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Acne - Treatment

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

If you have a few blackheads, whiteheads and spots, a pharmacist should be able to tell you on how to treat them.

They'll usually give you gels or creams (topical treatments) that contain benzoyl peroxide. Benzoyl peroxide helps reduce the amount of acne-causing bacteria.

Treatments from your GP

Talk to your GP if your acne is moderate or severe, or over-the-counter medicine hasn't worked. You will probably need prescription medication.

Prescription medications that can be used to treat acne include:

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

If you have severe acne, 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
  • painful nodules
  • scarring, or are at risk of scarring

A combination of antibiotic tablets and topical treatments is usually the treatment option for severe acne.

If this doesn't work, your GP may prescribe a medication called isotretinoin.

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

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

It should be used sparingly. Too much can irritate your skin. It also makes your face more sensitive to sunlight, so avoid too much sun and ultraviolet (UV) light, or wear sun cream.

Benzoyl peroxide can have a bleaching effect. You should 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 some treatment to prevent acne returning.

Topical retinoids

Topical retinoids work by removing dead skin cells from the surface of the skin (exfoliating). This helps to 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. Avoid excessive exposure to sunlight and UV.

Topical retinoids aren't suitable for use during pregnancy. There's a risk they might cause birth defects.

Common side effects of topical retinoids are mild irritation and stinging of the skin.

A 6 week course is usually needed. But you may be advised to continue using the medication 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. This is because there's a risk that the bacteria on your face could become resistant to the antibiotics.

This could make your acne worse and cause more 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. It's used 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. It's usually applied twice a day (or once a day if your skin is particularly sensitive).

The medication doesn't make your skin sensitive to sunlight. So you don't 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 are usually used in combination with a topical treatment to treat more severe acne.

Antibiotics called tetracyclines are usually prescribed, unless you're pregnant or breastfeeding.

Pregnant or breastfeeding women are advised to take an antibiotic called erythromycin. It's safer for them 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. They 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 don't already use it, your 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 for more severe acne that doesn't respond to antibiotics. It helps to reduce the production of sebum.

You'll 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.

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.

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

Other side effects of co-cyprindiol include:

  • bleeding and spotting between your periods. This can sometimes occur for the first few months
  • headaches
  • sore breasts
  • mood changes
  • loss of interest in sex
  • weight gain or weight loss

Isotretinoin

Isotretinoin has many beneficial effects. It:

  • helps to normalise sebum and reduce how much is produced
  • helps to prevent follicles becoming clogged
  • decreases the amount of bacteria on the skin
  • 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. These are cases that haven't responded to other treatments.

Because of the risk of side effects, only a specially trained GP or a dermatologist can prescribe isotretinoin.

Isotretinoin is taken as a tablet. Most people take a 4 to 6 month course.

Your acne may get worse during the first 7 to 10 days of treatment, but this is normal and soon settles.

Common side effects of isotretinoin include:

  • inflammation, dryness and cracking of the skin, lips and nostrils
  • changes in your blood sugar levels
  • inflammation of your eyelids (blepharitis)
  • inflammation and irritation of your eyes (conjunctivitis)
  • blood in your urine

Rarer side effects of isotretinoin include:

  • inflammation of the liver (hepatitis)
  • inflammation of the pancreas (pancreatitis)
  • kidney disease

Because of the risk of these rarer side effects, you'll need a blood test before and during treatment.

Isotretinoin and birth defects

Isotretinoin will damage an unborn baby. If you're a woman of childbearing age:

  • do not use isotretinoin if you're pregnant or you think you're pregnant
  • use 1 or, ideally, 2 methods of contraception for 1 month before treatment begins, during treatment, and for 1 month after treatment has finished
  • have a pregnancy test before, during and after treatment

You'll be asked to sign a form confirming that you

  • understand the risk of birth defects
  • are willing to use contraceptives to prevent this risk, even if you're not currently sexually active

If you think you may have become pregnant when taking isotretinoin, contact your dermatologist immediately.

Isotretinoin is also not suitable if you're breastfeeding.

Isotretinoin and mood changes

There have been reports of people experiencing mood changes while taking isotretinoin.

