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What your doctor can do about acne and spots

  • Do not feel shy about seeing your doctor. Most doctors are now sympathetic and helpful to people with acne, and recognize how much psychological distress even acne that is not very severe can cause. Tell your doctor how much your spots are upsetting you.
  • Getting prompt and effective treatment will lessen the chances of being left with scars. This is really important – acne is usually a temporary problem, but the scars can be permanent.
  • Do not expect an immediate miracle from the treatment your doctor will prescribe. Expect a 20% improvement in 2 months, 40% in 4 months and 80% in 8 months.
  • Acne treatments usually control rather than cure the condition. This means that if you stop the treatment the acne often reappears, so you may have to continue the treatment for several years.

Doctors now have some effective treatments to offer, which was not the case a few years ago.

Tretinoin cream/lotion/gel is an effective treatment if blackheads and whiteheads are the main problem, because it unblocks the pores by removing the build-up of dead skin cells. Apply it thinly at bedtime, because it is partly inactivated by light. There is usually a 60% improvement after 3 months’ treatment. In some people, the acne worsens during the first few weeks of treatment, but then improves.

Some peeling and irritation of the skin may occur. If this happens, use a smaller amount or use it less often (for example every other day), or apply it for an hour and then wash it off. Tretinoin can also make your skin sensitive to sunlight, so you should always use an oil-free sunscreen (at least SPF 15) during the day and avoid strong sunlight. Do not apply skin toners, astringents or aftershave to the area. Tretinoin should not be used by women who are pregnant or may become pregnant.
 
Adapalene and tazarotene are cream or gel treatments that are similar to tretinoin. Like tretinoin, they work for mild-to-moderate acne in which there are blackheads, whiteheads and inflamed spots. The effectiveness of adalpene is similar to tretinoin (60% improvement after 3 months), but it needs to be applied only once a day before bed, and is less irritating than tretinoin. Tazarotene may be slightly more effective, but can be more irritating.
 
Antibiotics. Antibiotic creams may contain tetracycline, clindamycin or erythromycin. Some antibiotic creams also contain zinc, benzoyl peroxide or tretinoin, which improves their action. Do not go clubbing with tetracycline cream on your face it fluoresces under ultraviolet light! Unfortunately, acne bacteria are starting to become resistant to these antibiotics (especially erythromycin).
 
For moderately severe acne, and especially if the spots are inflamed and angry-looking, the usual treatment is antibiotic tablets (usually tetracyclines, but sometimes erythromycin). There are various different types of tetracycline, but they are all equally effective for acne (British Journal of Dermatology 2008;158:208–16). Unfortunately, to be effective, some tetracyclines have to be taken several times a day, which can be inconvenient. If you think this will be problematic, ask your doctor if a once-daily tetracycline (such as lymecycline, doxycycline or minocycline) would be suitable for you. If you are taking doxycycline, avoid sunlight or you may get a skin rash. A low dose of doxycycline (20 mg twice a day) is effective (Archives of Dermatology 2003;139:459–464).
 
Antibiotics have to be taken for at least 6 months; the acne will improve gradually over this period. Benzoyl peroxide should be used at the same time. The treatment may need to continue for 2 years or more until the acne improves of its own accord. Do not stop taking antibiotics suddenly as this may cause a flare-up.
 
Antibiotics can interfere with the contraceptive pill, so women need to use an additional method of contraception. Also, tetracyclines must not be taken during pregnancy, while breastfeeding or by children under 12. Some women develop thrush while taking antibiotics.
 
Azelaic acid cream is another possibility for mild acne. It discourages bacteria, and has some anti-inflammation and anti-blackhead effects. It is a good treatment for acne in black skin because it helps to prevent the small dark patches that may follow acne inflammation in black skin (Pulse 2007;3 Oct:49–51).
 
Hormonal treatment. Women have the option of using hormonal treatment for acne such as Dianette (ethinyloestradiol with cyproterone acetate). This is usually stopped 6 months after the acne has gone. It is a contraceptive pill that blocks the action of the hormone called testosterone (testosterone can encourage the overproduction of sebum). Although it is usually thought of as the ‘lsqumale’ hormone, testosterone also occurs in women’s bodies. Dianette carries a higher risk of thrombosis than ordinary low-dose contraceptive pills, so is usually reserved for severe acne.
 
