What is acne?

Acne is a condition that causes pimples on your skin. It's very common, especially during and shortly after puberty (known as acne vulgaris). In some cases, acne can continue into adulthood (known as adult acne).

Acne most often appears on your face, chest, shoulders and back. Symptoms can come and go as flares or skin breakouts. Acne can also cause scarring of your skin.

Some cases of acne are mild, while others can be very severe and cause significant distress. Effective treatments are available for all forms of acne.

What treatments are available for acne?

There are many treatments available for acne. Your doctor will recommend the best treatment, or combination of treatments, based on the type of acne you have and your general health.

Acne treatment aims to:

• help improve your complexion
• prevent scarring
• help your acne clear up faster
• reduce low self-esteem or depression due to your acne

Some treatments cannot be used while you are pregnant.

Topical treatments

Topical treatments are applied directly on your skin, and include:

• creams containing benzoyl peroxide, azelaic acid, salicylic acid or glycolic acid
• topical retinoids such as adapalene or tretinoin
• topical antibiotics such as clindamycin or dapsone

Oral medicines

Oral medicines (pills or tablets) used to treat acne include:

• certain antibiotics such as doxycycline, minocycline or erythromycin
• retinoid medicines such as isotretinoin

Combined oral contraceptive pills

Some females may benefit from taking a combined oral contraceptive pill (COCP or 'the pill' ) to treat acne.

Anti-androgen medicines

Sometimes, medicines such as spironolactone are used to treat acne in females. These medicines reduce hormone levels of testosterone.

How do acne treatments work?

Acne is thought to be caused by a combination of factors, including:

• 'plugging' of pores in your skin with oil and skin cells
• increased oil production in your skin and pores
• increased levels of certain hormones (androgens), which also increase oil in your skin
• increased growth of bacteria that normally live on your skin, especially in the 'plugged' pores
• inflammation — which leads to swelling

Different acne treatments aim to treat these factors. For example:

• Some topical creams contain acids which help unclog your pores, dry your skin of excess oil and reduce inflammation.
• Retinoid treatments (both topical creams and oral medicines) reduce the amount of oil on your skin and in your pores.
• Antibiotics (both topical creams and oral medicines) reduce bacteria living on your skin.
• Anti-androgen treatments and the oral contraceptive pill reduce the effects of certain hormones (androgens) that increase oil production in your skin.

Acne has a range of causes, so you may need to use a combination of treatments to see an improvement in your symptoms.

Many treatments need to be used for weeks or months before you see an effect. It could be months before you get the full benefit of taking an oral medicine for acne.

Do I need a prescription?

Some topical treatments for mild acne are available over-the-counter at a pharmacy. These include products to help 'clear' blocked pores, including benzoyl peroxide, azelaic acid and salicylic acid.

If these preparations do not work, you will need to see your doctor. You will need a prescription to buy other medicines your doctor recommends for your acne.

Oral retinoid medicines are usually only prescribed by a dermatologist (a doctor who specialises in the diagnosis and treatment of skin disorders).

Take your medicine as it is prescribed to get the best effect. Don't skip doses and ask your pharmacist what to do if you forget to take it.

Do acne treatments have any side effects?

All medicines can cause side effects. Most side effects of acne treatments are mild.

Topical treatments

Topical treatments used to clear pores and dry your skin of excess oil can cause your skin to become very dry. Ask your doctor or pharmacist how often you should use these products, and if you also need a moisturiser.

Antibiotics

Common side effects of antibiotic medicines include diarrhoea, nausea and vomiting.

Doxycycline, which is an antibiotic often prescribed to control acne, can make your skin more sensitive to sunlight, so it's important to make sure you protect your skin with at least SPF30+ sunscreen, clothing and a hat.

Doxycycline can also affect tooth enamel, so it should not be taken by young children or if you are more than 16 weeks pregnant (when the baby's teeth are developing).

If you are taking oral contraceptive pills, ask your doctor if you need to use another form of contraception while you take doxycycline, as it can reduce the pill's effectiveness.