There's no evidence that these mood changes were the result of the medication.

But as a precaution, contact your GP immediately if you:

  • feel depressed
  • feel anxious
  • feel aggressive
  • have suicidal thoughts

Non-pharmaceutical treatments

Several treatments for acne don't involve medication.

These 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
  • photodynamic therapy – where light is applied to the skin in an attempt to improve symptoms of acne

But these treatments may not work and can't be routinely recommended.

Acne and toothpaste

Many websites say that toothpaste can dry up individual spots.

Using toothpaste in this way isn't recommended. There are far more effective and safer treatments available from pharmacists or your GP.

While toothpaste does contain antibacterial substances, it also contains substances that can irritate and damage your skin.

Complications

Acne scarring can sometimes develop as a complication of acne. Any type of acne spot can lead to scarring. But it's more common when the most serious types of spots (nodules and cysts) burst and damage nearby skin .

Scarring can also occur if you pick or squeeze your spots. It's important not to do this.

There are 3 main types of acne scars:

  • ice pick scars – small, deep holes in the surface of your skin that look like the skin has been punctured with a sharp object
  • rolling scars – caused by bands of scar tissue that form under the skin, giving the surface of the skin a rolling and uneven appearance
  • boxcar scars – round or oval depressions, or craters, in the skin

Treating acne scarring

Treatments for acne scarring are regarded as a type of cosmetic surgery. Talk to your GP if you're thinking about having cosmetic surgery. They'll be able to discuss your options with you.

It's important to have realistic expectations about what cosmetic treatment can achieve. While treatment can certainly improve the appearance of your scars, it can't get rid of them completely.

After treatment for acne scarring, most people see a 50-75% improvement in their appearance.

Treatments for acne scarring include:

Dermabrasion

Dermabrasion involves removing the top layer of skin. This is done either using lasers or a specially made wire brush.

After the procedure, your skin will look red and sore for several months. But as it heals you should see an improvement in how your scars look.

Laser treatment

Laser treatment can be used to treat mild to moderate acne scarring. There are two types of laser treatment:

  • ablative laser treatment – where lasers are used to remove a small patch of skin around the scar to produce a new, smooth-looking area of skin
  • non-ablative laser treatment – where lasers are used to stimulate the growth of new collagen (a type of protein found in skin).

This helps to repair some of the damage caused by scarring, and improves the appearance

Punch techniques

Punch techniques are used to treat ice pick scars and boxcar scars. There are 3 types of punch technique:

  • punch excision – used to treat mild ice pick scars. The scar is surgically removed and the remaining wound is sealed. After the wound heals, it leaves a smoother and more even area of skin.
  • punch elevation – used to treat boxcar scars. The base of the scar is surgically removed, leaving the sides of the scar in place. The base is then reattached to the sides, but lifted up so it's level with the surface of the skin. This makes the scar much less noticeable.
  • punch grafting – used to treat very deep ice pick scars. As with a punch excision, the scar is removed. But the wound is "plugged" with a sample of skin taken from elsewhere on the body (usually from the back of the ear).

Subcision

Subcision is a surgical treatment that can be used to treat rolling scars.

During surgery, the upper layer of the skin is removed from the underlying scar tissue. This allows blood to pool under the affected area.

The blood clot helps form connective tissue. This pushes up the rolling scar so it's level with the rest of the surface of the skin.

Once subscision has been completed, additional treatment can be used to further improve the appearance of the scar. This can include laser treatment and dermabrasion.

Depression

Acne can often cause intense feelings of anxiety and stress. You may become socially withdrawn. This combination of factors can lead to people with acne becoming depressed.

You may be depressed if during the last month you've often felt down, depressed or hopeless, and have little interest or pleasure in doing things.

If you think that you or your child may have depression, it's important to talk to your GP.

Treatments for depression include:

  • talking therapies such as cognitive behavioural therapy (CBT)
  • a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs)

Related topic

Depression in young people

Content supplied by the NHS and adapted for Ireland by the HSE.

Page last reviewed: 29/01/2019
Next review due: 29/01/2022