Acne Treatment

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Acne

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Acne is a common skin problem where pimples, whiteheads, blackheads or cysts develop on the face, neck, chest or back. It is caused by a build-up of dead skin cells, bacteria and dried up sebum (oil) which blocks the skin pores.

The sebum blocking the pores provides an ideal environment for a bacteria called Propionibacterium acnes to thrive on the skin. If they multiply to large numbers then this can cause the immune system to react producing inflammation and spots.

 


Common Symptoms

There are six types of spots caused by acne:

  1. Blackheads; black/yellow bumps in the pores of the skin.
  2. Whiteheads; white bumps in the pores of the skin.
  3. Papules; tender small red spots.
  4. Pustules; red spots with a white tip in the middle caused by pus.
  5. Nodules; large red hard lumps in the skin.
  6. Cysts; large pus filled lumps.
Common Treatments

There are a range of over-the-counter treatments you can try first. Please speak to your pharmacist for further advice, and see our 'Alternative treatments' section below. In more resistant cases of acne that have not responded to over-the-counter options, then antibiotic lotions or tablets may be considered. We can prescribe the treatments listed below. 

Please click on the medication to read the Patient Information Leaflet for important information about each drug.  

Possible treatments we prescribe if clinically appropriate: 

  • Lymecycline 408mg Once Daily: 1-month course (£4.26*) or a 2-month course (£8.52*)
  • Doxycycline 50mg Two Tablets Daily: 1-month course (£2.34*) or a 2-month course (£4.68*)
  • Zineryt (Erythromycin and Zinc) Lotion - 30ml (£9.25*) or 90ml (£20.02*)
  • Duac (Clindamycin and 5% Benzoyl Peroxide) Gel - 30g (£13.14*) or 60g (£26.28*)

*Prices shown are cost price of the medication, taken from the British National Formulary 2018, and are given as a guideline. Pharmacies will add a dispensing fee to this which will vary considerably, so it is worthwhile phoning around to compare prices. The medication is paid for at your chosen pharmacy. 

 

Alternative treatments

Benzoyl Peroxide

You can purchase this from the pharmacy. This can help clear inflamed spots, blackheads and whiteheads. It does so by reducing inflammation, killing bacteria and it helps to clear blocked skin pores. There are four different strengths from 2.5% to 10%. Start with the lowest and gradually increase it to the maximum tolerated level. Also gradually increase the time it is left on the skin before washing off. Use it once a day to start with, then increase it to twice a day. It is common for Benzoyl Peroxide to cause mild skin irritation. A water-based preparation instead of an alcohol-based version is less likely to irritate. 

Retinoids

These work well for unclogging the pores, so are effective at treating blackheads and whiteheads. They can also help with mildly inflamed spots. They can cause some skin redness and peeling which usually settles with time.

Azelaic Acid

Works best for treating blackheads and whiteheads, as it also helps to unclog the pores. It can also help to treat mildly inflamed spots but does not work as well as topical antibiotics or benzoyl peroxide for treating inflamed acne.

Information about Zineryt

Zineryt contains erythromycin and zinc. Do not use if you are allergic to erythromycin or zinc. You should apply topical treatments to all the affected areas of skin and not just to each spot. Zineryt is to be used twice a day. 

Before using Zineryt, wash the area first then spread the solution over the whole of the affected area including the surrounding skin. Try not to forget using it as this can slow down the rate of improvement of your acne. 

Topical antibiotics help to reduce the number of bacteria on the skin and treat the inflamed spots.

It will usually take four to six weeks before you see any improvement in your skin. For the skin to clear, maximum response to treatment can take four months or longer. Often people think the treatment is not working after a few weeks and stop using it. However, it is important to continue for the recommended time to ensure you see a result, as it usually takes time for your skin to respond. 

Many people will find that acne flares up again once the antibiotic treatment has stopped. Maintenance treatment will usually be required, and often this can be for up to 4-5 years. Maintenance treatment tends to be with either benzoyl peroxide or a topical retinoid ( such as adapalene, tretinoin, isotretinoin ) which can be used indefinitely.

Long-term antibiotics for maintenance are not recommended as it can lead to resistance of bacteria to the antibiotics.

Zineryt generally has a shelf life of 8 weeks once opened, but please check the packaging. Never give your medication to other people even if their condition appears to be the same as yours.

Side effects to Zineryt

Side effects of Zineryt are uncommon. Zineryt can sometimes cause mild skin irritation. Rare side effects (affecting less than 1 in 1000 people) include itching, redness, burning sensation and dry skin. 

If you develop a burning sensation or a very painful rash with Zineryt which does not settle within a few hours or worsens each time you use it, then stop the treatment and tell your doctor as soon as you can. 