There is also a risk of antibiotic resistance. Combining antibiotics with other treatments can help reduce the chance of antibiotic resistance.

Antibiotics should not be used long-term (for more than a year). Your doctor should review your antibiotic treatment every 3 to 6 months.

Oral retinoid medicines

Oral retinoid medicines can cause significant side effects, especially:

• severe skin dryness
• sensitivity to sun and increased risk of sunburn
• eye problems
• tiredness and muscle aches
• nosebleeds

Your doctor can suggest ways to reduce these side effects, such as regular use of moisturisers, lip balm and sun protection.

Oral retinoid treatments are also very toxic (poisonous) to an unborn baby. If you are female and take an oral retinoid, it's important that you take measures to avoid pregnancy during and for 1 month after treatment.

If you are taking an oral retinoid medicine, you should also let your doctor know straight away if you:

• experience nausea, headaches or visual changes, such as blurred vision or poor night vision
• become pregnant

Topical retinoid creams are also not recommended in pregnancy and can cause these side effects, but they are generally milder.

You should not take an oral retinoid with certain antibiotics — check with your doctor or pharmacist.

Hormonal treatments

There are many different combined oral contraceptive pills (COCPs) available. If the pill that you take causes side effects, talk with your doctor about trying a different type of pill.

Spironolactone cannot be used if you are pregnant because it may harm the fetus (unborn baby). Possible side effects of spironolactone are irregular menstrual periods and tender breasts.

When should I see my doctor?

If you feel like your acne is causing distress, see your doctor. You may have feelings of:

• social withdrawal or depression
• preoccupation with your skin and acne
• distorted body image
• low self-confidence or low self-esteem

If you have tried a treatment for 12 weeks or more and don't think it's helping, go back to your doctor.

Your doctor might be able to suggest a different acne treatment. They could also refer you to a mental health professional.

Other treatment options

Good skin care

Here are some tips for taking care of your skin and reducing the frequency of breakouts:

• Acne isn't caused by dirt, but it's still important to take care of your skin. Wash your face twice daily with a gentle cleanser. Washing your skin too often can cause dry skin, which can worsen your acne. Avoid using toners on your skin.
• Use an oil-free sunscreen daily. Sunburn is likely to make acne more severe.
• Wash your hair regularly, especially if your hair is oily. If you have long hair, keep it away from your face as much as possible.
• Oil-free makeup products can usually be used in moderation without making your acne worse.
• Don't pick at or squeeze any pimples. This can slow healing and increase the chance of scarring.

Skin care products

Many skincare products claim to treat acne. These claims may or may not be accurate, depending on the product. Ask your pharmacist which products may help you and how to use them most effectively.

Experts do not recommend harsh cleansers or exfoliants since these can actually make acne worse.

Diet

There isn't much evidence that special diets or avoiding certain foods, such as carbohydrates, dairy or chocolate, help prevent or reduce acne. In general, it's best to maintain a healthy, balanced diet. Try to minimise ultra-processed foods.

Physical treatments

This group of treatments can be given by a dermatologist and include:

• light therapy
• laser treatment
• peels
• injections

Physical therapies are not ideal for active acne treatment. Speak with a dermatologist about whether they are suitable for you.

Complementary medicines

There are many herbal and complementary treatments thought to be helpful for acne, for example, tea tree oil and acupuncture.

While most of these treatments don't cause major side effects, there's limited evidence for their safety and effectiveness at treating acne. If you're interested in trying complementary medicines for your acne, check with your doctor or pharmacist first. Some of them can interfere with other acne treatments such as prescription medicines and creams.

Resources and support

• Read the consumer medicines information (CMI) to learn more about your medicine.
• Find answers to your questions about acne on the All About Acne website.
• Learn more about conditions that affect your skin from the A-Z of skin, hosted by the Australasian College of Dermatologists.
• Read more about how to discuss acne with your child at acne.org.au.

You can also call the healthdirect helpline on 1800 022 222 (known as NURSE-ON-CALL in Victoria). A registered nurse is available to speak with you 24 hours a day, 7 days a week.