Some other contraceotive pills can help to improve acne, such as norgestimate with ethinylestradiol, desogestrel with ethinylestradiol, drospirenone with ethinylestradiol, levonorgestrel with ethinylestradiol (Mims Dermatology 2008;4:34–5). Spironolactone is another hormonal treatment that is sometimes prescribed for older women with acne, but it must not be taken by women who might become pregnant.
 
Isotretinoin tablets are the best treatment for severe acne, particularly if it is lumpy. For this, your family doctor will need to refer you to a dermatologist. This is usually very effective as it reduces sebum production, clears the build–up of the dead cells that block the pores and reduces inflammation. It is usually given for 4–6 months. Around two–thirds of people who use it are then permanently cured; in the others, acne will reappear over the next 18 months (Clinical Medicine 2005;5:569–72).
 
Isotretinoin is completely banned if you are pregnant or might become pregnant. It has some side effects, such as reddening and scaling of the skin, lip soreness, and aching muscles and joints. There have been rumours that isotretinoin might cause severe depression, perhaps by interfering with serotonin (the brain's feel-good chemical). This is possible, but has not been proved (Current Problems in Pharmacovigilance 2006;31:8–9). More research is needed; meanwhile, be aware that depression could be a possible effect of isotretinoin.
 
Freezing/steroid injection. Lumpy cysts can sometimes be treated by freezing with liquid nitrogen or injecting triamcinolone steroid.
 
Laser treatment with a ‘pulsed-dye’ laser (N-Lite) is being used by some dermatologists, though it is expensive and it is not provided by the National Health Service in the UK. A scientific study (Journal of the American Medical Association 2004;291:2834–9) has concluded that it does not improve acne.
 
Photodynamic therapy is claimed to destroy the bacteria that cause, and uses light–sensitising creams to amplify the effect. It also targets the sebaceous (grease) glands. It can provide some initial improvement, but most of the scientific studies of this treatment examined the patients for only the next 3 months, so we do not know whether it is effective long–term and more research is needed (Journal of the European Academy of Dermatology and Venereology 2008;22:267–78).
 

Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Friday, February 7th 2014

 


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Comments on this article

Posted by Optional on 12/07/2014 at 05:04

I ve acne since 10 yrs.I took treatment fr the past two yrs evn though am not satisfied. My big problem is after acne the impression of acne lik black marks is sp embarrassing. Wat shld I do for tis marks? Plz suggest me best pill to get rid of this black and ugly marks of acne

Posted by Optional on 16/06/2014 at 09:32

i was experiencing pimples and scars on my face and was embarrased to go ot, my friend suggested nouvo soap.they kept their promise of pure skin.

Posted by bride to be on 07/06/2014 at 05:38

My wedding is in 4 months and I get break out on my cheast and back what can I use

Posted by Amna on 03/06/2014 at 03:51

Firstly i had a little pimple on my reddish cheeks i ignored but now that only caused an acne patch :(::::::::::::::::::::::::::::::::::::::

Posted by ali on 20/05/2014 at 09:30

I HAVE ACNE FROM 3 YEARS WHICH IS INCREASING DAY BY DAY AND NOW IT IS IN LARGE AMOUNT PLZZ HELP ME WHAT CAN I DO

Posted by Optionalbruan on 05/05/2014 at 04:08

I have been suffering from acne for a long time on my chest and back.I had the lumpy cyst n treatment with steroid was very effective tho you still will have a mark there but my acne is still bad n I have tried all types of treatment.I kinda give up and haven't taken my shirt off in public in years.I have seen a lot worse but I'm very shy I guess or mostly embarrassed.Acne kinda takes a back seat from other diseases but it really has stressed me out for a long time from now going to the beach or in a buddy's pool or even shying away of taken some medical test cause I don't wanna take of my shirt .....oh well that's my story ..

