Acne Treatment: What Actually Works and When to See Your GP

A practical guide to treating acne properly, preventing scars and knowing when stronger treatment is worth considering

Acne is common, but that does not mean you simply have to put up with it.

It can cause:

• blackheads and whiteheads
• red pimples
• pustules
• deeper painful lumps
• pigmentation after spots heal
• permanent scarring.

It can also affect confidence, mood and social life.

The good news is that acne is treatable.

The challenge is that treatment needs to match the type and severity of acne, and it usually takes longer to work than people expect.

The useful question is not:

“What is the strongest acne cream?”

It is:

“What type of acne do I have, and what combination of treatment is most likely to work?”

What actually causes acne?

Acne develops in the hair follicles and oil glands of the skin.

Several things happen together:

• oil production increases
• dead skin cells block follicles
• bacteria within the follicle contribute to inflammation
• the immune system produces redness and swelling.

Hormones, particularly androgens, play an important role in increasing oil production and follicle activity.

That is why acne often begins around puberty, but it can continue well into adulthood.

Adult acne is common too, particularly in women.

Acne is not caused by dirty skin

This is worth saying clearly.

Acne is not simply a hygiene problem.

Aggressively scrubbing your face will not remove the blockage from inside the follicle.

In fact, over-cleansing can irritate the skin and make treatment harder to tolerate.

A gentle cleanser once or twice daily is usually enough.

The type of acne matters

Not all acne looks the same.

Comedonal acne
This is mainly:

• blackheads
• whiteheads
• small blocked pores.

Topical retinoids are particularly useful because they help prevent pores from becoming blocked.

Inflammatory acne
This includes:

• red papules
• pustules
• tender inflamed spots.

Treatment often needs to address both blocked follicles and inflammation.

Nodular or cystic acne
This involves deeper, painful lumps under the skin.

This type of acne carries a greater risk of scarring and is one reason to seek medical treatment earlier.

Acne with scarring
If acne is already leaving:

• permanent depressions
• raised scars
• persistent textural change,

the threshold for escalating treatment should be lower.

Preventing further scars is usually much easier than trying to repair established scars later.

What should I use first?

For mild acne, reasonable first-line options include treatments available without prescription, such as:

• benzoyl peroxide
• azelaic acid
• salicylic acid.

The choice depends on the acne pattern and how sensitive your skin is.

Benzoyl peroxide

Benzoyl peroxide is one of the most useful acne treatments.

It can:

• reduce acne-causing bacteria
• reduce inflammation
• help prevent new inflammatory lesions.

It is particularly useful for red and pustular acne and is often combined with other treatments.

Common problems are:

• dryness
• peeling
• irritation.

It can also bleach towels, pillowcases and clothing.

Starting slowly — for example, every second night — can improve tolerance.

Azelaic acid

Azelaic acid can help with:

• blocked pores
• inflammatory acne
• post-inflammatory pigmentation.

It is often useful when the skin is sensitive or where dark marks after acne are a particular problem.

It may cause mild stinging or irritation at first.

Salicylic acid

Salicylic acid helps exfoliate the upper layers of the follicle and may be useful for mild comedonal acne.

It is commonly found in cleansers and acne products.

For more significant acne, however, it is often not enough on its own.

What about topical retinoids?

Topical retinoids are among the most effective long-term treatments for acne.

Examples used in Australia include:

• adapalene
• tretinoin
• trifarotene.

They help prevent blocked follicles and can reduce both comedonal and inflammatory acne.

Retinoids often irritate the skin at first

This is probably the most common reason people stop them too early.

In the first few weeks, you may notice:

• dryness
• redness
• peeling
• mild stinging.

That does not automatically mean you are allergic to the medicine.

Often the solution is to:

• use a small amount
• start every second or third night
• use moisturiser
• increase gradually as tolerated.

The aim is not to make your skin peel dramatically.

More irritation does not mean the treatment is working better.

How much acne cream should I use?

Usually less than people think.

For many topical acne medicines, a small pea-sized amount is enough for the whole face.

Treat the acne-prone area, not just today’s visible pimple.

Why?

Because treatment is also trying to prevent the next blocked follicle from forming.

How long should I give treatment?

Acne treatment is slow.

You should not expect a major change after three nights.

A reasonable trial is often around 6–12 weeks, depending on the treatment and severity.

Some people notice mild improvement earlier, but clearer skin usually requires consistent treatment over weeks rather than days.

If there is no meaningful improvement after an adequate trial, that is the time to review:

• whether the diagnosis is correct
• how consistently treatment has been used
• whether the treatment is strong enough
• whether it is time to escalate.

Could it get worse before it gets better?

Sometimes acne looks temporarily more irritated after starting active treatments, particularly topical retinoids.

But severe worsening should not simply be dismissed as “purging”.

If acne becomes substantially more painful, inflamed or widespread, review is sensible.

Do antibiotics work for acne?

Yes — but they need to be used carefully.

Oral antibiotics such as tetracyclines can be useful for moderate inflammatory acne, particularly when there are many red papules and pustules or truncal acne that is difficult to treat topically.

But antibiotics should not become indefinite acne treatment.

