Acne - Treatment 

Treating acne 

Acne and toothpaste

A hint found on many websites is that toothpaste can dry up individual spots.

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

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

Compare your options

Take a look at a simple guide to the pros and cons of different treatments for 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, you should be able to treat them successfully with over-the-counter gels or creams (topical treatments) that contain benzoyl peroxide.

Some self-help techniques may also be useful:

  • Do not wash affected areas of skin more than twice a day. Frequent washing can irritate the skin and make symptoms worse.
  • Wash the affected area with a mild soap or cleanser and lukewarm water. Very hot or cold water can make acne worse.
  • Don't try to "clean out" blackheads or squeeze spots. This can make them worse and cause permanent scarring.
  • Avoid using too much make-up and cosmetics. Use water-based products that are described as non-comedogenic (this means the product is less likely to block the pores in your skin).
  • Completely remove make-up before going to bed.
  • If dry skin is a problem, use a fragrance-free, water-based emollient.
  • Regular exercise cannot improve your acne, but it can boost your mood and improve your self-esteem. Shower as soon as possible once you finish exercising as sweat can irritate your acne.
  • Wash your hair regularly and try to avoid letting your hair fall across your face.

Treatments can take up to three months to work, so don't expect results overnight.

See your GP if your acne is more widespread – for example, you have a large number of papules and pustules, or over-the-counter medication hasn't worked – as you probably need prescription medication.

Prescription medications that can be used to treat acne include:

If you have severe acne, such as a large number of papules and pustules on your chest and back as well as your face, or if you have painful nodules, your GP can refer you to an expert in treating skin conditions (dermatologist).

A combination of antibiotic tablets and topical treatments is usually the first treatment option for severe acne. If this doesn't work, a medication called isotretinoin may be prescribed.

Hormonal therapies or the combined oral contraceptive pill can also be effective in women who have acne. However, the progestogen-only pill or contraceptive implant can sometimes make acne worse.

Many of these treatments can take two to three months before they start to work. It's important to be patient and persist with a recommended treatment, even if there is no immediate effect.

Topical treatments (gels, creams and lotions)

Benzoyl peroxide

Benzoyl peroxide works in two ways:

  • it helps prevent dead skin plugging up hair follicles
  • it kills the bacteria on the skin that can cause plugged follicles to become infected

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 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 ultraviolet (UV) light, 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 six-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 reducing the production of sebum while preventing dead skin cells plugging hair follicles.

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

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

It is 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 is a risk that they might cause birth defects.

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

A six-week course is usually required, 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 are available as a lotion or gel that is applied once or twice a day.

A six- to eight-week course is usually recommended. After this, treatment is usually stopped as there is 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 is available as a cream or gel and is usually applied twice a day (or once a day if your skin is particularly sensitive).

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

You will 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 are 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 will usually take about six 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 four to six 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 will 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 that you start taking the combined oral contraceptive pill, even if you are 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 doesn't respond to antibiotics. It helps reduce the production of sebum.

You will probably have to use co-cyprindiol for two to six months before you notice a significant improvement in your acne.

There is 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 would 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 five years in their early twenties.

There is 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 is not thought to be safe to take co-cyprindiol if you are pregnant or breastfeeding. Women may need to have a pregnancy test before treatment can begin.

Other side effects of co-cyprindiol include:

  • bleeding and spotting between your periods, which 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 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

However, the drug can also cause a wide range of side effects. It is therefore 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 specially trained GP or a dermatologist.

Isotretinoin is taken as a tablet. Most people take a four- to six-month course. Your acne may get worse during the first 7 to 10 days of treatment. However, 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:

Read more about the side effects of isotretinoin.

Because of the risk of these rarer side effects, you will 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:

  • don't use isotretinoin if you are pregnant or you think you are pregnant
  • use one, or ideally two, methods of contraception for one month before treatment begins, during treatment and for one month after treatment has finished
  • have a pregnancy test before, during and after treatment

You will be asked to sign a form confirming that you understand the risk of birth defects and are willing to use contraceptives to prevent this risk, even if you are 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 are breastfeeding.

Isotretinoin and mood changes

There have been reports of people experiencing mood changes while taking isotretinoin. There is no evidence that these mood changes were the result of the medication.

However, as a precaution, contact your doctor immediately if you feel depressed or anxious, have feelings of aggression or suicidal thoughts.

Non-pharmaceutical treatments

Several treatments for acne do not 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

These treatments may not work and can therefore not be routinely recommended.

Page last reviewed: 04/04/2014

Next review due: 04/04/2016

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Comments

The 14 comments posted are personal views. Any information they give has not been checked and may not be accurate.

faizan0795 said on 01 June 2014

Just love yourself as the way you are. Do no compare yourself with others. When you learn to love yourself all the problems will be gone soon. In my case I was suffering then I found out the main problem was depression and stress. So went to the GP and he prescribed me Escitaopram, taking for few months I learnt to be happy and my acne getting improve day by day. After 2 to 3 months acne gone problem solved.

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Tenajuk said on 16 May 2014

After decades of suffering and all the possible available treatments a GP advised me to try Agnus Castus - this is the only solution to my acne - it helps regulate hormones. I've been on them for many years now but as soon as I stop taking them I look like a 50 year old teenager!

