What is Acne?

Acne, also known as acne vulgaris, is a skin condition where hair follicles become blocked by oil and dead skin cells. The spaces in which your hair follicles come out are known as sebaceous glands or skin pores. These produce an oily substance that stops the hair and skin from drying out, keeping it healthy. However, overproduction of this oil can result in the mixing of dead skin cells and bacteria that block pores.  

Acne is one of the most common skin conditions in the UK and it can affect up to 95% of adolescents to some extent. Of these people, 25%-30% will experience moderate or severe acne. The condition is more common in boys than girls during adolescence. However, it’s more common in adult women than adult men. 

It can be embarrassing and distressing, particularly in its severe form, and can affect self-confidence and mental wellbeing.

The symptoms you may experience from this condition are:

• Whiteheads - closed blocked pores
• Blackheads - open blocked pores
• Pustules - white and red bumps from infected blocked pores
• Nodules - hard closed pores

These usually appear on the face, chest, or upper back. They can vary in severity from mild to severe cystic acne. Cystic acne has a higher likelihood of causing long-lasting acne scars on the skin.

What Causes Acne?

Fundamentally it’s the blocking of skin pores that causes acne, however, there are various types of acne triggers.

Hormonal Acne

Hormone levels can greatly affect acne as they can drastically change how much oil the skin produces. Hormonal breakouts are tightly linked to changes in male hormone levels in puberty. Teenagers commonly experience symptoms in the T-zone of the forehead, face, and jaw.

The menstrual cycle also plays a large role in acne in women. Fluctuations in estrogen and progesterone levels around one week before menstruation often cause hormonal breakouts.

Cystic Acne

This is the most serious form of the condition. This occurs when the normal bacteria that live on the skin mixes in with the excess oil and dead skin cells and becomes trapped in a pore. This results in painful, red, and inflamed cysts on the skin, resulting in scarring if severe enough.

Medication-induced Acne

Some medicines can cause acne as a side effect. Particularly those that modify hormone levels in the body. Examples of drugs that can cause acne are corticosteroids, testosterone, and lithium.

Cosmetics

Oil-based cosmetics can worsen acne, especially if not removed regularly. For this reason, most cosmetics are now oil-free and recommended to be removed before sleeping.

Buying Acne Treatments Online

To request acne treatment online, simply fill out our online medical assessment, and our doctor will review your suitability for you choice of medication. The online doctor will then generate a prescription for our pharmacy team, who will dispense and post your medication.

There are various acne products available both over-the-counter and via prescription. The best acne treatment for you depends on the cause and severity of your symptoms. For this reason, it is best to speak to a health professional before treating your acne. They can provide advice on which treatment will be most appropriate.  

It is important to note that for almost every treatment, it will take about 4-8 weeks until symptoms begin to improve. A number of these products are available from our online doctor acne clinic.

Over the Counter Acne Gel

Benzoyl peroxide (available under the name Acnecide or Acnecide Wash Gel) is an acne gel you can buy over the counter. Benzoyl peroxide works by targeting the bacteria involved in causing spots. It can also unblock pores and reduce blockages, which may help prevent future spots. It is generally used for mild or moderate acne. Benzoyl peroxide can cause dry skin and burning and may not be suitable for certain types of acne such as cystic acne. 

Another over the counter product is the acne cream azelaic acid (brand name Skinoren). This also works by targeting the bacteria involved in acne. It also reduces the number of skin cells that block the pores of the face. This helps to reduce blackheads and whiteheads.

Prescription Topical Gels and Creams

The major prescription gels and creams are topical retinoids or combination topical retinoids. These medicines work by actively unblocking pores and preventing new blockages. The treatments are applied to the skin daily, usually at night, and are left on without being washed off.

A common prescription acne cream is Differin. It contains the retinoid adapalene. Epiduo Gel contains a combination of adapalene and benzoyl peroxide. 

You must speak with your doctors and inform them of any existing skin conditions before starting this treatment. Side effects of these gels and creams include redness, dry skin, skin burning sensation, irritation, itching, and skin sensitivity to sunlight.

Another common topical treatment is Duac Gel. This contains an antibiotic called clindamycin, as well as benzoyl peroxide. These active ingredients combine to reduce the bacterial growth causing the spots. This combination also helps to prevent antibiotic resistance.

Isotretinoin

Isotretinoin is an oral retinoid that is reserved for severe cases of acne that have not responded to other treatments. For acne treatment in the UK, It should only be prescribed by a dermatologist or skin specialist. This medicine works by actively unblocking pores and preventing new blockages. 

Isotretinoin is known to cause birth defects. Due to this risk, contraceptive methods must be used one month before, during, and one month after treatment.

Doctors are required to closely evaluate the risk vs. benefits of this treatment and suitability for each patient. Monitoring of side effects should be undertaken by the specialist.

Common side effects include dryness of the lips, mouth, nose, eyes, and skin, fragile skin, changes to the colour of the skin, increased susceptibility to sunburn, and hair growth.

Combined Oral Contraceptive Tablets

Birth control tablets for women can be used to treat hormonal acne as they can stabilise hormone levels in the body. The stabilisation of these hormones, particularly around the time before menstruation, can greatly improve symptoms.

Examples of contraceptives used as acne pills are Clairette and Dianette. This treatment may not be suitable for all women depending on medical conditions and their response to treatment.

Side effects for combined oral contraceptive pills include changes to mood, libido, weight gain, and increased risk of blood clots. Refer to your GP to discuss the risks and benefits of this therapy.

Oral Antibiotics

Lymecycline (brand name Tetralysal) is an antibiotic acne tablet taken daily, usually for 2 to 3 months. This is usually prescribed if someone has tried topical treatments but their symptoms haven’t improved.

Antibiotic tablets work by killing bacteria in the body, including bacteria that can worsen acne on the skin. These are particularly effective against cystic acne as it lowers the number of bacteria able to infect skin pores. 

These treatments are generally used after topical treatments but before oral retinoids. These treatments are not suitable for pregnant women or those with stomach problems. Each persons’ suitability should be discussed with a GP or specialist. Side effects of these treatments are increased skin sensitivity to sunlight, stomach upset, and oral or vaginal thrush.

Lifestyle and Home Remedies

Mild acne may be able to be treated by small changes to basic skincare routines such as:

• Avoiding oil-based cosmetics and creams - the excess oil from these products can worsen the skin.
• Avoid bursting pimples - bursting pimples releases the oils, dead skin and bacteria within, further exposing them to other pores.
• Wash the affected areas - washing the affected areas with gentle cleansers can remove dead skin and excess oils, lowing the potential for more blocked pores.
• Avoid heavy cleansers - heavy cleansers and skincare products can have the opposite effect as they can irritate the skin further.
• Shower regularly - this is to remove any excess oil or dead skin, particularly after sweating.