Posted by no on 08/12/2013 at 02:50

I have been having acne like rash for over 2yrs now and i have been battling with it. Wat is d possible treatment dat i can use.. Sha recently i hav startd taking dr james lady capsule... I havnt seen any significant improvement yet though.... Since its nt up to a month i startd usin it

Posted by Binyam on 08/12/2013 at 06:27

It is nice.Thank you! I want to ask you what I should do if I get blackspot on my face after taking tretinion cream

Posted by asma on 02/11/2013 at 06:57

I hav a lot of acne on my face so i have already meet with pharmacist anad prescribes me a lot of drug on interval first i was used beterderm, gentalene c, benzoyl peroxide, demorvate, hydrocortisone but until now i dont see any improvement ana acne increased i need your help........

Posted by Loud27 on 13/10/2013 at 09:59

I have been on doxycycline for 5 months for breakous and cystic acne around mouth and chin. Prior to this I was on dianette contraceptive on and off for almost ten years which kept the acne and spots mainly at bay. For almost a year I have being experiencing moderate to strong sore red pimples, which become infected if u push them and only water comes

Posted by Optional on 07/07/2013 at 10:05

I have acne since I was 11 years and it still won't go away please help im desperate

Posted by Optional on 03/06/2013 at 04:35

I have a lot of acne. My face has a ton. But my chest and back has alot more. Please give me solutions. I tried everything. Tea tree, foam cleaners and Sacillyic Acid, and it still won't go away.

Posted by Princess Ooh on 14/04/2013 at 08:07

I hear that some treatments hv side effects so i wld lyk 2 knw hw long those effects last n I rly cnt afford 2 stay at home as I am a grade 12 learner...

Posted by Optional on 10/04/2013 at 01:32

I've tried doxycycline on 50mg twice a day. Although my acne was slightly better under this, it did not go completely. However when I finished them the acne returned BIG time, so it must have done some good.

Posted by Optional on 06/03/2013 at 03:11

i m using isotritinion frm last 3 and half months but still pimples apperars .. also using benzoyl peroxide frm the 4th week of treatment.. my lips get so dry and sm times blleeding frm lips... i want to ask this side effect is life time or disappers after using isotritinion

Posted by Ana on 31/12/2012 at 06:59

hello I have spots for 6 years now and I have tried many ways to treat them. I don't know what to do. I am siting at home and scared to go parties. please help. thanx x

Posted by drake on 13/12/2012 at 12:09

how do i treat my acne is getting severe with red inflammation n few blck heads and some have become acne scars

Posted by Mijan54 on 20/11/2012 at 07:21

Hello.i am mijan.last 2 years i face seriously acne.i go to many doctor and use many meadicin b8 no improved.day by day my face dark& black sopt highly incrase.my whole face now dark by black cricle.please give me best ans

Posted by Aamir Hussain on 10/09/2012 at 11:44

i have big pimples on my face and shoulders please tell me the medicine about these pimples .

Posted by Optional on 16/08/2012 at 07:09

hii,m 26 yr old female...one of my friend got severe acne..she was suffering from severe acne since many years.she tried many treatments for the same but of no use.At last she go for the treatment of ISOTETROIN..AND now her problem is permanantly cured..so i would say that one should try this treatment once who are suffering from severe acne since many long..

Posted by Optional on 26/06/2012 at 03:59

Hi. I had really bad acne for 6 years and gave up on fighting it which was hard as everyday i would dread waking up to see what my face would be like. Some days i would call in sick rather than go to work as i felt the spots looked really bad. 8 months ago my doctor gave me Clarithromycin 500mg for a non-related infection, within a week my skin was nearly clear and has continued to be for the last 8 months. I've started to breakout again this week so i'm off to the doctors to try and get some more. BTY i only took Clarithromycin for 14 days.

Posted by Optional on 30/05/2012 at 05:31

i'm having this acne issue from the past 6years. I didn't get any improvement. Situation is getting worster and worster. What i should do to get back my clear skin?

