Acne is treated by combining two things that work in different ways and giving them 12 weeks before judging them. Most people improve on treatment they can get from a doctor rather than a clinic. Scarring is prevented, not repaired. A 30 minute consultation is £150.
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Any of these needs to be seen the same day. If you are severely unwell, go to your nearest emergency department or call 999.
Acne is a disease of the oil gland and its hair follicle. Four things happen together, more oil, a blocked pore, bacteria that live normally on skin multiplying in that pore, and inflammation around it. Treatment works by acting on more than one of the four.NICE NG198, 2021
It is not a hygiene problem and it is not caused by being unclean. Washing more often makes it worse by stripping the skin, and this is the single most common thing people are doing wrong when they arrive.British Association of Dermatologists BAD guideline, 2021
Blackheads and whiteheads without inflammation are mild. Red spots and pustules are moderate. Deep tender nodules and cysts are severe, and severity decides the treatment rather than how much it bothers you, which is a separate and equally valid question.NICE NG198, 2021
Adult acne along the jaw and chin in women, with irregular periods or new facial hair, is worth a hormonal work up. Some medicines and some steroid use cause acne directly, and a new eruption within weeks of starting one is treated as that until proven otherwise.Journal of the American Academy of Dermatology AAD guideline, 2024
Send us what you are seeing and we will tell you what it is likely to be.
Acne is diagnosed by looking. The appointment grades it, counts the lesion types, records where the scarring is, and photographs it so the review at 12 weeks compares like with like rather than memory.NICE NG198, 2021
Blood tests are for the minority. Where periods are irregular, facial hair is new, or the acne came on suddenly in an adult woman, hormones and thyroid are checked. Otherwise a test adds nothing to what the examination already showed.Journal of the American Academy of Dermatology AAD guideline, 2024
Changing the routine
A non foaming wash twice a day, a light moisturiser, and a sunscreen. Stop scrubs, toners and anything alcohol based. This alone improves the skin of people who have been over treating it.British Association of Dermatologists BAD guideline, 2021
Topical benzoyl peroxide
Available without a prescription. Trials show it works and it causes dryness, redness and bleached towels. Used at a lower strength and built up slowly it is tolerated better than the strongest version bought first.Cochrane Database of Systematic Reviews Yang, 2020
A topical retinoid combined with an antibacterial
The usual first prescription. Two mechanisms together work better than either alone and combining them reduces resistance.NICE NG198, 2021
Oral antibiotic treatment, reviewed at 12 weeks
Used alongside a topical rather than on its own, and reviewed at 12 weeks rather than repeated indefinitely. Courses that run for a year without review are how resistance builds.NICE NG198, 2021
Hormonal treatment for women
The combined pill reduces acne lesion counts compared with placebo, and different preparations differ less from each other than people expect.Cochrane Database of Systematic Reviews Arowojolu, 2012
Checking whether the pill is suitable for you
Blood pressure, migraine with aura, smoking and age all decide whether a combined preparation can be used at all, and that is checked before it is offered rather than after.Faculty of Sexual and Reproductive Healthcare UKMEC, 2016
Referral for oral retinoid treatment
For severe acne, or for acne that is scarring, this is specialist prescribing with pregnancy prevention requirements and additional oversight from the regulator. We refer rather than prescribe it, and the referral is arranged rather than described.Medicines and Healthcare products Regulatory Agency MHRA drug safety update, 2024
Give any treatment 12 weeks before judging it. Skin often looks worse in the first 2 to 4 weeks as blocked pores clear, and that is the point most people stop. Nothing is changed before 12 weeks unless the skin cannot tolerate it.NICE NG198, 2021
Treatment maintains as well as clears. Stopping everything once the skin is clear is followed by relapse in most people, so a maintenance topical continues after the oral course ends.Journal of the American Academy of Dermatology AAD guideline, 2024
Scarring is the part that cannot be undone. Every month of untreated inflammatory acne is a month of scarring, and treating early is worth more than any procedure afterwards.Plastic and Reconstructive Surgery Mustoe, 2002
Photograph your face in the same daylight, straight on and both profiles, on the first of the month. Do it before you start anything. Skin changes too slowly to judge by memory and the 12 week comparison is what decides whether treatment continues.
