Patient information from BMJ

Acne

Last published:Apr 15, 2025

Acne is a common skin condition, especially during adolescence, but it can affect people at any age. It can cause spots, redness, and sometimes scarring.

Having acne can be frustrating, and it may affect your confidence or comfort. But there are lots of treatments available. You can use this information to talk with your doctor and decide which treatment is right for you.

What is acne?

Acne is a common skin condition that causes spots and oily skin. It usually happens during adolescence when hormone changes begin to increase oil production. This leads to blocked pores, which causes spots. Acne can also happen during adulthood, and most people get acne at some stage in their life.

Acne can run in families or be linked to medical conditions. It can also be triggered by external factors. These include friction or pressure on the skin, certain cosmetics, and some medicines. In women, acne may flare up due to hormonal changes, such as those during your menstrual period or during pregnancy.

What are the symptoms of acne?

Acne usually causes 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). Some spots can become red, swollen, and painful to touch. In some cases, acne can leave scars after it heals, but getting treatment can help prevent scarring.

What are the treatment options for acne?

There are many treatment options for acne, and the right one for you might depend on how severe your acne is. If you’re a woman, it might also depend on whether you're pregnant or planning pregnancy, or if your acne is linked to your menstrual cycle or an underlying hormonal condition.

Your doctor will help you choose the best option for you. Keep in mind that acne treatments take time to work, so you may not see results right away. It can take a few weeks before you start noticing any improvement. If one treatment doesn’t work, you can talk with your doctor about switching to another.

In all cases, a good skincare routine may help prevent breakouts. Here are some general tips to keep your skin healthy:

• Only use skincare and makeup that won’t block your pores (these are called non-comedogenic products).

• Wash your face twice daily with a mild, pH-balanced cleanser.

• Avoid harsh products like scrubs, ‘tightners’, and fragranced products.

• Avoid getting hair products on your face.

• Don’t pick, squeeze, or scratch spots, as this can cause scarring.

Mild acne

If you have mild acne, your treatment will likely include combination therapy. This is where you apply gels or creams (called topical treatments) that contain multiple ingredients that work in different ways. These topical treatments may come in a single ready-made product, or as separate products that you use together.

Common ingredients used in combination therapy include:

• Topical antibiotics: These help kill bacteria on the skin. If they don’t improve your acne within 6 to 8 weeks, your doctor will stop this treatment to avoid the bacteria becoming resistant, which can make acne worse and cause infections. They will then suggest a different treatment. Side effects are rare but may include mild irritation, redness, burning, or peeling.

• Topical retinoids: These help remove dead skin cells to prevent blocked pores. Common side effects include mild irritation or stinging. Topical retinoids can make your skin more sensitive to the sun. If you're using them, try to avoid too much sun and always wear sunscreen.

• Benzoyl peroxide: This helps reduce bacteria and inflammation, and helps clear blackheads and whiteheads. Common side effects include dryness, redness, peeling, burning or itching. Benzoyl peroxide can also make your skin more sensitive to sunlight. If you’re using it, try to avoid too much sun, or wear sunscreen.

Some of these are available over the counter at a pharmacy, while stronger versions require a prescription from your doctor. If you're unsure about the ingredients in over-the-counter products, ask your doctor or a pharmacist.

Not everyone needs combination treatment. Sometimes, a single ingredient is enough. Depending on where you live, doctors may prescribe one of these treatments on its own. Your doctor will help you choose the best option for your acne.

Other topical treatments, such as clascoterone, salicylic acid, or azelaic acid, may also help. These can be used alone or alongside combination therapy.

Moderate to severe acne, or acne that doesn’t improve with usual treatments

If your acne is more severe, or if the above treatments haven’t worked or aren’t suitable for you, other options are available.

Your doctor may prescribe antibiotic tablets to help reduce inflammation and kill bacteria on the skin. You will usually take them for 2 to 3 months. You will also be given topical benzoyl peroxide to reduce the risk of antibiotic resistance.

Isotretinoin tablets are another treatment option. Isotretinoin helps reduce oil on your skin, which prevents your pores from getting blocked. It also lowers the amount of bacteria and can reduce redness and swelling around spots.

Isotretinoin can cause some serious side effects, so it can only be prescribed by a doctor. In some areas, a specialist may need to prescribe it. If your doctor thinks isotretinoin is right for you, they will talk with you about the benefits and risks.

It’s very important not to take isotretinoin if you're pregnant or planning to become pregnant. Women need to have a pregnancy test before starting a course of isotretinoin, and every month while they are taking the medicine. See the section below on acne in pregnant women for more information.

If you have very large, painful spots or ones that might scar, your doctor may suggest a corticosteroid injection alongside other treatments. They will use a small needle to inject the medicine directly into the spot to help it heal. Side effects are very rare but can include slight skin thinning or changes to your hormone levels.

Hormonal acne in women and girls

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

If treatment for mild acne hasn’t worked or isn’t suitable for you, or if your acne is more severe, taking some types of contraceptive pill may help. If you’re unsure about using contraceptive pills to treat your acne, or are worried about possible side effects, you can talk with your doctor about the benefits and risks.

Spironolactone is another medicine often used to treat hormonal acne in women. It works by blocking certain hormones that can trigger acne. While it's not officially approved for acne treatment, it might be a good option for women who don't want to use long-term antibiotics or contraceptive pills. 

Acne in pregnant women

Some women develop acne during pregnancy, especially in the early stages. This is due to hormonal changes. This type of acne usually clears up later in the pregnancy or after the baby is born.

Many acne treatments are not safe for women to use during pregnancy. Isotretinoin is particularly unsafe, and you should not take it if you're pregnant or planning to become pregnant. This is because it causes serious birth defects.

Some topical treatments can be used during pregnancy. For example, antibiotic creams and azelaic acid are considered safe. However, you should always check with your doctor before starting any acne treatment during pregnancy.

What happens next?

Acne often improves as you get older, especially after adolescence, but it can last into adulthood for some people. While most people don’t experience long-term effects, severe acne can sometimes leave scars.

Treatments can help clear up acne, and many people see improvement with the right care. However, it may take several months or even longer for acne to go away completely. If one treatment doesn’t work, it’s a good idea to check back with your doctor, as there may be other options that could work better for you.