Posted by ema on 17/05/2012 at 10:55

hiya, im a 34 year old female with a history of polycystic ovaries although they were treated and i was told awhile back that they had gone.However the last 6 weeks i have had stubborn acne that wont go and the last 3 years i put on 3 stone i was examined for fibroids but i didnt have them, i know something is wrong and the spots on my face have really dented my confidence.

Posted by Optional on 28/04/2012 at 07:11

I am a 62 year old male who has been suffering from a VERY serious case of acne on my arms, face and hands for almost 25 years now. It begins as a very sore zit on the face, and as a red itching rash on the arms or hands. These lesions first produce a yellowish fluid and they scale over severely. As they progress, the fluid is replaced by a multitude of little sebacious cysts (whiteheads) that grow under a scaly or leathery cover. These cysts are elongated and translucent at first then become more round with a snow white color. They usually take several months to clear up but as soon as one clears up, another breaks out somewhere else. Some became the size of a nickel and some have traveled quite a distance accross my face before finally clearing up. NO doctor or dermatologist I saw was able to pinpoint the problem but I am now convinced that it is a hormone problem. I suffer from bi-polar disorder and I believe my testosterone levels are surging as a result of hypersexuality associated with it. I get horrible episodes of depression as it is, but with this skin condition too, it's a miracle that I have not become suicidal.

Posted by sarah jane on 16/04/2012 at 08:36

i suffered from acne and the doctor prescrivbed me a lil tube where you would apply the gel to your spots and they would dry out, it takes a few weeks to see the effects but in that time i dident get any breakouts and my acne was helped, also he gave me horomonal tablets which was to block my hormones which caused me to breakout and no cosmetic product i would use would help me.

Posted by sanajafer on 22/01/2012 at 02:02

want to know the best acne ointment name,with its chemical name

Posted by Optional on 03/01/2012 at 06:46

i have lot of pimples and marks in my face. please tell me the medicin for that.

Posted by Optional on 19/12/2011 at 04:37

im mashfique im suffering acne many days. how i can prevent my acne?

Posted by Ria on 14/11/2011 at 08:54

Hi guys! I really need your help. I'm taking doxycycline for 5 weeks now and my break-outs are getting worst. I don't want to go out anymore but I have to attend my class. I'm a teacher and I don't know how to face my students everyday. I've been seeing a derma spending much and nothing seems to work. I'm frustrated, I've cancelled all the events that I need to atend to because of my condition. Is it really normal? How long should I wait? Can I have my regular facial even when I'm taking this antibiotic? I will appreciate it so much if I get replies. Thanks in advance!

Posted by Optional on 28/09/2011 at 08:35

where can i get these pills in South Africa

Posted by Optional on 26/09/2011 at 08:08

Hi, I have been on 100mg twice a day of Doxycycline for 2 1/2 weeks now,for pimples,and I am breaking out worse then normal. It's been like this since the day I started Doxycycline. Is this Normal? should I keep taking it? I have a wedding next weekend and I was hoping this antibiotic would kick in by then and start doing it's thing.

Posted by wejdnjwefiii on 14/09/2011 at 06:52

i don't have acne but i have spots and i'm soooo sick of them, NOTHING works:(

Posted by Optional on 22/03/2011 at 05:48

i have had acne since age 12 on my back, Dianette is the pill it works! you can also use Jasmine! Doctors do not like to prescribe them as they are expensive but the are known for working. I was able to wear a wedding dress that revealed my back this was the first time in my life I was ever able to show my back in public with confidence! Other pills did not work. My issue is that having come off pill aged 34 Acne is now back and creams still do not work can not take the pill as trying for a child, but depressed in having to cover up. Scarring back etc

Posted by Optional on 03/02/2011 at 03:43

Hi SAR415 Interested in what you said re your posative results with "Light Therapy" Could you please supply me with the discount code you mentioned for Brite-Box. Thanks

Posted by Optional on 14/11/2010 at 10:29

i have had acnes for about 5 yrs bt i have tried many medicines bt nothing have changed,am black can you guys help me out and tell me some medicine which i can use .plizz

