Patient information from BMJ

Acne

Last published:Sep 27, 2021

Most people get spots as teenagers. Some people also get them as adults. If you don't like the way your spots look, or if you're worried about scars, there are treatments that can help.

We’ve looked at the best and most up-to-date research to produce this information. You can use it to talk to your doctor and decide which treatments are right for you.

What happens?

Acne is just another word for spots. If the pores in your skin get blocked, natural oil in your skin can build up behind them. This causes spots.

You might hear people say that acne is caused by not washing enough. This isn't true. And there's no good evidence that eating fatty foods or chocolate causes acne.

What are the symptoms?

Acne usually means you have spots on your face. But you can also get acne on your neck, back, chest, or arms. You may get blackheads (small black marks) or whiteheads (white bumps). Spots can also become red and inflamed. Really bad spots can cause scars when they heal. But getting treatment can help prevent scarring.

What treatments work?

Less severe acne

Research suggests that the treatments most likely to help with mild acne are creams that contain substances called retinoids. You can buy some of them over the counter at a pharmacy, but for some stronger versions you will need a prescription from your doctor. If you're unsure about the ingredients in over-the-counter products you can ask the pharmacist to explain.

Retinoids work by helping to unblock the skin pores. Like all treatments for acne, they don't work straight away. It will probably be at least a few weeks before you see results.

Some people get side effects with retinoid creams that are similar to sunburn, such as red or peeling skin. But these will probably settle down after a few weeks.

Retinoids can make your skin more sensitive to sunlight, so it's best to take care in the sun while using them. This means staying out of bright sunlight as much as possible, and using sunscreen.

Retinoid cream is the only treatment that most people with mild acne need. But for people who have inflamed skin as well as spots (this is called inflammatory acne), doctors recommend a combination of at least two treatments, consisting of:

• A retinoid cream, plus

• An antibiotic (either as a cream or as tablets) or benzoyl peroxide cream, or both an antibiotic and benzoyl peroxide. Some treatments for inflammatory acne come as a cream that contains both an antibiotic and benzoyl peroxide.

If you are using both a retinoid cream and benzoyl peroxide, these two treatments should not be used on the same area of skin at the same time.

Some people get side effects with benzoyl peroxide, such as red or peeling skin or a tingling feeling. Benzoyl peroxide is a kind of bleach so it’s best to avoid getting it on your hair, clothes, or sheets. You should also take care in the sun while using it, by staying out of bright sunlight as much as possible and using sunscreen.

Doctors might recommend that some people with inflammatory acne also use a cream that contains azelaic acid. Azelaic acid helps reduce swelling and redness in the skin. You need a prescription from your doctor for this treatment.

Some people get side effects from azelaic acid such as itching, a burning feeling, and red or scaly skin.

More severe acne

For some people with moderate to severe acne that is only mildly inflammatory, a stronger prescription retinoid cream is the only treatment they need.

But most people with more severe inflammatory acne will need to take antibiotic tablets as well, usually for at least six weeks. And some people with severe inflammatory acne need to take them for much longer.

Your doctor might also recommend that you use azelaic acid cream as well as the other treatments, to help reduce swelling and redness.

Acne that is very severe or doesn't improve with usual treatments

If you have very severe acne, or if other treatments haven't helped, your doctor might suggest you take isotretinoin tablets. You need a prescription for this treatment.

Isotretinoin is a type of retinoid. These tablets stop your skin making as much oil as usual. This can reduce the number of spots you have.

But isotretinoin tablets can have serious side effects in some people.

If you get severe headaches, bad night vision, or mood changes while taking isotretinoin, you should stop taking them straight away. Like retinoid creams, isotretinoin can make you more sensitive to sunlight, so you should use sunscreen while you're taking it.

In some people isotretinoin can also cause dry skin, nosebleeds, aches and pains, and blood in your urine.

Isotretinoin and birth defects

Isotretinoin causes birth defects if taken during pregnancy. So you can't take it if you're pregnant or trying to get pregnant. Women need to have a pregnancy test before starting a course of isotretinoin, and every month while they are taking it.

Acne in women and girls caused by hormonal changes

Some women and girls get flare-ups of acne during their menstrual periods. A condition called polycystic ovary syndrome (sometimes called PCOS) and some other hormonal conditions that affect women and girls can also cause acne.

Taking some types of contraceptive pill can help treat this type of acne. If you don't like the idea of using contraceptive pills to treat your acne, or are worried about possible side effects from contraceptives, you can talk with your doctor and discuss what treatments might suit you.

Other medicines called anti-androgenic drugs can also be used to treat hormonal acne. These drugs help restore the balance of hormones in your body.

Severe acne in pregnant women

Some women find that they get acne while pregnant, and especially early in their pregnancy. This is caused by hormonal changes that happen during pregnancy. This type of acne usually clears up later in the pregnancy or after the baby is born.

Many acne treatments, including retinoids, are not safe for women to use during pregnancy. Some antibiotic creams and azelaic acid are considered safe. But you should talk to your doctor before using any treatments for acne while pregnant.

What will happen to me?

Acne usually goes away as you get older, although it can last for several years. But you don't need to wait this long. Treatments can often help you get rid of acne. However, some people need to keep using their treatments for months or even years before their acne goes away on its own.

If one treatment doesn't help you, it's worth going back to your doctor. There may be another treatment that works better for you.