Acne - Treatments

Benzoyl peroxide gel, cream or face wash

You can buy benzoyl peroxide over the counter from a pharmacy. Its brand names are Brevoxyl and PanOxyl. It comes as a gel, cream or face wash. It's probably the best treatment to try first.

Benzoyl peroxide helps to kill bacteria, unblock pores and make your skin less oily. It can be used for different types of acne: blackheads, whiteheads and red, inflamed spots.[4] You use the cream or gel once or twice a day, usually after you wash.

We found two systematic reviews that looked at the research on benzoyl peroxide.[1] [2] People who used it had fewer spots after four weeks to 12 weeks.

Side effects of benzoyl peroxide include dry, red or peeling skin, and a burning or tingling feeling. About 1 in 3 people get these side effects.[12] [13]

Benzoyl peroxide is a kind of bleach, so it's best to avoid getting it on your hair, clothes or sheets. You should also avoid your skin getting too much sunlight.[4]

You can also get benzoyl peroxide gel combined with an antibiotic called clindamycin. The brand name is Duac Once Daily. You can only get it on prescription from your doctor. We've included more information on antibiotics below.

Retinoid gels or creams

Retinoid gels or creams can help get rid of acne. They work by unblocking your pores. You usually need to use these creams or gels once or twice a day.

Some retinoids that come as creams or gels are:

• adapalene (brand name Differin)
• isotretinoin (Isotrex)
• tretinoin (Retin-A).

You can also get isotretinoin combined with an antibiotic called erythromycin. The brand name for the combination is Isotrexin.

Threre's some good research to show that retinoid creams or gels can help get rid of acne.[1] [2] People who use them have fewer spots after about eight weeks or 12 weeks.

In one study, the researchers asked people using tretinoin cream if they thought their acne had improved.[14] People who used tretinoin were more likely to say their acne had improved than people who used a dummy treatment (a placebo). But in another study, people who used adapalene didn't notice much of an improvement.[2]

The side effects of retinoid creams or gels are similar to sunburn, so you may get red or peeling skin.[1] [2] [15] [16] [17] But this will probably settle down after a few weeks.

You need to be quite careful with retinoid gels or creams. Try not to get them in your eyes, nose or mouth. And don't let the cream or gel build up on your skin, say at the sides of your nose or under your chin.

Using a retinoid cream or gel can make your skin burn more easily in the sun. Try to cover up or use sunscreen when you're outside.

You shouldn't use retinoids if you're pregnant. It may cause birth defects. If you're going to have sex, make sure you use contraception.[4]

Antibiotic gels and creams

Antibiotics are drugs that kill bacteria. Using an antibiotic gel or cream helps to get rid of the bacteria that make your spots red and inflamed.

You can get antibiotic gels or creams from your doctor. You'll need to use your treatment once or twice a day.

Some antibiotics that come as gels or creams are:

• clindamycin (brand names include Dalacin T and Zindaclin)
• erythromycin (Stiemycin).

There's good research to show that antibiotic gels and creams get rid of spots.[1] [2] But they're better at getting rid of red or inflamed spots. They don't help as much with whiteheads and blackheads.

It may be several weeks before your treatment starts working. In studies, it took between four weeks and 12 weeks for people to have fewer spots.

In some studies, researchers asked people if they thought their acne was getting better. People who used an antibiotic cream or gel were more likely to say their acne had improved.[18] [19] [20]

You can get a gel that combines clindamycin with benzoyl peroxide. The brand name is Duac Once Daily. We haven't looked at the research on this treatment yet.

You can also get erythromycin gel combined with zinc. The brand name is Zineryt. The idea is that zinc helps your skin absorb the antibiotic. But there's no research to say whether it's any better than an antibiotic on its own.

The research on antibiotic creams doesn't give much information about side effects.[1] [2] A few people who used clindamycin got a burning feeling in their skin, and others got diarrhoea. But we don't know how common this is. Erythromycin doesn't seem to cause any more problems than a dummy treatment (a placebo).

