Elle April 2018

Whether you're dealing with blackheads, whiteheads or the cystic, under-the-skin kind, spots can be debilitating to live with. You don't have to suffer though, because there is effective treatment.

I was recently interviewed by Jacqueline Kilikita on behalf of Elle Magazine to help readers decode some of the different acne treatments available. In the spirit of sharing, I thought I'd post the full answers to her questions below as they may be useful to anybody considering treatment for breakouts.

Remember, effective control of blemishes is not a one size fits all situation. If a treatment hasn't worked for someone else you know, it doesn't mean it won't work for you - and vice versa. When I am making a treatment plan for a new patient with acne in my clinic, there are a number of factors I take into consideration before prescribing a certain medication. This includes the types of spots you have, where they are on the body, if you are developing scarring or discolouration and what treatments you may already have tried. Sometimes a combination of treatments may be needed if they haven't worked alone.

If you are suffering with acne and would like effective treatment and skincare advice from someone who understands how it feels from personal experience, I'd love to help you. Click on the pink Contact button at the bottom of this blog post to get in touch.

Retinoid creams

Topical retinoids are derived from vitamin A and work by unclogging pores. They are the treatment of choice for blackheads and closed comedones, the small, stubborn skin-coloured bumps that often appear on the forehead and sides of the cheeks or jawline.

Topical retinoids also have direct anti-inflammatory effects and can be combined with other treatments, such as oral antibiotics, for treating more inflamed spots and maintaining results afterwards.

Side effects include include redness, dryness, itching and stinging. A good Consultant Dermatologist will give you tips on how to introduce these and which skincare products to combine them with to improve tolerability. Increased sensitivity to the sun means that treatment is usually applied at night and using a non-comedogenic (non pore-blocking) SPF in the morning is strongly recommended.

Benzoyl peroxide

Benzoyl peroxide works by killing the bacteria that cause acne. It can be applied regularly to help control ongoing breakouts and on an ad hoc basis to reduce flare-ups.

The main downside of benzoyl peroxide is that it can cause skin irritation, so you only need to apply a small amount to affected areas or redness and peeling are likely. It can also bleach your towels, clothing and bedsheets so be careful when and how you apply it and consider wearing an old T-shirt to bed if you are applying it to your back or chest.

Antibiotic lotions or gels

Topical antibiotics, such as erythromycin and clindamycin, are effective acne treatments but should not be used on their own wherever possible due to the risk of developing bacterial resistance. They can, however, be combined with benzoyl peroxide to reduce this risk and to improve results as they tackle bacteria in different ways.

Isotretinoin (Roaccutane)

Isotretinoin is an oral retinoid and the treatment of choice for severe or persistent acne associated with nodules or cysts, scarring or psychological distress and when other first-line treatments have failed.

It works by suppressing sebaceous gland activity, helps us to shed our dead skin cells more effectively to prevent blocked pores and also reduces inflammation and the growth of P. acnes, the bacteria implicated in acne development.

Isotretinoin is the most effective anti-acne treatment available, but does have some important side effects and may not be suitable for everyone. These include a high risk of birth defects, meaning that females must take careful steps to prevent pregnancy during treatment and close supervision by a Dermatologist experienced in prescribing the drug is mandatory.

Dry, cracked lips are common, blood tests must be done to monitor cholesterol and liver function, alcohol intake should be restricted and prolonged sun exposure must be avoided as there is a higher risk of getting a sunburn.


A medicine called spironolactone may also be helpful in some people by reducing the effects of testosterone on the skin. Prescription of this needs to be decided on as case by case basis by a Consultant Dermatologist, however, as it is licensed for the treatment of Polycystic Ovarian Syndrome (PCOS), not acne per se.

Spironolactone is often taken alongside the contraceptive pill as it can disrupt your menstrual cycle and it cannot be taken if you are planning a pregnancy due to potential effects on the developing baby. At higher doses, spironolactone is used as a diuretic so needing to pee more frequently is also possible at lower doses.

Spironolactone helps control spots in a third of people, reduces them in another third and has no effect on the final third.

Light and laser treatments

Although limited data has shown that laser or light treatments may improve acne in certain individuals, these are not recommended routinely as there is much less evidence of their benefits compared to prescription therapy when used for the wider population.

© 2018 Dr Justine Kluk. Any redistribution or reproduction of part or all of the contents of this post in any form is prohibited. You may not, except with our express written permission, copy, distribute or commercially exploit the content. Nor may you transmit it or store it in any other website or other form of electronic retrieval system.




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