The Complete Acne Guide
Everything that actually works for acne, following UK clinical guidelines, written by a pharmacist and independent prescriber.
Based on NICE NG198 and British Association of Dermatologists guidance
Understanding Your Acne
Learn what causes acne, the different types, and how to assess severity.
What Causes Acne?
Acne develops when four key factors come together:
Excess oil production
Your skin produces too much oil, often triggered by hormones
Blocked pores
Dead skin cells don't shed properly and clog pores
Bacteria
Bacteria multiply in clogged pores, causing inflammation
Inflammation
Your body's immune response creates redness and swelling
Types of Acne
Non-Inflammatory
Open pores that look dark due to oxidation
Closed pores that appear as small white bumps
Inflammatory
Small, red, tender bumps without pus
Red bumps with white/yellow pus at centre
Deep, painful lumps with highest scarring risk
How Serious Is My Acne?
Mild to Moderate
Any blackheads/whiteheads, up to 34 red bumps. Often responds well to over-the-counter treatments.
Moderate to Severe
35+ red bumps, nodules/cysts present, or scarring developing. May need prescription treatment.
Evidence-Based Treatments
Recommended treatments including over-the-counter and prescription options.
Benzoyl Peroxide (2.5-10%)
Gold StandardKills bacteria, reduces inflammation, and helps unclog pores. Start with 2.5% to minimise irritation, apply once daily.
Bleaches fabric — use white towels and pillowcases!
Adapalene (Retinoid) 0.1%
RecommendedPrescription only in the UK, usually combined with benzoyl peroxide. Normalises skin cell turnover and prevents clogged pores. Start 2-3x weekly at night, use a pea-sized amount. Expect some dryness initially.
Not safe during pregnancy. You must use SPF daily as it increases sun sensitivity.
Salicylic Acid 0.5-2%
Exfoliates inside pores and dissolves oil. Best for blackheads, whiteheads, and oily skin. Can be used daily long-term.
Azelaic Acid 10-20%
Antibacterial and anti-inflammatory, also fades dark marks. Well-tolerated and safe in pregnancy.
Niacinamide 2-10%
Reduces oil production and inflammation. Very well-tolerated and pairs nicely with most other actives.
Alpha Hydroxy Acids (AHAs)
Surface exfoliation that improves texture and mild dark marks. Start with lower strengths.
Building Your Routine
Morning and evening routines with evidence-based active ingredients.
Golden Rules
- Introduce only one new active at a time
- Wait 4-6 weeks before adding another product
- SPF is non-negotiable when using any active
- Even oily skin needs moisturiser
Morning
- 1. Gentle, fragrance-free cleanser
- 2. Niacinamide or Azelaic Acid serum (optional)
- 3. Lightweight, non-comedogenic moisturiser
- 4. SPF 30-50 (essential!)
Evening
- 1. Double cleanse if wearing SPF/makeup
- 2. Treatment (Benzoyl Peroxide OR Adapalene)
- 3. Wait 10-15 minutes for treatment to absorb
- 4. Moisturiser (be generous if skin feels dry)
Recommended First-Line Approaches
For Mild-Moderate: Adapalene 0.1% + Benzoyl Peroxide 2.5% combination (e.g., Differin + Acnecide) OR Benzoyl Peroxide + Azelaic Acid
For Moderate-Severe: Consider speaking with your GP or a dermatologist about prescription options
When to Seek Prescription Help
Signs you need professional help and what treatments are available.
Important Note
Prescription acne treatments require assessment by a qualified prescriber such as your GP or a dermatologist. The information below is for educational purposes to help you understand what options may be available.
When to Seek Professional Help
- • Moderate-severe acne not responding to over-the-counter products after 12 weeks of consistent use
- • Nodules or cysts present (deep, painful lumps)
- • Acne causing scarring
- • Significant impact on your mental health or confidence
- • You suspect hormonal acne (jawline breakouts, related to periods)
Common Prescription Options
Topical Antibiotics
Clindamycin or erythromycin — always prescribed with benzoyl peroxide to prevent bacteria becoming resistant
Oral Antibiotics
Lymecycline or doxycycline — typically 3-month courses. You should see improvement within 6-8 weeks
Combined Oral Contraceptives
For hormonal acne in women — options include Dianette, Yasmin. Takes 3-4 months to see improvement
Isotretinoin (Roaccutane)
Dermatologist-only prescription for severe or scarring acne. Very effective but requires careful monitoring
How to Access Prescription Treatment
- • Your GP: Can prescribe most acne treatments and refer to dermatology if needed
- • NHS Dermatologist: Referral via GP for severe or persistent acne
- • Private Dermatologist: Faster access, typically £150-300 for initial consultation
Think you need prescription treatment?