Why not stay on antibiotics for years?

Because unnecessary prolonged antibiotic use contributes to:

• antibiotic resistance
• gastrointestinal side effects
• other medication complications.

When oral antibiotics are used, they are generally combined with an effective topical acne treatment, often benzoyl peroxide and/or a topical retinoid, so that the antibiotic can later be stopped while topical maintenance continues.

The long-term goal is usually:

control the acne without needing continuous oral antibiotics.

What about topical antibiotics?

Topical antibiotics can be useful in selected combination regimens.

However, they should generally not be used as prolonged stand-alone therapy because of concerns about bacterial resistance.

If an antibiotic is being used, combining it appropriately with benzoyl peroxide can help reduce resistance pressure.

Hormonal treatment

For some women, hormones clearly influence acne.

Clues may include:

• acne concentrated around the jawline and lower face
• flares around menstruation
• persistent adult acne
• acne associated with features of androgen excess.

Hormonal treatment may include:

• certain combined oral contraceptive pills
• anti-androgen treatment such as spironolactone in selected patients.

These treatments require individual assessment because suitability depends on:

• medical history
• blood pressure and clotting risk where relevant
• pregnancy plans
• other medicines.

When should I think about isotretinoin?

Isotretinoin is one of the most effective treatments for severe or persistent acne.

It may be considered when acne is:

• nodular or cystic
• causing scarring
• severe
• resistant to adequate conventional treatment
• causing major psychological distress
• repeatedly relapsing despite appropriate therapy.

Is isotretinoin only for extremely severe acne?

Not necessarily.

The decision is not based only on how dramatic the acne looks on one particular day.

A person with moderate acne that has:

• persisted for years
• caused permanent scarring
• failed appropriate treatment
• substantially affected quality of life

may still have good reasons to discuss isotretinoin.

Early referral can be reasonable when the risk of scarring is becoming significant.

Who prescribes isotretinoin in Australia?

Isotretinoin prescribing arrangements vary between Australian states and territories.

In NSW, it is generally managed through an appropriately authorised prescriber, commonly a dermatologist.

A GP can assess the acne, start appropriate first-line treatment, document previous therapies and refer when isotretinoin is worth considering.

What should I know before taking isotretinoin?

Isotretinoin is a powerful and effective medicine with important precautions.

Common effects include:

• very dry lips
• dry skin
• dry eyes
• increased sun sensitivity
• nose dryness or nosebleeds.

Blood tests may sometimes be needed to monitor:

• liver function
• cholesterol and triglycerides
• other issues depending on the patient and prescribing approach.

The important point is not to label isotretinoin as either:

“dangerous”

or:

“just another acne tablet.”

It is an effective treatment that needs careful prescribing and monitoring.

What about mood and sexual side effects?

Current Australian isotretinoin safety advice recommends checking mental health before treatment and monitoring for new or worsening symptoms during treatment.

Reported psychiatric effects have included:

• low mood or depression
• anxiety
• suicidal thoughts
• unusual behavioural or psychiatric symptoms.

Sexual-function symptoms have also been reported, including changes in:

• libido
• erectile function
• genital comfort or dryness
• sexual pleasure.

These reports do not automatically prove that isotretinoin caused the symptom, and acne itself can also have a major effect on mood and self-esteem.

But new or concerning symptoms should not be ignored.

If mood, behaviour or sexual function changes during treatment, discuss it promptly with the prescriber.

If someone develops suicidal thoughts or is at immediate risk of self-harm, seek urgent medical help.

Pregnancy and isotretinoin

This is critical.

Isotretinoin must not be used during pregnancy because it can cause severe birth defects.

People who could become pregnant need strict pregnancy-prevention advice and monitoring according to the prescribing requirements being used.

Pregnancy planning should therefore always be discussed before isotretinoin treatment.

What about topical retinoids in pregnancy?

Topical retinoids are also generally avoided during pregnancy and when planning pregnancy.

If you are pregnant or trying to conceive, tell your GP before starting acne treatment.

Other options can usually be chosen.

Does acne mean I have polycystic ovary syndrome?

No.

Acne is common and most people with acne do not have PCOS.

However, assessment for hormonal causes may be reasonable if acne occurs together with features such as:

• irregular periods
• excess facial or body hair
• scalp hair thinning
• difficulty with ovulation
• other signs of androgen excess.

Testing every woman with acne for PCOS is unnecessary.

Does diet cause acne?

Diet is not the sole cause of acne.

Some evidence suggests that higher-glycaemic dietary patterns may worsen acne in some people, and there may be associations between acne and certain dairy products in susceptible individuals.

But acne is rarely solved by eliminating multiple foods.

A balanced diet is sensible.

Extreme restrictive diets usually are not.

If one food repeatedly seems to trigger a flare, it is reasonable to observe the pattern rather than assume every acne patient needs the same diet.

What about chocolate?

Chocolate is often blamed.

The more useful question is not whether one square of chocolate “causes acne”, but whether a person’s overall dietary pattern may influence acne severity.

There is no reason for every teenager with acne to be banned from chocolate.

Does squeezing pimples make things worse?

