Acne occurs when the pores of your skin become blocked with oils (sebum) and dead skin or bacteria.
A pore is a small hole in the skin that contains a hair follicle and a sebaceous gland. The sebaceous gland produces sebum to keep the hair and skin moist and in good condition.

In acne, this gland produces too much sebum. This mixes with dead skin cells and forms a plug that blocks the pores causing inflammation of the skin.
If the plug is near the surface of the pore it will bulge outwards and form a whitehead. If it is deeper and the pore remains open at the skin surface, a blackhead will form.

The natural bacteria found on the skin can then infect the plugged follicles which provide the ideal environment for bacteria to thrive, causing pus-filled spots, nodules and cysts.
The sebaceous glands of those who are prone to acne are more sensitive to hormonal changes. Puberty, pregnancy and menstrual cycle changes can trigger acne symptoms and flare-ups.

This is the cause of acne in the majority of patients. Medical conditions such as polycystic ovarian syndrome (PCOS), and medications (antiepileptic, corticosteroids, contraceptives and lithium) can cause acne symptoms.

This acne treatment service is suitable for you if:

• You are 17 years of age or older.

• You have had a previous diagnosis of acne by a doctor.

• You have mild-moderate acne.

• You can provide 2 clear, up-to-date photographs of your acne.

This service is not suitable for you if:

• You have not been diagnosed with acne by a doctor.

• You have severe acne with painful lumps/ scarring.

• You require a prescription for treatment other than those listed. Please note we are not able to prescribe Roaccutane, Dianette, Minocycline or Tretinoin 0.5%/ Retin-A.

• You require treatment for a skin condition other than acne.

• You require a dermatology referral. 

Acne can settle or clear up with the right treatment.
There are lots of products to treat acne available over the counter in your local pharmacy.

If these do not help, we can prescribe treatments for mild to moderate acne such as creams/ gels alone or in combination with oral antibiotics.

It is important to be aware that it can take 8-12 weeks of using your treatments before you will notice any significant improvement in your symptoms. This is because the treatments are not managing your current flare, but are affecting the skin cycle to try and prevent future flares in new skin.

If you are not seeing improvements at the end of this time, you should speak with a doctor to review your treatment.

There are many different types of acne treatments.
It is important that a treatment to help unblock pores (hair follicles) and reduce inflammation is used in all cases. This is generally a gel or cream. These products can be used on an ongoing basis, as required to control symptoms.

If there is a bacterial infection present, antibiotics can be used to kill the infection. These can be in cream or tablet form. These products should be used short-term to treat any active infection and then stopped. This helps to maintain their effectiveness if needed again and reduces bacterial resistance developing.

Ongoing symptoms should be managed with non-antibiotic products.

We can arrange prescriptions for a variety of treatments. The topical treatments (creams/ gels) can be used alone or in combination with oral antibiotic treatments. 

As per current medical guidelines, we do not prescribe oral antibiotics with topical antibiotics. 

Oral antibiotics are always prescribed with a topical treatment that does not contain an antibiotic for best results and to reduce bacterial resistance.

Topical Treatments (Creams/ Gels) 

These treatments are applied directly to the affected skin every day. All of these products are applied once daily (with the exception of Skinoren which is applied twice daily).

Skinoren 

This contains azelaic gel 15%, which has anti-inflammatory and antimicrobial properties. It can also help to unblock pores. It is not as harsh as benzoyl peroxide and causes less skin irritation, making it useful for those with sensitive skin. Bacteria do not develop resistance to Skinoren.

Benzoyl Peroxide

This treatment works in a few different ways. It is a peeling agent that kills bacteria, settles inflammation and helps to unblock pores. It is available to buy without a prescription in your pharmacy, but a prescription is required for the 5% strength. Bacteria do not develop resistance to benzoyl peroxide and it can be used ongoing to manage symptoms. 

Duac

This is a combination product that contains benzoyl peroxide (see above) and the antibiotic clindamycin that targets common bacteria associated with acne. A prescription for 12 weeks of treatment will be issued for this treatment. After this time, you should continue with an acne treatment such as benzoyl peroxide, or seek medical review if your symptoms have not improved.

Treclin

This medication is a combination of tretinoin (a vitamin A derivative that exfoliates the skin and reduces inflammation) and clindamycin antibiotic which targets common bacteria associated with acne.

A 3 month prescription for this treatment will be provided if clinically appropriate. After this, you should use a retinoid treatment to maintain symptom control. 

Differin

This contains the retinoid adapalene which works by exfoliating the skin and reducing inflammation. Bacteria do not develop resistance to Differin and it can be used ongoing if needed for symptom control. 

Epiduo

This medication is a combination of adapalene and benzoyl peroxide, which work together but in different ways to treat acne. Bacteria do not develop resistance to Epiduo and it can be used ongoing for symptom control. 

Oral antibiotics: Doxycycline & Tetralysal 

Oral antibiotics target bacteria commonly associated with acne flares and they also have anti-inflammatory properties. If clinically appropriate, a prescription for 12 weeks of antibiotic treatment will be issued with a topical treatment (such as Epiduo or Differin), which can be continued after the oral antibiotic treatment is completed.

The most common side effect of the topical treatments is skin irritation (dry skin, redness, peeling and burning sensation).

Using these products more frequently than advised will not have any beneficial effect on symptom control, and will significantly increase the risk of problematic skin irritation.

Be aware that benzoyl peroxide may bleach hair, clothes and bed linen that it comes into contact with.

Some patients may develop side effects when using oral antibiotics such as nausea, vomiting, diarrhoea and abdominal pain (‘heartburn’). If you develop a persistent headache with blurred vision/ loss of vision, stop this medication and seek urgent medical advice.

Topical retinoid creams/ gels and oral antibiotic treatments will make your skin more photosensitive and therefore more likely to burn. Exposure to sunlight/ sun lamps should be avoided.

For full details on potential side effects of your medication, please ensure that you read the patient information leaflet that comes with your medication before you start to use it for full details on potential side effects.

If you are concerned that you are developing any side effects, we advise that you stop your medication and seek medical advice.

It is important that you let us know if you are pregnant/ trying to conceive or breastfeeding so we can give you safe and appropriate advice.

For further information about acne, including useful skincare tips,  please visit Acne – BAD Patient Hub