Everyone is different and so is their experience of acne

Everyone is different and so is their experience of acne. Some people will only ever develop mild acne, while others can experience large, deep, painful lumps or cysts under their skin – a severe form of acne.

There are different ways to manage or treat each type of acne. You can get some treatments over the counter at your local pharmacy, but for others you will need to visit your GP or dermatologist.

Here is an overview of the steps you may need to take for each type of acne, from mild to severe, along with how to manage acne during pregnancy.

Mild acne

If your acne condition is limited mainly to whiteheads and blackheads, you probably have mild acne, especially if the lesions do not cover large areas of the face or body.

A whitehead occurs when the opening to the pore is closed off and the hair follicle fills with oil and dead skin cells.

A blackhead occurs when the opening to the pore is blocked by a dark plug of oil and dead skin cells. A chemical reaction causes the surface to darken and form a blackhead. 

Early treatment and regular preventive skin care can reduce mild acne. Acne treatments available without a prescription at pharmacies or on supermarket shelves can help control mild acne.

Managing mild acne

  • Speak to your pharmacist about recommending some over the counter treatments for your particular skin type
  • Follow the instructions carefully to help clear existing pimples and prevent new ones from forming. 
  • Stick with your recommended treatment
  • Use a gentle cleanser and mild moisturiser 
  • Try not to use a lot of makeup and particularly avoid oil-based products, which may clog the pores 
  • If you’re still concerned about your acne after eight weeks, make an appointment to visit your GP 

If you have mild acne, just changing to a non-acnegenic topical product may make a big difference to your acne control.  Non-acnegenic means the product is less likely to cause acne or make it worse.

Topical skin care products containing such ingredients as salicylic acid, benzoyl peroxide and nicatinamide (also called niacinamide) can be effective for people with mild acne and are widely available without a prescription. Examples include Benzac and Papulex products.

Moderate acne

If you have papules (raised reddish bumps) or pustules (raised reddish bumps with white centres) you may have moderate acne, especially if the lesions are widespread across the face or body. 

Breakouts last longer than in mild acne and often do not go away. 

If over the counter products are not working, you should visit your doctor who can decide if you need a different treatment or if you should be referred to a dermatologist.  

When moderate acne is not treated early enough, it can leave a permanent scar on the skin, so it’s good to get in early with the right advice. 

Managing moderate acne

  • Make an appointment with your  GP 
  • You may be prescribed a topical or oral (explained below) antibiotic and/or topical retinoid by your GP. If so, allow up to 12 weeks for treatment to work. 
  • If you’re still concerned about your acne after 12 weeks, ask your GP for a referral to a dermatologist. 

Severe acne

If you have large, deep, solid and painful lumps or cysts under your skin, you may have severe acne. The breakouts cover large areas of the face or body and last longer than in moderate acne, often not going away for months or years. 

Severe acne can have a huge impact on self-confidence and self-esteem, leading to anxiety and depression. This type of acne will not usually respond to over the counter skincare products available at pharmacies or from supermarket shelves. 

Untreated, severe acne can cause permanent and disfiguring scars.

If you have severe acne, your doctor may refer you to a dermatologist for assessment and further treatment.Severe acne can prevent a person from doing many things they usually enjoy because of a concern about their appearance and the opinion of others.

Managing severe acne 

  • Get a referral from your GP for a dermatologist as soon as possible. 
  • At your appointment with the dermatologist, don’t be afraid to ask any questions you may have. If you think of a question after the visit, ring back their office. 
  • You may be prescribed antibiotics or isotretinoin. It’s important to follow the dermatologist’s instructions completely if you are prescribed these treatments.
  • If you have severe acne, you should still follow a skin care routine of cleanse, treat and protect. 

Managing acne during pregnancy

Taking retinoids, such as isotretinoin, by mouth carry a high risk of birth defects. 

Creams containing retinoids should not be used during pregnancy.

If you find out that you are pregnant and have been using a retinoid cream, you should stop using the cream immediately. 

Acne treatments with proven safety in pregnancy

  • Topical treatments: benzoyl peroxide, erythromycin, clindamycin, Duac gel and azelaic acid 
  • Oral medication: erythromycin

Treatments to avoid during pregnancy

  • Topical treatments: retinoids (tretinoin,adapalene, isotretinoin, tazarotene) 
  • Oral: Isotretinoin and tetracycline antibiotics (including doxycycline and minocycline), spironolactone

If you have been taking topical retinoids while you were pregnant do not immediately assume the worst. Findings from a study of a large number of pregnancies where the mother was exposed to topical retinoids, along with data from studies looking into the absorption of retinoids after use of topical cream on the face, suggests that you have not exposed your child to any extra risks. However, as retinoids are known to cause birth defects, it is important that you discuss this issue with your doctor.

If you discover you have become pregnant while taking spironolactone, you should stop the drug immediately. Reassuringly, there is no evidence of any risk of harm if it is taken inadvertently during the first few months of pregnancy. It does not cause birth defects but if taken during the last few months of pregnancy, it could interfere with the normal development of a male child, due to its effects on male hormones.  

Adult acne

Saying goodbye to your teens no longer means saying goodbye to pimples!  Experiencing acne as an adult appears to be a global trend affecting more women than men. 

Adult acne is acne in the post adolescent phase and it's not always the same as acne that affects teenagers. The skin is different - younger skin is oily and less sensitive, whereas adult skin is drier and more fragile. Acne in female adults tends to be found around the jawline, chin and neck.  The pimples tend to be deeper, more painful and last longer.

The causes of adult acne are not clear-cut.  In addition to the usual suspects such as hormones and family history, polycystic ovarian syndrome (PCOS) and stress may also be triggers for acne later in life.  This makes it even more important to see a doctor so the cause can also be identified and treated.

Managing adult acne

  • Have your acne assessed by a GP or dermatologist
  • If your doctor believes another medical condition may be responsible for your acne, such as PCOS, investigations may be required
  • Treatments will vary according your type of acne
  • Poor skin care can make acne worse so discuss this with your doctor too  
Find out more about medical treatments for acne