Book a 30 minute online consultation. As an independent prescriber I can assess your acne, advise on the right treatment route, and tell you honestly if you need a GP or dermatology referral. £45.
Common Mistakes to Avoid
Pitfalls that can delay progress or make acne worse.
Avoid these common pitfalls that can make acne worse or delay your results.
Giving up too soon
Treatments take 6-8 weeks minimum. Full results often take 12 weeks. Don't give up after 2-3 weeks!
Using too many products at once
Start ONE active ingredient at a time. Wait 4-6 weeks before adding another to know what's working
Over-cleansing or harsh scrubbing
Stick to gentle, pH-balanced cleanser twice daily. Over-washing damages your skin barrier
Skipping moisturiser because skin is oily
Dehydrated skin produces MORE oil. Use a lightweight, non-comedogenic moisturiser
Not using SPF with actives
SPF 30+ daily is essential with retinoids/acids — sun damage worsens marks and irritation
Picking and squeezing spots
This causes scarring and spreads bacteria. Use hydrocolloid patches instead if tempted
Using antibiotics alone
Antibiotics should always be combined with topical treatments to prevent resistance
Your 12-Week Action Plan
A structured approach to introducing treatments and tracking progress.
A structured approach to introducing treatments and tracking your progress.
Foundation
- Establish gentle cleansing routine (morning and evening)
- Add non-comedogenic moisturiser
- Start daily SPF 30+
- Take baseline photos for comparison
First Active
- Choose ONE: benzoyl peroxide, azelaic acid, OR adapalene
- Start slowly (2-3x weekly for retinoid, daily for benzoyl peroxide)
- Monitor for irritation and adjust if needed
Assess & Adjust
- Review your tracking — notice any patterns?
- Compare progress photos
- If improving, continue! If not, increase frequency of active
Evaluate Progress
- You should see noticeable improvement by now
- If seeing improvement, continue with maintenance
- If not adequately improved, seek professional consultation
Purging vs Bad Reactions
How to tell if your skin is adjusting or if a product isn't right for you.
Normal Purging
- • Only happens with cell-turnover actives (retinoids, AHAs, BHAs)
- • Breakouts in your usual problem areas
- • Small, surface-level spots that heal faster than usual
- • Improves within 4-6 weeks
- • May have mild dryness or peeling (especially retinoids)
Bad Reaction — Stop Product
- • Breakouts in new areas where you don't normally get spots
- • Painful cysts or deep nodules
- • Severe burning, stinging, or itching
- • Excessive dryness, cracking, or peeling
- • Gets worse after 6-8 weeks
How Long Does Purging Last?
• Retinoids: 4-8 weeks, sometimes up to 12
• Benzoyl peroxide: 2-4 weeks
• Salicylic acid: 2-3 weeks
• Azelaic acid: 2-4 weeks
If in doubt: Stop the product and see if your skin improves within 1-2 weeks. If purging continues beyond 8 weeks or worsens, consult a healthcare professional.
Treating Scars & Marks
Understanding PIE, PIH, and permanent scarring — and what helps.
After acne heals, you may be left with marks. Understanding the difference between temporary marks and permanent scars is key to choosing the right treatment.
PIE (Post-Inflammatory Erythema) — Red/Pink Marks
Caused by damaged blood vessels beneath the skin. More common in lighter skin tones. Can take 3-12 months to fade naturally.
What helps: Azelaic acid, niacinamide, vitamin C, SPF, and time
PIH (Post-Inflammatory Hyperpigmentation) — Dark Marks
Caused by excess melanin production after inflammation. More common in medium to darker skin tones. Can take 6-24 months to fade. Sun exposure makes it worse!
What helps: Vitamin C, azelaic acid, tranexamic acid, retinoids, and SPF is CRITICAL
Atrophic Scars (Indented/Pitted)
Ice pick, boxcar, and rolling scars from collagen loss. These cannot be fixed with skincare products alone.