Posted by my daughter on 12/11/2010 at 08:58

Has tried all of above! Problems starting at 11 so began on more gentle options and built up to 2 courses of Isotretinoin.Had been clear after second course for about 8 months.Unfortunately over last two months started coming back and now picking up severity.Depression side of Isotretinoin is a worry but as our dermatologist pointed out acne can cause very severe depression too.Now going back to hospital again but not sure if any help will be available as already said not likely to prescribe Isotretinoin again.Was hoping maybe some other option available even if not on NHS as in light treatment etc although our specalist had said it doesn't have a success rate.When your children feel so sad and their skin looks and feels so painful you just want to find the miracle cure.She really blossomed in confidence and looks for a while but seems to be loosing it again.She has also been checked for Polycystic ovaries and lipid inbalance. Any ideas please?

Posted by Ammy on 12/10/2010 at 06:38

I used the tetracycline antibiotic as Doxycycline for my acne problem. I can get recommended dose info at InternationalDrugMart. I think this medication works by interrupting the growth of bacteria and it is effective and better for me at all.

Posted by Jim on 06/09/2010 at 07:33

I've had really bad acne for 5 years (since I was 13), I never thought that doctors would actually be able to prescribe anything for acne, but after reaidng this article I'm going to book an appointment with my local GP. Thanks!

Posted by Optional on 20/07/2010 at 02:38

I have had spots since i was 13, have tried most products on the market but none of them seem to do anything. I now just use simple soap and a moisturiser. It has given me the best results, but still suffer from flare-ups which is very frustrating. Have been using the same routine for 4 months. I guess the key to success is persistence, and not to get down about spots when they appear. Hopefully my clear skin is just around the corner

Posted by anon on 04/07/2010 at 12:48

I have been to my doctor so many times regarding my acne that i have lost count, I have tried every treatment going and nothing ever made a visable improvement. I then through research dicovered light therapy and its amazing!!! I can see clearer skin and make up no longer looks like its stored in my face!! I got my light box from britebox-led.com and even have a discount code if anyone out there is interested, it SAR415

Posted by Optional on 02/04/2010 at 10:45

Hi Please help! I have suffered badly with huge red lumpy and sore spots on my upper back, chest and face. Although it is far worse on my back, I have suffered from this since I was about 12 years old, so for the last 16 years. I have tried all sort creams, lotions, tablets, prescribed treatment. I did find Roaccutane worked wonders I got a lot of side affect, but have been on it 3 times at different stages and I have also changed my contraceptive pill a number of times. However I had a bad year last year and underwent major surgery and was off work for 7 months, and it completely cleared up! But as soon as I went back in January within 2 weeks it was back, and it's terrible again now. What's you advise? The best produce in your range? Thank you for your time. Miss K Hooper.

Posted by Anonymous on 30/10/2009 at 12:54

I've had acne since my teens and tried everything including Isotretonoin/Roaccutane three times - it works initially but comes back. I think that we are all different and different cures will work for different people. For me, to keep my spots at bay, I have a low GI diet (no white bread, limited sugar, limited dairy) and take hormonal balancing tablets from a qualified Chinese doctor (my own GP is not remotely interested).

Posted by Anonymous on 15/09/2009 at 09:38

i have had acne since the age of 12, nothing helped including private and very expensive treatment. the only thing that worked was roacutane- very strong and only given by hospital with many side affects. it takes 2 months to work and then comes back when you finish it (so i have had clear skin for 2 months in 10 years).

Posted by Anonymous on 03/08/2009 at 03:15

it really helped reading this :) thanks

Posted by Bridgette on 09/02/2009 at 05:56

I have severe acne. It started getting worse last year. My neck, back,chest and face is covered with spots. I have tried everything. I am despondent that I don't feel like going out anymore.

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Fascinating facts

The worst ages for spots are 16-18 years for women and 18-19 years for men, but people of any age can get them

Acne was more severe in teenagers 20 years ago than it is now

More people in their 20s and 30s seem to have acne these days

At 40 years of age, 5 women in 100 and 1 man in 100 have acne

The ancient Egyptians relied on a spot cream made from bullocks' bile, ostrich egg, olive oil, salt and plant resin, mixed to a paste with flour and milk

Americans spend $100 million a year buying acne treatments

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