Treatment - Acne

Treatment for acne depends on how severe it is. It can take several months of treatment before acne symptoms improve.

If you just have a few blackheads, whiteheads and spots, a pharmacist should be able to advise you on how to treat them successfully with over-the-counter gels or creams (topical treatments) that contain benzoyl peroxide.

Treatments from a GP

See a GP if your acne is moderate or severe, or medicine from your pharmacy has not worked, as you probably need prescription medicine.

Prescription medicines that can be used to treat acne include:

• topical retinoids
• topical antibiotics
• azelaic acid
• antibiotic tablets
• in women, the combined contraceptive pill

If you have severe acne, or prescription medicines are not working, your GP can refer you to an expert in treating skin conditions (dermatologist).

For example, if:

• you have a large number of papules and pustules on your chest and back, as well as your face
• you have painful nodules
• you have scarring, or are at risk of scarring
• your condition is making you feel very low or anxious

For mild to moderate or moderate to severe acne, you’ll usually be started on a combination of topical treatments, or antibiotic tablets combined with topical treatments.

Hormonal therapies or the combined oral contraceptive pill can also be effective in women who have acne.

But the progestogen-only pill or contraceptive implant can sometimes make acne worse.

Many of these treatments can take 2 to 3 months before they start to work.

It's important to be patient and persist with a recommended treatment, even if there's no immediate effect.

Topical treatments (gels, creams and lotions)

Benzoyl peroxide

Benzoyl peroxide works as an antiseptic to reduce the number of bacteria on the surface of the skin.

It also helps to reduce the number of whiteheads and blackheads, and has an anti-inflammatory effect.

Benzoyl peroxide is usually available as a cream or gel. It's used either once or twice a day.

It should be applied after washing to all of the parts of your face affected by acne.

It should be used sparingly, as too much can irritate your skin.

It also makes your face more sensitive to sunlight, so avoid too much sun and sources of ultraviolet (UV) light (such as sunbeds), or wear sun cream.

Benzoyl peroxide can have a bleaching effect, so avoid getting it on your hair or clothes.

Common side effects of benzoyl peroxide include:

• dry and tense skin
• a burning, itching or stinging sensation
• some redness and peeling of the skin

Side effects are usually mild and should pass once the treatment has finished.

Most people need a 6-week course of treatment to clear most or all of their acne.

You may be advised to continue treatment less frequently to prevent acne returning.

Topical retinoids

Topical retinoids work by removing dead skin cells from the surface of the skin (exfoliating), which helps prevent them building up within hair follicles.

Tretinoin and adapalene are topical retinoids used to treat acne. They're available in a gel or cream and are usually applied once a day before you go to bed.

Apply to all the parts of your face affected by acne 20 minutes after washing your face.

It's important to apply topical retinoids sparingly and avoid excessive exposure to sunlight and UV.

Topical retinoids are not suitable for use during pregnancy, as there's a risk they might cause birth defects.

The most common side effects of topical retinoids are mild irritation and stinging of the skin.

A 6-week course is usually required, but you may be advised to continue using the medicine less frequently after this.

Topical antibiotics

Topical antibiotics help kill the bacteria on the skin that can infect plugged hair follicles. They're available as a lotion or gel that's applied once or twice a day.

A 6- to 8-week course is usually recommended. After this, treatment is usually stopped, as there's a risk that the bacteria on your face could become resistant to the antibiotics.

This could make your acne worse and cause additional infections.

Side effects are uncommon, but can include:

• minor irritation of the skin
• redness and burning of the skin
• peeling of the skin

Azelaic acid

Azelaic acid is often used as an alternative treatment for acne if the side effects of benzoyl peroxide or topical retinoids are particularly irritating or painful.

Azelaic acid works by getting rid of dead skin and killing bacteria.

It's available as a cream or gel and is usually applied twice a day (or once a day if your skin is particularly sensitive).

The medicine does not make your skin sensitive to sunlight, so you do not have to avoid exposure to the sun.

You'll usually need to use azelaic acid for a month before your acne improves.

The side effects of azelaic acid are usually mild and include:

• burning or stinging skin
• itchiness
• dry skin
• redness of the skin

Antibiotic tablets

Antibiotic tablets (oral antibiotics) are usually used in combination with a topical treatment to treat more severe acne.

In most cases, a class of antibiotics called tetracyclines is prescribed, unless you're pregnant or breastfeeding.

Pregnant or breastfeeding women are usually advised to take an antibiotic called erythromycin, which is known to be safer to use.

It usually takes about 6 weeks before you notice an improvement in your acne.

Depending on how well you react to the treatment, a course of oral antibiotics can last 4 to 6 months.

Tetracyclines can make your skin sensitive to sunlight and UV light, and can also make the oral contraceptive pill less effective during the first few weeks of treatment.

You'll need to use an alternative method of contraception, such as condoms, during this time.

Hormonal therapies

Hormonal therapies can often benefit women with acne, especially if the acne flares up around periods or is associated with hormonal conditions such as polycystic ovary syndrome.

If you do not already use it, a GP may recommend the combined oral contraceptive pill, even if you're not sexually active.

This combined pill can often help improve acne in women, but may take up to a year before the full benefits are seen.

Co-cyprindiol

Co-cyprindiol is a hormonal treatment that can be used for more severe acne that does not respond to antibiotics. It helps to reduce the production of sebum.

You'll probably have to use co-cyprindiol for 2 to 6 months before you notice a significant improvement in your acne.

There's a small risk that women taking co-cyprindiol may develop breast cancer in later life.

For example, out of a group of 10,000 women who have not taken co-cyprindiol, you'd expect 16 of them to develop breast cancer by the time they were 35.

This figure rises to 17 or 18 for women who were treated with co-cyprindiol for at least 5 years in their early 20s.

There's also a very small chance of co-cyprindiol causing a blood clot. The risk is estimated to be around 1 in 2,500 in any given year.

It's not thought to be safe to take co-cyprindiol if you're pregnant or breastfeeding. Women may need to have a pregnancy test before treatment can begin.

Other side effects of co-cyprindiol include:

• headaches
• sore breasts
• mood changes
• loss of interest in sex
• weight gain or weight loss

Isotretinoin

Isotretinoin is a treatment for severe acne that comes in capsules. It has a number of beneficial effects:

• it helps normalise sebum and reduce how much is produced
• it helps prevent follicles becoming clogged
• it decreases the amount of bacteria on the skin
• it reduces redness and swelling in and around spots

But the drug can also cause a wide range of side effects. It's only recommended for severe cases of acne that have not responded to other treatments.

Because of the risk of side effects, isotretinoin can only be prescribed by a specialist doctor.

Read all about isotretinoin, including who can take it, side effects and the risks in pregnancy.

Non-pharmaceutical treatments

Several treatments for acne do not involve medicine.

You may be recommended to have photodynamic therapy, where light is applied to the skin in an attempt to improve symptoms of acne.

Other non-pharmaceutical treatments include:

• comedone extractor – a small pen-shaped instrument that can be used to clean out blackheads and whiteheads
• chemical peels – where a chemical solution is applied to the face, causing the skin to peel off and new skin to replace it

But these treatments may not work and cannot be routinely recommended.