach the colour. Benzoyl peroxide may also bleach your hair. You might not see an improvement immediately and your skin might get a bit worse to start with but there are ways to manage this – just ask your pharmacist for advice.
  • Salicylic acid. This acts as a chemical exfoliator. It works by getting into your hair follicles and oil glands and dissolving blocked dead skin cells, oil and other debris that can cause acne. It also helps to reduce the amount of oil produced by your oil glands, making it less likely that new acne-causing blockages will form or grow bigger.
  • Niacinamide. This may help to reduce the swelling, redness and oil production that’s associated with acne. You can’t use this medicine if you’re pregnant.

This is just a selection of what’s available – ask your pharmacist for more information.

Support

Having acne can be very distressing. If you’re feeling low or anxious about your acne, talk to your GP.

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Treatment of acne

The best acne treatment for you will depend on how severe your acne is, and you may need to take a combination of medicines.

If you have tried to treat acne with over-the-counter medicines such as benzoyl peroxide but it hasn’t worked, your GP may prescribe one of the treatments below. Be patient with any treatment you take – it can take four to eight weeks to see an improvement and several months to see a significant improvement. When you first start treatment, your skin might feel more irritated but this will get better. If this happens, you could try stopping the treatment for a few days and then build up slowly, but check with your doctor.

Creams, lotions and gels

  • Topical retinoids such as tretinoin and isotretinoin. It may take several months before the effects of these medicines are noticeable. Your skin may become more sensitive to sunlight when you use a retinoid 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 because they can harm your baby.
  • Azelaic acid. This is an antibacterial medicine usually used as an alternative to benzoyl peroxide and retinoids. It's less likely to irritate your skin as much. It’s also available over-the-counter in a lower concentration.
  • Antibiotic lotions or gels, such as clindamycin or erythromycin. These can help to reduce inflammation (swelling) by reducing the levels of natural P. acnes bacteria on your skin. You’ll usually take antibiotic lotions or gels in combination with benzoyl peroxide.

Oral antibiotics

If you have moderate or severe acne and creams and lotions haven’t worked, your GP may prescribe an antibiotic such as oxytetracycline, lymecycline or doxycycline. They’ll 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 after three months, but antibiotics may continue to work for a number of months, or even longer. Your doctor may also give you a retinoid cream or lotion, or benzoyl peroxide to use at the same time.

Oral contraceptives

For women with acne thought to be caused by hormones, your GP may prescribe an oral contraceptive pill. Contraceptive pills suppress the hormone testosterone, which is responsible for increasing sebum production.

If you have severe acne and antibiotics haven’t helped, your doctor may suggest you take a medicine called co-cyprindiol. This works as a type of contraception and reduces the levels of testosterone in your body. Your doctor will discuss the risks and benefits of this treatment with you.

Oral isotretinoin

If your acne is more severe, your doctor may advise you to take an oral retinoid medicine called isotretinoin (also known as Roaccutane). This reduces the amount of sebum your skin produces. This is a strong medicine and is only prescribed by, or under the supervision of, a dermatologist.

Your acne may get worse for a few weeks when you start taking oral isotretinoin before it begins to improve.

Isotretinoin can cause side-effects, such as dry eyes, lips and skin, nose bleeds, pain in your joints, and it can affect your night vision. It may also cause more serious problems, such as liver problems or raised cholesterol levels. You’ll need to have regular blood tests to check for any problems, for example to check your cholesterol levels. Experts aren’t sure if isotretinoin can cause depression, but your doctor will monitor you for this. If you’ve had depression in the past, let your dermatologist know before you start treatment.

When having this treatment, you need to try and stay out of direct sunlight and use sunscreens and moisturisers (including lip balm).

Women who take isotretinoin will need to consider contraception because isotretinoin could cause significant birth defects in pregnancy. You may need to have a regular pregnancy test and a review meeting to discuss 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.

