Acne treatment

Medical information

Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC & GPhC.

Acne is common, potentially distressing, but is usually treatable.

Many young people have some acne, usually lasting about 4-5 years, although acne is not uncommon in adults and can last longer. The face is the most commonly affected area, although it can also occur on the chest and back and less frequently on the buttocks and in other places.

Acne is often triggered by hormonal changes especially at puberty. Oil-producing glands in the skin are sensitive to hormone balance. Too much of the oily secretions (sebum), combined with shed skin cells, blocks pores and leads to acne.

Blackheads and whiteheads develop. The acne bacteria (cutibacterium acnes) grow in the blocked pores leading to inflammation, pustules, and cysts.

Severe acne with pustules, nodules, and scarring needs to be assessed with a doctor face-to-face and possible specialist referral.

Acne is not the same as rosacea, which sometimes appears similar, although there are no blackheads with pure rosacea.

Untreated, acne usually clears up without scarring. Acne can be treated with non-prescription skin preparations (creams, gels, and solutions) bought from chemists/pharmacies or alternatively with prescription skin (topical) preparations and prescription tablets/capsules, including antibiotics.

Acne treatment from Dr Fox

Dr Fox does NOT supply medicines for under 18s or 60 years and over.

Dr Fox is able to supply a range of prescription-only topical preparations (Differin, Zineryt, Duac, and Epiduo) and antibiotic capsules (lymecycline) for the treatment of acne. Some acne treatments are not available from Dr Fox, particularly isotretinoin (Roaccutane) and specialist contraceptive pills such as Dianette, Yasmin, Eloine, or Mercilon.

Treatment is usually stepwise, starting with lower strength topical preparations applied to the skin, moving on to combination topical preparations. Topical treatments should be continued if starting antibiotics (capsules or topical) as they continue to work alongside the antibiotic.

Dr Fox acne treatment plan

See a doctor face-to-face for diagnosis and advice before you start treatment.

Start at the step closest to your acne type. Try each step for 8-12 weeks before moving to the next step if acne is not improving. Apply skin treatments to all the affected skin, not just the spots.

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Step 1: Mild acne

Start with non-prescription benzoyl peroxide topical preparations bought from chemists/pharmacies without prescriptions. Apply every night. Topical benzoyl peroxide is not available from Dr Fox.

See NHS - Benzoyl peroxide.

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Step 2: Mainly blackheads

Stop other treatments. Apply Differin every night.

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Step 3: Blackheads and whiteheads

Stop other treatments.

• Option A: Swap to a combination treatment, either Epiduo or Duac every night.
• Option B: Try the other Step 3A treatment (either Epiduo or Duac every night).
• Option C: Zineryt solution twice daily.

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Step 4: Blackheads, whiteheads, inflammation, infection, pustules, and cysts

Add lymecycline capsules in the mornings and continue to use Epiduo (but not Duac or Zineryt) at night.

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Step 5: Active scarring (especially in skin of colour), severe distress

Consult your own GP without delaying. Further options include contraceptive pills (for women) and referral to a specialist dermatologist to consider Roaccutane (isotretinoin) capsule treatment.

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When to stop treatment

If oral antibiotic capsules (lymecycline) or topical antibiotics (Zineryt, Duac) are used long-term, bacteria may possibly build-up resistance, and treatment can become less effective. Dr Fox doctors are likely to decline orders for repeats of topical antibiotics beyond 3 months and lymecycline beyond 6 months following current dermatology guidance.

Once acne clears up, usually after 4-6 months, try stopping treatment. It can always be restarted if the acne comes back.

Ordering online

You must read the manufacturer's 'patient information leaflets' (links below) before ordering.

You will need to complete a short medical questionnaire before ordering.

Sometimes different topical preparations contain the same active ingredients. Some topical preparations contain two active ingredients. You should not usually use more than one topical treatment at the same time, without discussing this with a doctor.

• Differin - retinoid
• Epiduo - retinoid with peeling agent (benzoyl peroxide)
• Zineryt - antibiotic
• Duac - antibiotic with peeling agent (benzoyl peroxide)

Antibiotic capsules (e.g. lymecycline) should be taken whilst continuing to use topical Differin, and Epiduo, but should NOT be taken whilst using Zineryt or Duac (topical antibiotics).

Multiple ordering

After the consultation you can choose your order option, although it is not possible to order more than one item per consultation. This is for medical reasons as above.

If more than one item is required, a separate questionnaire must be completed for each item.

If more than one item has been ordered, you should message the doctors from your account to explain why.

If the doctors approve more than one item, email info@doctorfox.co.uk or message from your account and we will refund additional postage and consultation fees.

Declined orders are automatically refunded.

Diagnosis of acne

It is important that people obtaining treatment online for acne have previously seen a doctor about it. There are other causes of spots and rashes apart from acne. These other skin problems might require investigations, and might not respond to acne treatment. In some rare cases acne is associated with hormonal disturbance requiring investigation. This is rare. Women with acne and facial hirsutism, and irregular periods should be checked for polycystic ovaries.

How long to use treatment

Creams, solutions, or gels and antibiotic capsules for acne take time before they start to work, usually at least 8 weeks and sometimes up to 4 months. It is best to use one new treatment at a time, and allow 8 weeks of continuous treatment before switching to, or adding a new one. If a treatment works well, stick with it.

