What is acne?

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

Topical treatments

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

• creams that help 'clear' blocked pores, including benzoyl peroxide, azelaic acid, salicylic acid and glycolic acid
• topical retinoids
• topical antibiotics

Oral medicines

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

• certain antibiotics
• retinoid medicines such as isotretinoin

Combined oral contraceptive pills

Some females may benefit from the 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, so your skin is less oily.

How do acne treatments work?

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

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

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

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

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 are ineffective, you will need to see your doctor. Other medicines your doctor recommends to treat your acne will require a prescription.

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

Do acne treatments have any side effects?

All acne treatments can cause side effects, but most 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 antibiotics 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 teeth enamel, so it should not be taken by children under the age of 8 years, 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.

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

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

Oral retinoid treatments are also very toxic (poisonous) to embryos and fetuses. If you are female and are using an oral retinoid, it is 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 also cause these side effects, but they are generally milder.

Is there anything else that works to treat acne?

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.
• 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 any evidence that special diets or avoiding certain foods, such as carbohydrates, dairy or chocolate, helps prevent or relieve acne. In general, it's best to maintain a healthy, balanced diet.

Complementary medicines

There are many herbal and complimentary 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/or effectiveness at treating acne. If you're interested in trying complementary medicines for your acne, make sure to check with your doctor or pharmacist first, as some of them can interfere with other acne treatments such as prescription medicines and creams.

Resources and support

• 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.