Simplify the routine now and it costs nothing. One non foaming wash morning and night, one light moisturiser, one sunscreen. Stop scrubs, toners, alcohol based products and anything with more than 3 active ingredients. Two weeks of that alone settles a proportion of what people arrive with.British Association of Dermatologists BAD guideline, 2021
List everything you have tried with how long you gave it. Most people have tried the right treatment for the wrong length of time, and 4 weeks of the right thing reads as a failure when it was never given 12.NICE NG198, 2021
Do not buy a course of facials or peels while inflammatory acne is active. They treat the surface, they cost more than the treatment that works, and the scarring continues underneath while you have them.Plastic and Reconstructive Surgery Mustoe, 2002
Do not buy a food intolerance test to explain acne. There is no evidence behind it for this, and the diets people adopt on the strength of one are restrictive and unnecessary.
Do not accept a repeat oral antibiotic beyond 12 weeks without a review. It is the cheapest thing to keep issuing and it is the wrong thing to keep issuing, and saying so means fewer repeat appointments here.NICE NG198, 2021
Step 1
What type, how severe, where it is scarring, and what you have already tried and for how long.
Step 2
A prescription that acts on more than one part of the problem, with the routine simplified around it, and a clear instruction about what the first 4 weeks will look like.
Step 3
Against the photographs. If it has not worked the next step is decided then, including a referral where the acne is severe or scarring.
Ask before you book if you are not sure this is the right appointment.
Twelve weeks before it is judged. Skin often looks worse for the first 2 to 4 weeks as blocked pores clear, which is when most people give up. Nothing is changed before 12 weeks unless the skin cannot tolerate it, and the photographs are what make that call.
The evidence is weak and inconsistent. A high sugar diet may make it slightly worse in some people. Cutting out dairy or gluten on the strength of an intolerance test is restrictive, unnecessary and does not treat the disease, so the treatment comes first.
Sometimes, alongside a topical rather than on their own, and reviewed at 12 weeks rather than repeated. A course that runs for a year without review is how resistance builds, so the review is the part that matters more than the prescription.
No. Oral retinoid treatment is specialist prescribing with pregnancy prevention requirements and additional regulatory oversight. Where your acne is severe or scarring we say so, arrange the referral, and keep hold of the plan while you wait.
A 30 minute consultation is £150 and the 12 week review by telephone is £59. Where hormones need checking the Advanced panel is £650. A clinician skin consultation is £150. Prescriptions are dispensed and priced by the pharmacy, separately from the appointment.
Inflammatory acne scars while it is active, and that is the part no procedure fully repairs afterwards. Treating early is worth more than anything done later, which is why deep tender lumps are a reason to be seen rather than to wait and see.
No. Stripping the skin makes acne worse and it is the most common mistake people arrive having made. A light non comedogenic moisturiser alongside treatment is what makes a retinoid tolerable enough to keep using for 12 weeks.
This page is general information about a condition and it is not a diagnosis. Treatment depends on what a doctor finds when they examine you, and no outcome is guaranteed. If you are severely unwell, or if any of the warnings at the top of this page apply to you, go to your nearest emergency department or call 999.
British Association of Dermatologists
Guidelines for the management of acne vulgarisBAD guideline, 2021
Cochrane Database of Systematic Reviews
Combined oral contraceptive pills for treatment of acneArowojolu, 2012
Cochrane Database of Systematic Reviews
Topical benzoyl peroxide for acneYang, 2020
Faculty of Sexual and Reproductive Healthcare
UK medical eligibility criteria for contraceptive useUKMEC, 2016
Journal of the American Academy of Dermatology
Guidelines of care for the management of acne vulgarisAAD guideline, 2024
Medicines and Healthcare products Regulatory Agency
Isotretinoin, introduction of new safety measures including additional oversightMHRA drug safety update, 2024
NICE
Acne vulgaris, managementNG198, 2021
Plastic and Reconstructive Surgery
International clinical recommendations on scar managementMustoe, 2002
Written by the clinical team at The Wellness. Awaiting clinical sign off.
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