The best response to treatment is usually seen after 3 to 6 months. If acne has completely gone or is very much improved after 3 to 6 months, treatment should be stopped. Treatment may need to be restarted if the acne comes back. Sometimes long-term maintenance treatment may be needed, possibly with lower or less frequent amounts being required.

If antibiotic capsules (lymecycline) or topical antibiotics (Zineryt, Duac) are used long-term, bacteria may build-up resistance, and treatment can become less effective. Topical antibiotics should be stopped after 3 months. Lymecycline can be used for 3 months continuing to 6 months if acne has not yet completely cleared, but then a break of at least 3 months is recommended.

If there is no improvement or a worsening of acne after 8 weeks, a different treatment can be tried, or a new acne treatment can be added.

What else can help improve acne?

• Avoid oil based cosmetics and hair products/pomades.
• Remove all makeup at night.
• Use a neutral or slightly acid skin cleanser twice daily, but do not clean skin excessively.
• Do not pick and scratch spots as it leads to scarring.
• UV light can be of help, preferably sunlight filtered through window glass.
• Some people find improvement by following a low-glycaemic diet.
  • Increasing the consumption of whole grains, fresh fruits and vegetables, fish, olive oil, garlic.
  • Decreasing the consumption of high-glycaemic index foods such as sugar, biscuits, cakes, ice creams, and bottled drinks.
• Stop smoking.
• Avoid humid conditions, e.g saunas, tropical holidays, working in hot steamy kitchens.

Some medications can cause or aggravate acne. These include:

• Lithium
• Ciclosporin
• Topical and oral corticosteroids
• Phenytoin and carbamazepine
• Isoniazid
• Progesterone in female contraceptives
• Vitamin B1, B6, and B12
• Anabolic steroids
• Iodides taken orally, which may be part of some homoeopathic therapies.

Consult your GP before stopping prescribed medications.

Treatments available from Dr Fox for acne

Differin - topical retinoid

Retinoids are good at unplugging blocked pores. They can cause irritation particularly at the start of treatment. Irritation can be reduced by starting treatment on alternate days, and building up to the prescribed dose as tolerated.

Differin comes as a gel or a cream containing the retinoid, adapalene. It is applied to the skin once daily, usually at night. See the manufacturer's 'patient information leaflet' of Differin Gel and Differin Cream for details, including how to use, side effects and cautions.

Differin Gel Patient Leaflet
Differin Cream Patient Leaflet

Epiduo - combination topical treatment

Can cause irritation particularly at the start of treatment. Irritation can be reduced by starting treatment on alternate days, and building up to the prescribed dose as tolerated.

Epiduo is a gel containing the retinoid adapalene combined with peeling agent benzoyl peroxide, 2.5%. It is applied once daily. See the manufacturer's 'patient information leaflet' for details, including how to use, side effects, and cautions.

Epiduo Gel Patient Leaflet

Zineryt & Duac - topical antibiotics for acne

Acne is associated with infection of the skin which can be reduced by applying creams, lotions or gels which contain antibiotics. Topical antibiotics should NOT be used at the same time as taking antibiotic capsules (lymecycline).

Topical antibiotics are not normally recommended for more than 3 months at a time because antibiotic resistance could build-up, although Zineryt and Duac are less prone to antibiotic resistance than other topical antibiotics.

Zineryt contains the antibiotic erythromycin in solution. It is usually applied twice daily. See the manufacturer's patient information leaflet of Zineryt for details, including how to use, side effects, and cautions.
Zineryt Patient Leaflet

Duac is a gel which contains the antibiotic clindamycin combined with peeling agent benzoyl peroxide. See the manufacturer's 'patient information leaflet' for details, including how to use, side effects, and cautions.
Duac Gel 3% Patient Leaflet

Lymecycline 408mg - antibiotic capsules for acne

Lymecycline 408mg capsules contain a tetracycline-type antibiotic which also has anti-inflammatory effects. The dose used to treat acne is usually one capsule daily. A non-antibiotic topical treatment, Differin, Epiduo, or benzoyl peroxide should be continued whilst taking lymecycline and lymecycline should not normally be taken continuously for more than 6 months to help prevent the development of antibiotic resistance.

Lymecycline should NOT be taken whilst using Zineryt or Duac (topical antibiotics).

See the manufacturer's 'patient information leaflet' of Lymecycline 408mg for details, including how to use, side effects and cautions.

Lymecycline 408mg Patient Leaflet

Acne treatments compared

Product	Form	How many times a day?	Dr Fox treatment plan	Type of treatment	Active ingredient(s)
Differin	Gel/cream	Once	Step 2	Retinoid	Adapalene
Epiduo	Gel	Once	Step 3	Retinoid and peeling agent	Adapalene, benzoyl peroxide
Duac	Gel	Once	Step 3	Antibiotic and peeling agent	Clindamycin, benzoyl peroxide
Zineryt	Lotion	Twice	Step 3	Antibiotic	Erythromycin, zinc
Lymecycline	Capsules	Once	Step 4	Antibiotic	Lymecycline

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Antibiotic guardianship

To combat antibiotic resistance please:

• Only use antibiotics when needed
• Never share antibiotics
• Always complete course as instructed
• Take unused medicine to local pharmacy for disposal

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Buy treatment

Dr Fox supplies acne treatment on prescription - you are required to answer a short medical questionnaire before your order can be completed.

1. Medical questions
2. Choose treatment
3. Complete order

Answer medical questions to order(acne)

Honest & accurate responses are necessary for safe medical assessment