Professional options: Microneedling (£150-400/session), TCA CROSS (£100-300/session), laser resurfacing (£400-1500+), subcision. Expect 50-70% improvement with multiple sessions.
Most important step: Daily SPF 30+ is essential. UV exposure darkens existing marks and prevents them from fading. Nothing else will work without sun protection!
Layering Actives Safely
Which ingredients can be used together and what to keep separate.
Once you've introduced actives one at a time and your skin has adjusted, you can combine them strategically. Never introduce multiple new products at once.
Safe Combinations
- • Niacinamide + almost anything (very versatile)
- • Hyaluronic acid + anything
- • Benzoyl peroxide AM + Retinoid PM (different times of day)
- • Azelaic acid + Niacinamide
- • Azelaic acid AM + Retinoid PM
Avoid Together (Same Routine)
- • Retinoids + AHAs/BHAs (too irritating together)
- • Benzoyl peroxide + Vitamin C (BP deactivates vitamin C)
- • Multiple strong acids at once
- • Retinoids + Benzoyl peroxide at the same time
Sample Advanced Routine (After 3+ Months)
Morning:
1. Gentle cleanser
2. Vitamin C or Azelaic Acid
3. Niacinamide (optional)
4. Moisturiser
5. SPF 30+
Evening:
1. Gentle cleanser
2. Wait 5 mins for skin to dry
3. Retinoid OR Benzoyl Peroxide
4. Wait 10-15 mins
5. Moisturiser
Tip: When in doubt, alternate nights or use one product in the morning and one in the evening.
Emergency Spot Treatment
Quick fixes for sudden breakouts before important events.
For a Red, Angry Spot
- 1. Ice wrapped in cloth for 10 mins on, 10 mins off, repeat 2-3x — reduces swelling
- 2. Benzoyl peroxide 2.5-5% spot treatment — leave on overnight
- 3. Hydrocolloid patch overnight — absorbs fluid and protects from picking
For a Cyst or Deep Nodule
- 1. Do NOT squeeze — this makes it worse and causes scarring
- 2. Warm compress to help draw it out
- 3. For urgent events, a dermatologist can do a cortisone injection
Covering a Spot with Makeup
- • Apply hydrocolloid patch first if possible, then makeup over top
- • Use green colour corrector for redness, then concealer
- • Pat gently, don't rub
- • Use non-comedogenic products only
What DOESN'T Work (Despite What You See Online)
- ❌ Toothpaste — too harsh, can cause burns
- ❌ Lemon juice — causes irritation and pigmentation
- ❌ Baking soda — disrupts skin pH
- ❌ Tea tree oil undiluted — can cause severe irritation
- ❌ Picking/squeezing — causes scarring and spreads bacteria
Realistic expectations: Nothing makes a spot disappear overnight. These methods reduce redness, size, and pain. Prevention with a consistent routine is always better than emergency treatment.
Pregnancy-Safe Options
Safe acne treatments during pregnancy according to UK guidelines.
Safe Options During Pregnancy
Azelaic Acid (10-20%)
First-line treatment for pregnancy acne. Minimal absorption, excellent for both acne and pigmentation.
Benzoyl Peroxide (2.5-5%)
Limited absorption through skin, generally considered safe. Use lower strengths.
Niacinamide
Vitamin B3 derivative, safe to use morning and evening.
Gentle cleansing + moisturising
Fragrance-free, gentle cleansers and non-comedogenic moisturisers.
AVOID During Pregnancy
- ❌ ALL retinoids (adapalene, tretinoin, isotretinoin) — can cause birth defects
- ❌ Oral tetracyclines (doxycycline, lymecycline)
- ❌ Salicylic acid above 2% (low concentrations may be okay — ask your GP)
- ❌ Spironolactone — affects fetal development
Sample Pregnancy-Safe Routine
Morning:
1. Gentle cleanser
2. Azelaic acid 15-20%
3. Niacinamide serum
4. Moisturiser
5. SPF 30+
Evening:
1. Gentle cleanser
2. Benzoyl peroxide 2.5-5%
3. Moisturiser
Important: Always tell your GP or midwife about any skincare products you're using during pregnancy.
Body Acne
Treating acne on your back, chest, and shoulders.