All medications can cause allergic reactions. However, reactions to Zineryt are very rare. 

Information about Duac

Duac contains the antibiotic clindamycin and also benzoyl peroxide. Do not use it if you are allergic to any of the ingredients

You should apply topical treatments to all the affected areas of skin and not just to each spot. Duac is to be used once a day in the evening to the entire affected area. First, wash the area using a mild cleanser and dry it thoroughly. Then apply the gel in a thin layer. Wash your hands after use. 

Avoid contact with the mouth, eyes, lips, other mucous membranes or areas of irritated or broken skin. Rinse well with water if any accidental contact occurs. 

Many people notice increased reddening and peeling of the skin in the first few weeks. If that is the case, then you can use a moisturiser, or reduce the frequency of use, or temporarily discontinue use until the skin settles.  

If the skin irritation is severe, then stop using the gel.  

Topical antibiotics help to reduce the number of bacteria on the skin and treat the inflamed spots.

It will usually take four to six weeks before you see any improvement in your skin. Duac should not be used for more than 12 weeks continuously. Often people think the treatment is not working after a few weeks and stop using it. However, it is important to continue to ensure you see a result, as it will usually take time for your skin to respond. 

Many people will find that acne flares up again once the antibiotic treatment has stopped. Maintenance treatment will usually be required, and often this can be for up to 4-5 years. Maintenance treatment tends to be with either benzoyl peroxide or a topical retinoid ( such as adapalene, tretinoin, isotretinoin) which can be used indefinitely.

Long-term antibiotics for maintenance are not recommended as it can lead to resistance of bacteria to the antibiotics.

Duac generally has a shelf life of 8 weeks once opened, but please check the packaging. Never give your medication to other people even if their condition appears to be the same as yours.

Side effects of Duac

All medications have the potential to cause side effects, but not everyone experiences them. The most common ones for Duac include:

  • redness
  • peeling
  • dryness
  • burning sensation
  • photosensitivity

Increased sensitivity to sunlight can occur with Duac due to the benzoyl peroxide. It is advised to avoid prolonged exposure to the sun or sunbeds. If this can not be avoided then use a high SPF sunscreen and protective clothing. 

If you develop a burning sensation or a very painful rash with Duac which does not settle within a few hours or worsens each time you use it then stop the treatment for a few days to allow your skin to recover. If it continues or worsens then tell your doctor as soon as you can. 

Avoid contact with hair and fabrics as Duac may cause bleaching of such materials. 

Uncommon side effects include:

  • itching
  • rash
  • worsening of the acne
  • severe diarrhoea

If you develop severe diarrhoea then stop the medication and consult your doctor before using it again. 

 

Information about Doxycycline

Doxycycline is an antibiotic that can be used to treat acne. Take doxycycline with plenty of water while standing or sitting up to stop the capsules from causing any irritation to your throat. Do not lie down for at least thirty minutes after taking Doxycycline capsules, to allow the capsule to move quickly into the stomach and prevent irritation of the throat or food pipe. 

Take doxycycline with milk or a meal if you have an upset stomach.

Keep taking the Doxycycline until the full course is finished (unless a doctor tells you to stop), even if you feel that the acne has cleared up as it may return. If you forget to take a dose, take one as soon as you remember unless it's nearly time for your next dose. In this case, just leave out the missed dose and take your next dose as normal.

Avoid indigestion remedies, or supplements containing iron, magnesium, or zinc at the same time as doxycycline (from 2 hours before to 2 hours after taking doxycycline) as they stop the antibiotic from working properly.

Avoid drinking any alcohol as it may make the antibiotic less effective.

If you suffer from visual disturbances such as blurring of vision while taking Doxycycline, then do not drive or use machines.

Never give your medication to other people even if their condition appears to be the same as yours.

It will usually take a few months before you see any improvement in your skin. For the skin to clear, maximum response to treatment can take four months or longer. Often people think the treatment is not working after a few weeks and stop using it. However, it is important to continue to ensure you see a result, as it usually will take time for your skin to respond. 

Many people will find that acne flares up again once the antibiotic treatment has stopped. Maintenance treatment will usually be required, and often this can be for up to 4-5 years. Maintenance treatment tends to be with either benzoyl peroxide or a topical retinoid ( such as adapalene, tretinoin, isotretinoin) which can be used indefinitely.

Long-term antibiotics for maintenance are not recommended as it can lead to resistance of bacteria to the antibiotics.

Side effects to Doxycycline

Most types of medicines can cause potential side effects. However, not everyone will experience them. The side effects often improve as your body adjusts to the new medicine, but if any of them continue or become troublesome then speak with your doctor or pharmacist.

