Be patient. Acne improves slowly even with the most powerful treatments from your doctor. Do not expect much improvement in the first few weeks of any treatment.
Do not pick! Discipline yourself not to pick your spots, as this may encourage scarring. Relaxation techniques may help you break the habit (CDs, DVDs or books may be useful).
If you have a large yellow spot containing pus that you feel you really must get rid of, pierce it with a sterilized needle and gently squeeze the pus out using a tissue and clean hands.
For blackheads, you can buy a ‘comedone spoon’ (extractor). This has a hole in it, which you can place around the blackhead. Then, with some gentle pressure, you can release the blackhead from the pore; abandon the attempt if the blackhead does not come out easily.
Wash carefully. Wash the affected area twice a day with a pH-balanced, unperfumed soap. Antibacterial soap is no better than ordinary soap, and harsh soaps can irritate some skins. Alternatively, use a gentle antibacterial facewash. A variety of brands are available and can usually be found alongside the anti-acne products in pharmacies and supermarkets. Avoid facial scrubs and abrasive cleansers, which might increase the inflammation of the skin and make scarring more likely.
Spot creams, gels and lotions. Most over-the-counter medications (salicylic acid, sulphur and resorcinol) provide little benefit. Avoid wasting your money on anti-acne preparations that simply describe themselves as ‘medicated’. Most have very little effect. They are also expensive, and you are likely to need to continue your anti-acne treatment for months or even years. Similarly, expensive creams containing alpha hydroxy acids (also called AHAs or fruit acids) are sometimes advertised for treating acne, but there is little scientific evidence in their favour. Acne support groups suggest that some cosmetic companies are preying on the vulnerability of people with acne, and highlight the need for tighter regulation of the cosmetic industry.
Tea tree oil has antibacterial properties and might be worth trying if your acne is only mild. Apply a small amount of the 5% strength twice a day after washing, taking care to avoid your eyes.
Nicotinamide gel (available from pharmacies) may be helpful if the spots are inflamed, but not very severe.
Benzoyl peroxide. Your best bet is to ask the pharmacist for 2.5% benzoyl peroxide. This zaps skin bacteria and is available as a cream or gel. The gel releases its active ingredient more effectively than the cream but is more drying. Before using benzoyl peroxide, draw a diagram of your face on a sheet of paper. Mark in the areas where your spots are, and roughly how many. This will help you later to decide whether the treatment works.
Apply the treatment thinly twice a day after washing, avoiding the lips and eyes. Its main action is to prevent new spots, so apply it over the whole area – do not just dab it on individual spots that are already there. After a week or two, upgrade to the 4% and then the 5–10% strengths, unless you have excessive peeling and redness; some slight peeling is usual. If your skin feels very dry, use the treatment every other day or cut down the time you leave the treatment on your skin, and use an oil-free moisturizer. Keep benzoyl peroxide away from your clothes as it has a bleaching effect; you may also find bleach marks on coloured bed linen.
After about 2 months, decide whether your spot count has improved by about a third. If it has, continue with the benzoyl peroxide. You may need to continue it for several months. If there has been no improvement, see your family doctor for some stronger treatment.
In 60% of people with acne, their back and chest, as well as their face, is affected. Applying a cream or gel to the back can be tricky and it is useful to get a friend or relative to help.
Pore strips. Be cautious with pore strips. These are not really a treatment for acne; they do more harm than good if used on red, inflamed spots. However, they can lift out blockages at pore openings (blackheads) and improve the appearance of the skin. The adhesive can irritate sensitive skin, so:
- do not use pore strips more than once a week
- peel the strip off very carefully
- if pulling the strip off is painful, dampen it with water before continuing
- after use, wash your face with a gentle antibacterial wash.
Avoid heavy and greasy make-up. Oil-free make-up is available in some ranges. Remove it at night with a gentle cleanser before washing. If your acne is all over your face, with lots of blackheads, your make-up might be aggravating the problem, so consider different brands. To disguise an individual spot, use a medicated spot concealer stick or cream a couple of shades lighter than your normal skin tone to counteract any redness. Apply it with a tiny brush to just cover the spot, removing any excess by tapping the area gently with your finger. Do not apply it to a large area or you may make the skin sensitive.
Check your contraceptive pill. The label will tell you which progestin it contains. The newer progestins – gestodene, desogestrel and norgestimate – are least likely to worsen acne. The pill containing drospirenone (Yasmin) also seems to be a particularly good choice for women with acne. In the USA, the Food and Drug Administration has approved a contraceptive pill containing norgestimate (Ortho Tri-Cyclen) for treating acne in women.
Consider a zinc supplement. One study has shown that zinc may be beneficial in acne that is inflamed, although the evidence has not been supported by other studies.
Chemical peels can be helpful in some cases of acne with many blocked pores, and for acne scars. It is important to seek professional advice if you are considering trying a chemical peel to avoid side effects.
First published on: embarrassingproblems.com
Reviewed and edited by: Fiona Elliott
Last updated: December 2020