Why Body Acne Is Different
- • Thicker skin needs higher concentrations or wash-off products
- • Friction from clothing, backpacks, bra straps can worsen it
- • Sweat and heat get trapped under clothes
- • Harder to reach for applying products
Benzoyl Peroxide Wash (Most Effective)
Apply to damp skin, leave on for 3-5 minutes (this is key!), then rinse. Use 3-4x weekly. UK options: Acnecide 5% Wash, PanOxyl 4% or 10% Wash.
Salicylic Acid Body Wash
Use daily or alternate with benzoyl peroxide. CeraVe SA Smoothing Cleanser or Neutrogena Body Clear are good options.
Salicylic Acid Sprays
Easier to reach your back! Neutrogena Body Clear Spray is a good UK option.
Lifestyle Tips
- • Shower immediately after sweating or exercise
- • Wear loose, breathable fabrics (cotton)
- • Change bed sheets weekly
- • Wash gym clothes after EVERY use
- • Sports bras: moisture-wicking fabric, wash after each wear
- • Avoid tight backpack straps
See your GP if: Severe or painful cysts on back/chest, no improvement after 12 weeks of consistent treatment, or scarring developing.
Hormonal Acne & PCOS
Understanding and treating hormone-related breakouts.
Signs of Hormonal Acne
- • Breakouts along jawline, chin, and lower cheeks
- • Flares 7-10 days before your period
- • Deep, painful cysts rather than surface whiteheads
- • Persists past age 25
- • Doesn't respond well to standard acne treatments
Signs of PCOS (Beyond Acne)
- • Irregular periods (more than 35 days between periods)
- • Excess hair growth on face, chest, or back
- • Hair thinning on scalp
- • Weight gain, difficulty losing weight
- • Darkening skin on neck, armpits, or groin
Over-the-Counter Approach
- • Topical treatments still help: Adapalene + benzoyl peroxide
- • Azelaic acid is excellent for hormonal acne
- • Niacinamide reduces inflammation and oil
Prescription Options (UK)
- • Combined Oral Contraceptive (COCP) - Recommended for hormonal acne in women. Takes 3-4 months to see improvement.
- • Spironolactone - Anti-androgen medication used off-label. Takes 3-6 months for full effect. NOT safe in pregnancy.
When to see your GP: Suspected PCOS, hormonal acne not responding to topical treatments, or if you're considering prescription options.
Makeup Tips
Choosing products that won't worsen your acne.
What to Look For
- • "Non-comedogenic" on the label — won't clog pores
- • "Oil-free" for foundations and concealers
- • Mineral makeup — often better tolerated
- • Water-based formulas
Application Tips
- • Clean brushes and sponges weekly — bacteria builds up
- • Use a separate brush for concealing active spots
- • Don't share makeup with others
- • Remove ALL makeup before bed — every night
- • Use oil-free makeup remover or micellar water
Avoid
- • Heavy, oil-based foundations
- • Old/expired makeup — bacteria grows over time
- • Sharing makeup
- • Sleeping in makeup — EVER
If you're breaking out: Try going makeup-free for 2 weeks to see if it helps. Simplify to just SPF + concealer on spots only.
Mental Health & Support
The emotional impact of acne and where to get help.
You're Not Alone
- • It's the 8th most common condition worldwide
- • Adult acne (25+) is increasingly common, especially in women
When to Seek Help
- • Acne is significantly affecting your daily life
- • You're avoiding social situations because of your skin
- • You feel depressed or anxious
- • You're picking or scratching excessively
- • Suicidal thoughts — seek help immediately
UK Mental Health Resources
- • Your GP — can refer you for counselling or CBT on the NHS
- • IAPT services — you can self-refer for free NHS talking therapies
- • Samaritans: 116 123 (24/7, free, confidential)
- • Mind: Mental health charity with resources and helplines
Coping Strategies
- • Remember: Most people notice your acne far less than you do
- • Focus on what you CAN control (routine, sleep, stress)
- • Don't compare yourself to filtered social media
- • Talk to someone you trust
- • Consider therapy — CBT is particularly helpful
Note: If you're on isotretinoin (Roaccutane) report any mood changes to your prescriber immediately.
Diet & Lifestyle
What research says about diet and practical lifestyle tips.
UK guidelines say there's not enough evidence to recommend specific diets for acne. However, some research suggests potential links that may be worth exploring.
