Tackling Acne: What causes it and what actually helps
- 9 hours ago
- 5 min read
Around 95% of people will experience acne in some form during their lifetime. It's most common during the teenage years and early adulthood, though it can affect people well beyond their teens too.
Persistent or severe acne isn't something you simply have to put up with. Effective treatments exist, and getting advice early can make a real difference, especially if your skin is beginning to scar or acne is knocking your confidence.
Your GP is a good place to start. They can assess your skin, talk through how it's affecting you and recommend or prescribe treatment, then review how well it's working. If needed, they can refer you to a dermatologist to explore further options.
What causes acne?
Acne develops in the hair follicles and the sebaceous glands attached to them, which produce the natural oils that protect our skin.
When these glands become blocked and inflamed, bacteria that normally live harmlessly on our skin can add to the inflammation. That's what leads to the redness, soreness and pus-filled spots most people associate with acne.
Severity varies widely, from blackheads and whiteheads through to larger, painful, inflamed spots. In more severe cases, it can lead to permanent scarring.
The myth of dirty skin
Acne isn't caused by poor hygiene. That dark colour in a blackhead isn't dirt, it's what happens when material within the blocked follicle is exposed to air and oxidises.
Repeatedly washing or scrubbing your skin won't clear acne. If anything, harsh products or over-treating your skin tends to leave it irritated and sore.
Who gets acne?
Acne is most common among teenagers and young adults, but it doesn't necessarily disappear once your teenage years are behind you. For some people it persists into their 20s, 30s and even 40s.
Whatever your age, if it's persistent, causing scarring or affecting how you feel, it's worth seeking advice.
The impact goes beyond the skin
Acne often develops during the teenage years and early adulthood, a time when confidence and self-esteem can already feel fragile. For some people it affects how they feel about socialising, going to school or work, playing sport or swimming. Acne on the chest or back can make changing in front of others uncomfortable, and visible facial acne can knock confidence hard.
If it's affecting your mood or the things you feel able to do, that's reason enough to ask for help. You don't need to wait for it to become severe.
How your GP can help
There isn't one treatment that works for everyone. Your GP will take into account your skin, how severe your acne is, what you've already tried and the impact it's having on you.
Treatment usually starts with something applied directly to the skin, such as benzoyl peroxide, topical antibiotics or a topical retinoid like adapalene. Retinoids can work well, but they can also cause dryness, redness and irritation, particularly when you first start using them, and they make your skin more sensitive to sunlight, so it's worth following the advice you're given closely.
Oral antibiotics such as lymecycline are sometimes recommended too. When they're used for acne, it's usually for their anti-inflammatory effect rather than because acne is a straightforward infection.
Treatments can take time to work, so your GP will review your progress and adjust things where needed. If your acne might benefit from specialist input, they can refer you to a dermatologist, where isotretinoin (Roaccutane) is one of the options that could be discussed.
When might you be referred to a dermatologist?
Your GP may suggest a referral if your acne is severe, beginning to scar, or hasn't responded well to other treatments.
A dermatologist can look at your acne in more detail and talk through the specialist options available. This matters most once scarring starts, because treating the underlying acne won't undo a scar that's already formed. Getting acne under control early is what helps prevent further scarring.
One of the treatments a dermatologist might discuss is isotretinoin, better known as Roaccutane. Because it's a strong medication requiring specialist oversight, it can only be prescribed by a consultant dermatologist or someone working under their direct supervision.
What is Roaccutane, and when is it used?
Roaccutane is a brand name for isotretinoin, a retinoid medication used to treat acne. You may also have seen it called Accutane, particularly online.
For the right patient, it can be extremely effective. Around 85 to 90% of people clear after one course and won't need further systemic treatment, though some may still get the odd spot or need topical treatment afterwards.
It's a strong medication and isn't suitable for everyone. Because of that, it can only be prescribed by a consultant dermatologist. Before starting, your dermatologist will talk through the potential benefits and risks, along with the monitoring involved.
Isotretinoin works by significantly reducing how much oil the skin produces, which is part of why it's so effective, and also why it comes with some of its more common side effects. People taking it can experience dry skin and lips, dry eyes and nosebleeds, and it can make skin considerably more sensitive to sunlight.
There are strict precautions around pregnancy, since isotretinoin can cause serious harm to a developing baby, so pregnancy prevention and testing safeguards are built into how it's prescribed. Potential effects on mental health are taken seriously too. Patients are screened before starting and monitored throughout, so any concerns can be picked up as part of their care.
Being referred to a dermatologist doesn't mean you have to take isotretinoin. They'll explain the options, answer your questions, and help you decide what's right for you.
Should you follow acne advice on social media?
There's a huge amount of skincare content online, and not all of it suits every skin type.
Retinoids are a good example. Used correctly, they have a genuine role in treating acne, but they can also irritate the skin and increase sun sensitivity. Starting with too much, too often, tends to leave skin red, sore and uncomfortable.
There's also a growing trend for teenagers without acne to use retinoids as part of an "anti-ageing" routine. Young skin doesn't need anti-ageing treatment, and using active skincare products unnecessarily can cause problems rather than prevent them.
If you're unsure about a product, or you've spent a lot of time and money on different skincare without seeing results, it's worth speaking to a healthcare professional.
When should you see your GP about acne?
You don't need to wait until acne becomes severe to ask for help. It's worth booking an appointment if:
Your acne is persistent or getting worse
Treatments you've tried aren't working
You're beginning to develop scars
You have painful or significantly inflamed acne
Acne is affecting your confidence, mood or everyday life
You're unsure which treatments or products are right for you
Your GP can assess your acne, talk through the options and review how well treatment is working, and discuss whether a referral to a dermatologist could help.
Want to know more about acne?
In the latest episode of the Doctors Decoded podcast, our GP and Practice Chairman Dr Nick Dunn is joined by Medical Specialist Group Consultant Dermatologist Dr Alice Walker for a wide-ranging conversation about acne.
They explore what causes it, the treatments available, the impact it can have on mental health and confidence, and why treating it early can help prevent scarring. They also take a closer look at Roaccutane (isotretinoin), including how effective it can be, its side effects and the safeguards involved in prescribing it, along with some of the acne advice circulating on social media.
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