Azelaic acid cream

Azelaic acid comes as a cream. It's a bit like benzoyl peroxide, but you can only get it on prescription from your doctor. Its brand name is Skinoren.

Azelaic acid seems to reduce the number of spots people have, but there are problems with some of the research.[1] [2] For example, lots of people dropped out of one study, and another looked at people with different degrees of acne.[21] [22]

Side effects of azelaic acid include itching or stinging, a burning feeling, and red or scaly skin.[21] [22] [23] You may be less likely to get side effects from azelaic acid than you are with benzoyl peroxide.[4]

Antibiotic tablets

Antibiotics are drugs that kill bacteria. If you've tried antibiotic gels or creams and they haven't worked, your doctor may suggest antibiotic tablets. You'll need to keep taking them for several months.

Some antibiotic tablets that are used for acne are:

• doxycycline (brand name Vibramycin)
• erythromycin (Erymax and Erythrocin)
• lymecycline (Tetralysal 300)
• minocycline (Minocin MR and Sebomin MR)
• oxytetracycline
• tetracycline.

Antibiotic tablets can reduce the number of red and inflamed spots you have.[1] [2] [24] They may not help as much with whiteheads or blackheads.

In one study, 3 or 4 out of 10 people who took antibiotic tablets found that their acne cleared up completely after six months.[7]

Antibiotic tablets can cause side effects. The most common are diarrhoea, an upset stomach, nausea and vomiting.[6] [7] [8] In one study, 14 in 100 people had these problems.[6]

In one study of minocycline, about 2 in 100 people had changes in their skin colour.[25] This can be permanent. Some studies found that minocycline can cause liver damage or a problem where your immune system attacks your body.[9] [11] These problems are rare, but your doctor may want to keep a check on you just in case.

You can't take some types of antibiotic if you're pregnant. Taking antibiotic tablets can stop the contraceptive pill working. If you're going to have sex, ask your doctor about contraception.

Isotretinoin tablets

We haven't looked at the research for this treatment in the way we have for others on this website. But we've included it because you may have questions about it.

If you have very severe acne or have tried other treatments that haven't helped, your doctor may prescribe isotretinoin tablets. Isotretinoin tablets stop your skin making as much oil (sebum). They can reduce the number of spots you have or even cure your acne completely.[26]

You should only have this treatment prescribed by a doctor who specialises in skin problems. This type of doctor is called a consultant dermatologist.[4]

The brand name for isotretinoin tablets is Roaccutane.

Isotretinoin causes birth defects. It's very important that you're not pregnant when you start taking it. And you have to make sure you don't get pregnant while you're taking it. Your doctor will ask you to take a pregnancy test before you start treatment. If you're going to have sex, you need to make sure that you use contraception. You need to use contraception for a month before you start taking isotretinoin, all the time you're taking it, and for a month afterwards.[4] You need to have a pregnancy test every month during treatment, and five weeks after you stop treatment.

Isotretinoin tablets can also cause other side effects, including:[4]

• Very dry skin
• Dry eyes, lips, nose and throat
• Nosebleeds
• Headaches
• Muscle or joint aches
• Blood in your urine
• Anaemia (when you don't have enough iron in your blood, which makes you feel tired).

Isotretinoin can cause some very severe side effects, but these are rare. They include permanent mood changes, depression and aggressive behaviour.[4] If you have any feelings of depression, thoughts of harming yourself, or any change in your mood, contact your doctor straight away.

Isotretinoin can also cause skin problems and hair loss. Very rarely, it can cause diarrhoea, drowsiness, and problems with your bones and vision.[4]

Isotretinoin may make you more sensitive to sunlight, so you should use sunscreen while taking it. If you usually wax your skin to remove hair, you should stop. While taking this drug, waxing can damage your skin.[4]