Acne — from topical care to prescription options
Reviewed by the My London Pharmacy clinical team, Michelle Chuku, Pharmacist Independent Prescriber
·29 July 2026
·7 min read
Quick answer
Acne happens when pores become blocked with oil and dead skin, allowing bacteria to build up and cause spots. Mild acne often responds to gentle skincare and pharmacy products, while more persistent or scarring acne may need prescription topical treatments or oral antibiotics, guided by a clinician.
What acne actually is
Acne is one of the most common skin conditions in the UK, affecting most people at some point, most often during the teenage years but frequently continuing into adulthood. It develops when the tiny glands near the surface of the skin, called sebaceous glands, produce too much oil. This oil combines with dead skin cells and blocks the hair follicles, creating the blackheads and whiteheads you can see.
When a blocked follicle becomes inflamed or a bacterium called Cutibacterium acnes multiplies within it, the result can be red, tender spots or deeper, painful lumps. Acne most commonly appears on the face, but the back, chest and shoulders are also affected in many people. Understanding that acne is a medical skin condition, not a sign of poor hygiene, is an important first step in treating it kindly and effectively.
Types and severity
Recognising the type of acne you have helps guide treatment. Clinicians often describe acne as mild, moderate or severe:
- Mild acne is mostly blackheads and whiteheads, with a few inflamed spots.
- Moderate acne involves more widespread red papules and pustules.
- Severe acne includes deep, painful nodules or cysts and carries a higher risk of scarring.
Severity matters because it influences how quickly to consider stronger options. Persistent acne, acne that is leaving marks or scars, or acne that is affecting your confidence and mood are all good reasons to seek advice rather than waiting for it to settle on its own.
What causes acne, and common myths
Several factors combine to cause acne. Hormonal changes are a major driver, which is why it so often begins during puberty when levels of hormones called androgens rise and stimulate the oil glands. This is also why acne can flare at other times of hormonal change, including around the menstrual cycle, during pregnancy, and sometimes when starting or stopping certain forms of contraception. A tendency towards acne can run in families, so genetics play a part too.
A number of persistent myths can make acne harder to manage. Acne is not caused by poor hygiene or dirty skin, and over-washing or scrubbing hard tends to irritate the skin rather than help. Chocolate and greasy food are not direct causes for most people, although some individuals notice certain foods seem to affect their skin. Sunlight is often thought to clear acne, but any short-term improvement is usually offset by longer-term damage and darker marks, so sun protection remains sensible. Understanding what genuinely drives acne helps you focus on treatments that address the real causes rather than chasing quick remedies that rarely work.
Everyday skincare that genuinely helps
A simple, consistent routine supports any treatment. Wash affected skin twice a day with a mild cleanser and lukewarm water, and avoid vigorous scrubbing, which can irritate the skin and make things worse. Harsh or heavily fragranced products often aggravate acne-prone skin, so gentler is usually better.
Look for non-comedogenic moisturisers and make-up, meaning products designed not to block pores. Resist the urge to squeeze or pick spots, as this can push inflammation deeper and increase the chance of scarring. Over-the-counter products containing benzoyl peroxide can be a reasonable starting point for mild acne, and a pharmacist can help you choose one and use it correctly.
Topical treatment options
When everyday care is not enough, topical treatments applied directly to the skin are usually the next step. Several prescription options combine ingredients that unblock pores, reduce bacteria and calm inflammation. A retinoid-based gel such as Differin works by encouraging skin cells to turn over so pores stay clear, while a combination product like Epiduo pairs a retinoid with benzoyl peroxide to tackle both blockage and bacteria.
For people who cannot tolerate retinoids, Skinoren, which contains azelaic acid, can be a gentler alternative that also helps with the marks acne sometimes leaves behind. A topical antibiotic lotion such as Zineryt may be considered for inflammatory acne, usually alongside another agent to reduce the chance of bacterial resistance. Topical treatments often take six to eight weeks to show a clear difference, so patience and consistent daily use are important.
It is normal for skin to feel a little dry or to look slightly worse in the first few weeks of using a retinoid, before it begins to improve. Starting slowly, for example every other night, and pairing treatment with a gentle non-comedogenic moisturiser, helps the skin adjust. Applying these treatments in the evening and using daily sunscreen is sensible, as some ingredients can make the skin more sensitive to sunlight. A pharmacist or clinician can explain exactly how to introduce a treatment so you get the benefit while keeping irritation to a minimum.
When oral prescription treatment is considered
For moderate to severe acne, or acne that has not responded to topical treatment, a clinician may consider an oral antibiotic such as Oxytetracycline. These are used for a defined course, typically several months, to reduce inflammation and bacteria while topical treatment continues to do the day-to-day work. Antibiotics are not usually used alone or indefinitely, in line with NICE guidance on using them responsibly.
Hormonal factors drive acne in some people, particularly women whose spots flare around their menstrual cycle, and certain combined hormonal treatments can help in those cases. The most severe or scarring acne may need referral to a dermatologist for specialist medication. The right choice depends on your skin, your medical history and your preferences, which is exactly what a consultation is designed to explore.
Managing scarring and marks
Acne can leave two kinds of lasting change: flat discolouration, and textured scarring. The brown or red marks left after a spot heals, known as post-inflammatory pigmentation, usually fade over months and are helped by sun protection and treatments such as azelaic acid. True scars, where the skin texture is altered, are more stubborn.
The most effective way to reduce scarring is to treat active acne early and avoid picking. If scars have already formed, options exist through specialist services, but preventing new inflammation remains the priority. Daily sunscreen is worth the habit, as ultraviolet light can darken marks and make them more noticeable.
When to seek advice
It is worth speaking to a pharmacist or clinician if your acne is not improving after a couple of months of over-the-counter care, if it is moderate to severe, if it is scarring, or if it is affecting how you feel about yourself. Acne has a real impact on wellbeing, and effective treatment is available.
A clinical consultation allows a suitable treatment to be recommended based on your skin type and history, with clear guidance on how to use it and what to expect. Treatment is always subject to suitability, and a clinician can advise on the safest approach for your circumstances.
It also helps to go into a consultation with a sense of what you have already tried, how long you used it, and how your skin responded, as this makes it easier to choose the next step. Bringing along the names of any products or medicines you currently use, including anything you take for other conditions, allows a clinician to check for interactions and suitability. Acne treatment is rarely a single decision; it is usually a process of finding the right combination and adjusting it over time, with reviews to check progress. Approaching it as a partnership, with realistic expectations about the weeks it takes to see change, tends to give the most rewarding results and helps you stay with a treatment long enough for it to work.
Frequently asked questions
How long does acne treatment take to work?
Most topical treatments take around six to eight weeks to show a noticeable improvement, and full results can take several months. Consistency is key, and it is normal for skin to look a little worse before it settles.
Does diet cause acne?
For most people diet is not the main cause, though some find certain foods seem to trigger flares. A balanced diet supports skin health, but treatment usually focuses on skincare and medication rather than restrictive dieting.
Can I use more than one acne treatment at once?
Sometimes, but combining products can cause irritation, and some ingredients should not be layered together. A clinician or pharmacist can advise on a routine that works without over-drying your skin.
Will acne go away on its own?
It often improves with age, but this can take years, and waiting risks scarring in the meantime. Effective treatments are available, so there is no need to simply put up with persistent acne.
Is adult acne different from teenage acne?
The underlying process is similar, but adult acne, especially in women, is more often driven by hormones and tends to appear around the jaw and chin. Treatment approaches can differ, which is worth discussing with a clinician.