Doxycycline may cause your skin to become more sensitive to sunlight than usual. Avoid strong sunlight and do not use sunbeds. Use a sun cream with a high sun protection factor on bright days, even when it is cloudy. If you develop skin redness then speak to your doctor or pharmacist as soon as possible. 

Other side effects include:

  • diarrhoea
  • abdominal symptoms: upset tummy, indigestion or abdominal pain
  • headaches
  • thrush
  • dry mouth, throat irritation
  • sweating or feeling anxious
Information about Lymecycline

Lymecycline is an antibiotic that may be used to treat acne. The usual dose is one capsule taken preferably in the morning once a day. 

Take Lymecycline with plenty of water while standing or sitting up to stop the capsules from causing any irritation to your throat. You can take it with or without food. Take it with a meal if you have an upset stomach.

Keep taking the Lymecycline until the full course is finished (unless a doctor tells you to stop), even if you feel that the acne has cleared up as it may return. If you forget to take a dose, take one as soon as you remember.

Avoid indigestion remedies, ulcer healing drugs or supplements containing iron, magnesium, calcium, aluminium or zinc at the same time as Lymecycline (from 2 hours before to 2 hours after taking Lymecycline) as they stop the antibiotic from working properly.

It will usually take a few months before you see any improvement in your skin. For the skin to clear, maximum response to treatment can take four months or longer. Often people think the treatment is not working after a few weeks and stop using it. However, it is important to continue to ensure you see a result, as it usually will take time for your skin to respond. 

Many people will find that acne flares up again once the antibiotic treatment has stopped. Maintenance treatment will usually be required, and often this can be for up to 4-5 years. Maintenance treatment tends to be with either benzoyl peroxide or a topical retinoid ( such as adapalene, tretinoin, isotretinoin) which can be used indefinitely.

Long-term antibiotics for maintenance are not recommended as it can lead to resistance of bacteria to the antibiotics.

Side effects to Lymecycline

Most types of medicines can cause potential side effects. However, not everyone will experience them. The side effects often improve as your body adjusts to the new medicine, but if any of them continue or become troublesome then speak with your doctor or pharmacist.

The most common side effects include nausea, diarrhoea, abdominal pain and a headache.

Lymecycline may sometimes cause your skin to become more sensitive to sunlight than usual. Avoid strong sunlight and do not use sunbeds. Use a sun cream with a high sun protection factor on bright days, even when it is cloudy. 

The side effects often improve as your body adjusts to the new medicine, but if any of them continue or become troublesome then contact us, or speak with your doctor or pharmacist. 

If you develop a serious illness with fever, severe peeling and blistering of the skin, then it is important that you stop the medication and seek medical advice straight away.

Allergic reactions to medications

All medications can cause allergic reactions, however, serious allergic reactions are rare. 

Please note that i-GP DOES NOT TREAT Medical Emergencies. 

If you develop any of the following symptoms, then you must STOP the medication and seek medical advice immediately (from your GP, Out of Hours Service, Urgent care centre, NHS 111). Call an ambulance or go to A&E if the symptoms are severe:-

  • Wheeze
  • Difficulty in Breathing
  • Swelling of the eyelids, face or lips or throat
  • A rash particularly if affecting your entire body
  • Severe skin reactions, including large fluid-filled blisters, sores and ulcers
  • Chest pain
  • Fainting or collapse
Complications of acne

Mild acne will often settle without specific treatment however it sometimes can cause complications including scarring, skin discolouration, low self-esteem and depression. 

Acne scarring can have different appearances, the main types include uneven skin texture, craters, small deep holes and bumps where the pimples used to be. Scarring may also occur if you squeeze or pick the spots. 

Acne can be an embarrassing condition for some people particularly when it affects the face. This can lead to low self-esteem, and sometimes even depression if it is not adequately addressed. If it is affecting you psychologically then it is important to be able to discuss how it makes you feel with someone you can trust or your GP. 

Treatments for scarring

Options available for scarring include laser resurfacing of the skin, dermabrasion or chemical peeling of the skin, breaking the scar tissue down with a sterile needle (subcision) and injection of collagen filler.

When seeking advice for cosmetic procedures it is important to ensure you consult a suitably qualified practitioner, such as a GMC registered Dermatologist to ensure you receive the best possible outcomes. 

Antibiotic Guardianship

Antibiotics should be used responsibly and only when really necessary. Overuse and misuse of antibiotics can lead to antibiotic resistance. This is where the antibiotic becomes less effective at treating certain types of bacterial infection, so they do not work when needed. 

Antibiotics should be taken as prescribed, and it is important to complete the full course as this can reduce the chance of the bacteria developing an immunity to that antibiotic. It is important not to share antibiotics, and always take unused medication to your local pharmacy for disposal.

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