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bluelittlebutterfly said on 13 March 2014

I am currently 16 and I have had bad 'sandpaper' acne on my face, chest, back and arms for about 2-3 years now they cause me a bit of pain and discomfort and mainly embarrassment and low self esteem. I have been on all the prescribed medications I can possibly try all the antibiotics, gels and creams you name it and I've had in. My acne has had no response to any of these treatments so today I have been referred to the dermatologist so hopefully I will find something that helps soon. Does anyone have any general lifestyle or washing tips? I currently exfoliate 3 times a week and cleanse, tone & moisturise every morning and night I shouldn't wear as much make up as I do (its MAC) but I cannot go without it! :(

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emmajean1985 said on 29 January 2014

I have suffered from acne since I was 20. It got so bad I was put on roaccutaine and at 22 it was cured and has been until a recent pill change. I am now 28 and suffering again. The problem is that hardly any gps take this seriously. I am now going to have to go through months of topical treatments etc when I know I need the antibiotics, which hopefully will shift it. But instead the rigmarol you go through stresses you out and makes it worse!

Pair this with no one checking the effect the hormone pills have on you and as a women you are just left to get up and go to work with a strangers face and dangerously low self asteem. I am on the verge of a breakdown all because the people I am asking for help from tell me I need to trh this first!

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mike_d100 said on 26 January 2014

do you want to know about achne problems. i have suffered from the age of 9 and am now 51 still suffering. i use creams everyday. sometimes its okay but at other times like now i get outbreaks of spots. it seems to me that i will have this problem for life. so those of you suffering for a few teenage years think how lucky you are. imagine being 51 and still getting spots regularly.

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hannahfaye93 said on 15 December 2013

When I was about 16 I started to develop spots around my mouth and chin, which then formed into scarring scabs. For about three years I struggled with many different medications and remedies for my skin until early summer this year. My sister was using Co-cyprindiol as a contraception but also as a treatment for her spots too, I decided to give it a try and six months on I haven't been happier! As it says on the treatment page you need to give it a good two or three months to see a difference and I definitely did! I also began exercising at the gym, which I think has played a role in my skin's healing process. I get maybe one or two spots every month but they are gone with in days :) Another thing I found helpful was a homemade recipe of ground cinnamon, nutmeg and honey mixed into a paste an then applied to the spot for 20 minutes. It acts as an anti-bacterial and leaves your skin feeling smooth! Look it up if you want to try :) Good luck to everyone!

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Sana Javed said on 09 November 2013

Acne is not a serious condition but it needs care. Acne can emerge on face, cheek, chin and pretty any part of the body. To say it is important to learn the basics of skin care. Generally skin care specialists find the causes of skin blemishes by knowing your lifestyle routine. It should also be kept in mind that what you eat or drink directly affects your body. So eat and drink healthy to be healthy.

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Suj said on 24 January 2013

http://articles.timesofindia.indiatimes.com/2012-11-15/beauty/29739359_1_tomatoes-taste-acne-skin

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techguy365 said on 15 January 2013

Hi, just wanted to add my experiences, especially after reading poster aru1986's comments. Please do try this! I too found that no other treatments worked for me but this regime did it for me.

Use cream with Benzoyl peroxide, build up the strength over time. If you can get Panoxyl Aquagel I found this the best as it does small tubes of 2.5%, 5% and 10% strength, I started off using 2.5% and noticed a difference then built up top 10% over 3 months. Quinoderm also do 5% and 10%. This must be used every morning and night after cleansing with a very mild cleanser, even just water if needs be. Importance is not using anything to agitate, especially not facial scrubs! Pat skin dry then apply cream around affected area. Now another important point is that the cream will dry out your skin a lot, I mean a lot, so it is important to also use a non-pore blocking moisturiser and jojoa oil. A pea sized blob of moisturiser mixed with one drop of jojoba oil. Mix this on your hand and apply over the top of the cream you applied. This make sure you don't dry out and you can head out in the morning without flaky skin.

Stick to this and I'm sure it will work for the majority as it did for me. Any deviation does not give the required results. Good luck and don't give up hope!

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aru1986 said on 13 January 2013

i have been suffering from acne for 1 year now, its got worse, ive used the gel but never worked and now taking 1 tablet a day, i hoping this works for me, i feel so updet about this, i dont even put make up on and dont like to look at myself as makes me feel so down and horrible about myself. i sont feel like going anywhere with these spots. i hope this works for me.
does anyone have any tips on this for me?

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daabe said on 25 August 2012

Hi i had acne when i was 13 years old and now i am 28 i have been treating them for many years i have been on different medication and specialist for years but no improvement.I have lots of deep scars i feel very shy and depress I really want to see myself with no acne and scars but i am helpless i am not being able to put anything on my face it would just make it worst as its already worst enough so i cant even cover with make up and if i put on make up the scars are too deep it wont cover properly.Just because of these acne and scar i feel i look like im over 60 and i hate to look in the mirror too.i was very depress and went to see my GP last week and he gave me antibiotic.I am taking it and will finish the course but i have no hope tht will work coz i have been on antibotic for nearly a years.I want to do laser treatment but they are too expensive.If anyone know any better treatment please do share it with me too..

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Joe Barrington said on 19 July 2012

I use a treatment with east cape oil and jojoba oil and it works well for me. Nothing has really helped except this.

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cp3o said on 11 July 2012

Perioral Dermatitis: toothpaste could be the cause.

Hi all,
I've had "acne" around my mouth for years and it has came and went. Antibiotics, creams and cleansing lotions never managed to cure it.

I Googled my symptoms and discovered Perioral dermatitis caused by toothpaste. I am surprised that it is not mentioned by the NHS as a possible cause on this page.

So I have stopped using toothpaste. Instead for the last month I've used only water.

All of my "acne" has cleared up. For the first time in 20 years! Try it and if toothpaste is the cause then within a week you will start to see the difference though the scars still take a few weeks to completely clear so be patient.

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JC228 said on 26 March 2011

Hi~ when I was 14, I had many acnes on my face. They were healed but left many red spot on my face. I'm 20 now but the spots are still on my face. how can I make them disppear?

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