Often, yes.

Picking and squeezing can:

• increase inflammation
• damage surrounding tissue
• prolong redness
• increase pigmentation
• increase scarring.

Deep cysts are particularly poor candidates for home surgery.

Leave them alone where possible.

What skincare should I use?

Acne treatment works better when basic skincare is simple.

Consider:

• a gentle cleanser
• non-comedogenic moisturiser
• non-comedogenic sunscreen
• acne treatment suited to the acne type.

Avoid continually adding:

• scrubs
• acids
• masks
• essential oils
• harsh cleansers
• multiple active ingredients

all at once.

Sometimes what looks like “treatment-resistant acne” is partly treatment-irritated skin.

Do I still need moisturiser if my skin is oily?

Usually, yes.

Acne treatments often dry the skin.

A light, non-comedogenic moisturiser can make effective treatments easier to tolerate.

Oily skin can still have a damaged skin barrier.

What sunscreen should I use?

Choose a sunscreen labelled:

• non-comedogenic
• suitable for acne-prone skin
• broad spectrum.

This is particularly important when using retinoids or other treatments that may irritate the skin.

Sun protection also helps reduce the persistence of post-inflammatory pigmentation.

What about acne scars?

Acne can leave two different types of marks.

Post-inflammatory marks
These are flat red, brown or darker marks after a spot resolves.

They may fade gradually over time.

True scars
These alter the texture of the skin.

They may be:

• depressed
• pitted
• rolling
• raised.

True scars do not simply disappear when the acne settles.

That is why preventing new scars is such an important reason to treat active acne properly.

Can acne scars be treated?

Yes, but usually after the acne itself is under reasonable control.

Depending on scar type, dermatology or cosmetic treatments may include:

• laser
• microneedling
• subcision
• chemical peels
• scar-specific procedures.

The right treatment depends on the type of scar.

There is no single best “acne scar treatment” for everyone.

Could it be something other than acne?

Sometimes.

Conditions that may resemble acne include:

• rosacea
• folliculitis
• perioral dermatitis
• medication-related eruptions.

Some forms of folliculitis can cause an itchy acne-like eruption on the chest or back and require different treatment.

If the rash is unusually itchy, very sudden, symmetrical or not responding as expected, reconsidering the diagnosis is worthwhile.

When should I see my GP?

You do not need to wait until acne is severe.

A GP review is worthwhile if:

• over-the-counter treatment has not worked
• acne is painful or widespread
• deeper nodules or cysts are developing
• scarring is starting
• pigmentation is becoming a major problem
• acne is affecting your confidence or mood
• you may need oral treatment
• pregnancy affects treatment choices
• you are not sure the rash is actually acne.

When should I see a dermatologist?

Dermatology referral becomes particularly useful when there is:

• severe nodular or cystic acne
• significant scarring
• failure of appropriate treatment
• consideration of isotretinoin
• uncertainty about the diagnosis
• difficult adverse effects
• major psychological impact.

The aim is not to make patients “earn” specialist care by failing years of treatment.

Sometimes the risk of permanent scarring makes earlier escalation sensible.

Acne can affect mental health

Acne is visible.

That matters.

Even acne that another person considers “mild” can have a substantial effect on:

• self-esteem
• relationships
• school
• work
• willingness to socialise.

Do not dismiss this as vanity.

If acne is significantly affecting mood or quality of life, tell your GP.

That can influence how actively treatment should be escalated.

A common misconception

MYTH: Acne treatment failed because I still had pimples after two weeks.

REALITY: Most acne treatments need several weeks of consistent use.

Stopping too early is one of the most common reasons treatment appears not to work.

A more useful approach is:

choose the right treatment → use it consistently → review after an adequate trial → escalate if needed.

Another common misconception

MYTH: The more products I use, the faster my acne will improve.

REALITY: Too many active products can irritate the skin and make treatment harder to tolerate.

A simple treatment plan used consistently is usually better than a bathroom shelf full of half-used products.

A practical starting routine

For uncomplicated mild acne, a reasonable routine may look something like this.

Morning

• gentle cleanser
• appropriate acne treatment if prescribed
• moisturiser if needed
• sunscreen.

Evening

• gentle cleanser
• topical acne treatment
• moisturiser as required.

The exact product matters less than matching the treatment to the acne type and using it consistently.

The question I ask

When someone tells me their acne treatment “didn’t work”, I want to know:

“What did you use, how often did you use it, and for how long?”

Those three questions often explain the problem.

A medicine used three times over two weeks is very different from an adequate treatment trial.

The bottom line

Acne is treatable.

The best treatment depends on whether acne is mainly:

• blocked pores
• inflammatory
• hormonal
• nodular or cystic
• already causing scars.

For mild acne, topical treatments such as benzoyl peroxide, azelaic acid and retinoids may be enough.

Moderate inflammatory acne may require prescription combinations or a limited course of oral antibiotics.

Hormonal treatment can help selected women.

Severe, scarring or persistent acne may justify dermatology assessment and consideration of isotretinoin.

And one principle matters throughout:

do not wait for permanent scars before deciding the acne deserves proper treatment.

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