Light treatment

New treatments that involve therapy with light or lasers are being developed. Doctors aren't sure how well light therapy works for acne yet and research is still on-going. Before these therapies are offered as treatments, more scientific proof is needed to show how useful they are. Ask your dermatologist for more information.

Complications of acne

Acne scars

Acne usually clears up as you get older without leaving any noticeable scars. But one in five people with acne get noticeable scars. Usually people with severe acne get scars, although milder acne can also leave them. If you pick and squeeze the spots, it can also cause acne scars.

Scars can be narrow ‘ice pick’ scars or broader deeper scars. Less often, ‘keloid’ (firm lumpy) scars develop on your skin. See our FAQs for information about treatments and advice on how to get rid of acne scars.

Dark and light spots

  • Hyperpigmentation is when your skin becomes darker in the areas affected by acne. This is usually more noticeable if you have a dark skin tone.
  • Hypopigmentation is when your skin becomes lighter in the areas affected by acne. This is usually more noticeable if you have a dark skin tone.

Psychological problems

Acne can cause anxiety and depression in some people. It can also affect your self-confidence or self-esteem, for example if people comment on your acne. If acne is making you feel low, talk to your GP for help and advice.

Frequently asked questions

  • There are lots of myths about what causes acne. Here are some of the most common.

    • Acne is caused by bad hygiene. This isn’t true. Cleaning the skin won’t improve your acne and washing too much can make acne worse.
    • Acne is the result of a bad diet. There’s no concrete proof that chocolate or fatty foods cause acne, but many people report that it does and there’s some research for chocolate being a culprit. There’s also some research that suggests that high glycaemic index (GI) foods may make acne worse but more evidence is needed to know for sure. Eating a healthy diet will help your general health so aim to do this, and if you think any foods are linked to your acne, it’s probably worth giving them a miss.
    • Acne is contagious. No, it’s not – it can’t be caught or passed onto anyone else.
    • Stress causes acne. When it comes to stress and skin problems, experts aren’t completely sure about the effect stress has on acne. There’s a link, but stress doesn’t necessarily cause acne – although having acne can be stressful.
    • Acne treatments make your skin worse. To start with, some treatments may irritate your skin and take some time to work (up to eight weeks). Usually, this settles and you’ll start to see an improvement, but speak to your pharmacist or doctor for advice if it doesn’t.
    • Sunlight improves acne. It’s unclear if sunlight will improve or flare up acne, but it will age your skin. Some acne medicines also make your skin more sensitive to the sun so you’ll need to help protect your skin with sun lotion.

  • Several treatments have been designed to reduce and improve acne scars but at the moment there isn’t much evidence that any of them work. Treatments to get rid of acne scars include laser resurfacing, dermabrasion and chemical peels, and a procedure called skin needling.

    Dermabrasion and chemical peels can tighten the skin and lift the scars to reduce the depth of them, with the aim of making them less noticeable. Laser resurfacing uses lasers to produce the same effect. These treatments don’t remove scars completely and the end results will vary.

    These treatments aren’t available on the NHS because they’re considered to be cosmetic surgery. But if you want to find out about treatments for acne scars, there are lots of private clinics that offer these treatments. Make sure that you do your research and that any treatment you have is done by a qualified professional. See Other helpful websites for more information.

    Skin creams can keep your scar moisturised so it doesn’t become dry. Scars can be particularly sensitive to sunlight, so wear sunscreen to protect your skin when going out in the sun.

    There are make-up products designed to help cover up some types of acne scarring. These are creams and powders that match your skin colour – but they can’t fill in scars or flatten out raised scars. You can access these products through a Skin Camouflage Service. You can refer yourself or your doctor may be able to refer you. To find out more about this service run by the charity Changing Faces, see Other helpful websites.


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Related information


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  • Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, December 2019
    Expert reviewer Dr Anton Alexandroff, Consultant Dermatologist
    Next review due December 2022



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