What Research Suggests
- High-glycaemic foods (white bread, pasta, sugary foods, white rice)
Some studies show a link with acne — these cause blood sugar spikes
- Dairy products (especially skimmed milk)
Mixed evidence — may be worth tracking if you consume a lot of dairy
What We CAN Recommend
- • Track your triggers — keep a food diary alongside your breakout log to spot patterns personal to YOU
- • Stay hydrated — drink plenty of water
- • Balanced diet — plenty of vegetables, fruits, and whole foods
- • Don't stress about food — diet is just one small factor
Free/Low-Cost Lifestyle Improvements
- • Change pillowcases weekly (have 2-3 sets)
- • Clean your phone screen regularly
- • Don't touch your face
- • Sleep 7-9 hours
- • Manage stress (free meditation apps available)
- • Exercise regularly (shower straight after)
Bottom line: While we can't make definitive dietary recommendations, tracking your diet alongside breakouts can help YOU identify personal triggers. But remember — skincare routine is far more important than diet for most people.
Budget-Friendly Routines
Effective UK pharmacy products that won't break the bank.
Effective skincare doesn't have to be expensive. Here's how to build a routine on a tight budget.
Minimum Effective Routine (~£19/month)
UK Product Recommendations by Category
Treatment: benzoyl peroxide
First-line in NICE NG198. Kills C. acnes without resistance.
- Acnecide 5% GelPharmacy medicine. Start every other day.
- Acnecide Wash 5%Good for body acne and very oily skin.
Treatment: azelaic acid
Alternative first-line in NICE NG198. Also fades dark marks. Safe in pregnancy.
- The Ordinary Azelaic Acid Suspension 10%Once daily, can be used with benzoyl peroxide on alternate days.
Cleanser: salicylic acid
Helps unblock pores. Useful alongside a treatment, not a replacement for one.
- CeraVe Blemish Control Cleanser2% salicylic acid with niacinamide.
- La Roche-Posay Effaclar Purifying Foaming GelGentler option for combination skin.
Support: niacinamide
Reduces sebum and inflammation at 2% to 5%. Pairs with everything.
- The Ordinary Niacinamide 10% + Zinc 1%Morning or evening. Mix into moisturiser if 10% tingles.
Moisturiser: non-comedogenic
Reduces irritation from actives so you can stay on treatment. Adherence is what clears acne.
- CeraVe Moisturising LotionCeramides, fragrance-free.
- Simple Kind to Skin Light MoisturiserBudget option, fragrance-free.
SPF: broad spectrum, oil-free
Essential with retinoids and benzoyl peroxide, and the main way to stop marks darkening.
- Altruist Face Fluid SPF 50Dermatologist-founded, very good value.
- La Roche-Posay Anthelios UVMune 400 Oil Control SPF 50+Matte finish for oily skin.
Adapalene (Differin) is prescription only in the UK and is not sold over the counter. Ask about a prescription if benzoyl peroxide alone is not enough after 12 weeks. Most products above are also stocked by Boots and Superdrug, often on 3-for-2. Links marked "affiliate" may earn us a small commission at no extra cost to you.
Money-Saving Tips
- • Buy larger sizes when on offer (Boots/Superdrug have frequent 3-for-2)
- • Check Boots Advantage Card deals
- • Amazon Subscribe & Save (5-15% off)
- • The Ordinary — affordable, effective actives
What You DON'T Need
- • Toners (usually unnecessary)
- • Multiple serums
- • Eye creams (use your regular moisturiser)
- • Expensive cleansers (they all wash off!)
- • Face mists or sheet masks
Realistic Timeline
What to expect week by week when starting treatment.
What "Clear" Actually Means
- • Not zero spots forever — that's unrealistic
- • 90%+ improvement from your baseline
- • Occasional spot (especially hormonal) is normal
- • Manageable with a maintenance routine
Why Treatment Sometimes Fails
- • Not giving it enough time (stopping before 12wks)
- • Inconsistent application
- • Wrong product for your acne type
- • Not addressing all factors (stress, hormones)
Remember
- • Progress isn't linear. You'll have good and bad days
- • Hormonal flares stress induced breakouts are normal!
- • Take progress photos monthly. Daily checking makes it hard to see change
- • Be patient. Be consistent. Trust the process. 💜
Need personalised advice?
Book a consultation to discuss your skin concerns with a GPhC-registered pharmacist.