Acne management

Author: Dr Amanda Oakley, Dermatologist, Hamilton, New Zealand, 1999. Reviewed and updated by Dr Amanda Oakley; Vanessa Ngan, Staff Writer, February 2014.


How is acne treated?

Treatment of acne depends on its severity – mild, moderate or severe.

General principles of treatment

  • Acne can be effectively treated, although response may sometimes be slow.
  • Where possible, avoid excessively humid conditions such as a sauna, working in an unventilated kitchen or tropical vacations.
  • Consider a low-glycaemic, low-protein and low-dairy diet (note that the evidence that this helps is weak). Avoid protein or amino acid supplements, particularly if they contain leucine. Eat plenty of fresh fruit and vegetables.
  • If you smoke, stop. Nicotine increases sebum retention and increased scale within the follicles, forming comedones (blackheads and whiteheads).
  • Minimise the application of oils and cosmetics to the affected skin.
  • Abrasive skin treatments can aggravate both comedones and inflammatory lesions.
  • Try not to scratch or pick the spots.
  • Exposure to sunlight filtered through window glass can help – see information about lasers, lights and acne. To avoid sunburn, protect your skin outdoors using a sunscreen and protective clothing.
Acne affecting the back

Management of mild acne

Most patients with mild acne can be treated with topical treatment (gels, solutions and lotions) that can be obtained over-the-counter in New Zealand without prescription. Most people just use topical agents for facial skin as they can be difficult to apply to one's back. Extra vitamins and minerals have not been proved to help.

  • Wash affected areas twice daily with a mild cleanser and water or an antiseptic wash.
  • Acne products should be applied to all areas affected by acne, rather than just put on individual spots.
  • A thin smear should only be applied to dry clean skin at nighttime.
  • Acne products may work better if applied in the morning as well.
  • They often cause dryness particularly in the first 2–4 weeks of use. This is partly how they work. The skin usually adjusts to this.
  • Apply an oil-free moisturiser only if the affected skin is obviously peeling.
  • Avoid applying oily cosmetics such as foundation or sunscreen.
  • It may take several weeks or even months to see convincing improvement.
  • Discontinue using product if severe irritation results. See your doctor for advice.

Suitable topical agents for mild acne that can be obtained without prescription include:

  • Antiseptic washes with triclosan or benoyl peroxide (Acnederm wash™, Benzac™ AC Wash, Dalacin™ T Prewash, Oxy™ Daily Skin Wash)
  • Mild salicylic acid preparations to exfoliate and unplug the follicles (Neutrogena® Oil-free Acne Wash and many others)
  • Benzoyl peroxide cream/lotion/gel (PanOxyl™ Acne Gel, Brevoxyl™ Cream, Oxy-10™, Clearasil™ Ultra Acne Cream, Benzac AC Gel)
  • Azelaic acid (Skinoren™ cream, Acnederm™ medicated lotion, Azclear™ Action Lotion)
  • Hydrogen peroxide in stabilised cream (Crystacide®, Crystaderm™)
  • Immune defence proteins (Epiology®)
  • Tea tree oil, bee venom, polyphenols and other products for which evidence of efficacy is limited.

Topical agents for mild acne which require prescription include:

  • Antibiotics, such as clindamycin solution (Topicil™, ClindaTech™) or erythromycin solution (Stiemycin™) and gel (Eryacne™), which are best used with benzoyl peroxide or azelaic acid to reduce the chance of antibiotic resistance
  • Retinoids i.e. tretinoin (ReTrieve™, Retin-A™), isotretinoin (Isotrex™), adapalene (Differin™); in some countries, adapalene is available without prescription.

Combination prescription topicals include clindamycin / benzoyl peroxide (Duac™) and adapalene/benzoyl peroxide gel (Epiduo™).

Lights and lasers including blue light have been found to be safe and helpful for mild to moderate acne when oral medications are unhelpful or unsuitable.

See your doctor or dermatologist for advice if your pimples fail to clear up within six weeks or you have severe acne.

Management of moderately severe acne

Treatment for moderately severe acne usually includes the topical agents described above. In addition, oral medication may be prescribed, usually for at least 3–6 months.

Suitable oral medications include:

When oral antibiotics are discontinued, control should be maintained long term by continuing topical therapy.

Management of severe acne

Treatment for severe acne requires oral treatment. Patients should be under the care of a dermatologist.

Many patients will be treated with oral isotretinoin.

The following may also be prescribed:

Physical treatments for acne

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