The acne treatments with the strongest evidence are benzoyl peroxide, topical retinoids such as adapalene, topical antibiotics used alongside them, and, for moderate to severe acne, antibiotic tablets for a limited time or isotretinoin. None of them work overnight: the American Academy of Dermatology says it takes at least 6 to 8 weeks to see fewer breakouts.
That waiting period is where most people give up and start hopping between products. Here’s what each treatment does, a simple routine that won’t make things worse, the myths worth dropping, and when it’s time for a dermatologist.
Why acne happens
Acne starts in the hair follicles. Oil (sebum) and dead skin cells block the opening, forming blackheads and whiteheads. Bacteria that live on the skin then multiply in the blocked pore, and inflammation turns it into a red spot, a pus-filled pimple, or a deep, painful lump.
Hormones drive the oil production, which is why acne is so common in teenagers and can flare around periods or in pregnancy, as the NHS notes. Greasy skin and hair products and some medicines can also contribute.
Treatments that work, and how they compare
The 2024 acne guideline from the American Academy of Dermatology, published in the Journal of the American Academy of Dermatology, graded each option on the evidence:
| Treatment | What it does | Guideline grade | Things to know |
|---|---|---|---|
| Benzoyl peroxide (gel or wash) | Kills acne bacteria, mildly unclogs pores | Strong | Available at pharmacies. Can dry the skin and bleach towels and pillowcases. |
| Topical retinoids (adapalene, tretinoin) | Unclog pores and prevent new blackheads | Strong | Often sting or peel at first. Avoid in pregnancy. |
| Topical antibiotics (clindamycin, erythromycin) | Reduce bacteria and redness | Strong | Best combined with benzoyl peroxide rather than used alone. |
| Azelaic acid | Reduces bacteria and inflammation | Conditional | Gentler; can be used in pregnancy. |
| Salicylic acid | Mild exfoliant for blackheads | Conditional | Useful for mild acne; weaker evidence. |
| Oral doxycycline | Antibiotic for moderate to severe inflammatory acne | Strong | Should be used for the shortest time possible, together with a topical treatment. |
| Combined pill or spironolactone (women) | Lower the hormones that drive oil production | Conditional | Prescription only; suits hormone-related acne. |
| Oral isotretinoin | The most powerful acne tablet | Strong (for severe or scarring acne) | Specialist prescription. Strict pregnancy rules (see below). |
The guideline also recommends combining topical treatments that work in different ways, limiting antibiotic tablets, and always pairing them with a topical treatment. Your doctor will choose the strength and combination. The AAD is blunt about one thing: applying more than your dermatologist recommends will not clear acne faster.
Isotretinoin and pregnancy: the rules that matter
Isotretinoin is the most effective acne medicine, and the one with the most serious rules. The guideline strongly recommends it for severe acne, acne that’s causing scarring or real distress, and acne that hasn’t responded to other treatment. It is usually prescribed by a skin specialist.
- It causes serious birth defects. The NHS says you must not take it during pregnancy or while trying to conceive.
- Contraception before, during and after. Anyone who could get pregnant should use contraception starting at least 1 month before treatment and continuing for at least 1 month after stopping.
- Mood. The NHS lists hallucinations, psychosis and thoughts of self-harm among serious side effects. Tell your doctor about any past depression, and get help straight away if your mood changes.
- Common side effects include dry skin and lips, sore eyes, nose and throat, headaches, and muscle or joint pain.
Never take isotretinoin bought without a prescription or borrowed from someone else.
Pregnancy affects the creams too. DermNet advises avoiding topical retinoids (tretinoin, adapalene) during pregnancy and avoiding tetracycline antibiotics later in pregnancy, while benzoyl peroxide and azelaic acid are considered safe options.
A simple daily routine
Treatment works better on skin that isn’t being scrubbed raw. A plain routine is enough:
- Wash twice a day with a gentle cleanser. Skip harsh scrubs.
- Spread your treatment thinly over the whole area where acne appears, rather than dabbing it on single spots, since it’s meant to prevent new ones.
- Use a non-comedogenic moisturiser if the treatment dries your skin.
- Choose non-comedogenic make-up and sunscreen, and take make-up off at night.
- Keep hair oils and heavy pomades off your forehead and face.
- Don’t pick or squeeze spots. The NHS warns this can cause scars.
If oiliness is your main problem, our post on controlling oily skin covers that separately.
Acne myths worth dropping
- “Acne means dirty skin.” Acne starts inside the pore, not from surface dirt. Washing twice a day is enough; scrubbing harder just irritates the skin.
- “Toothpaste dries out pimples.” It isn’t an acne treatment and can irritate the skin. Use benzoyl peroxide instead.
- “Diet has nothing to do with it.” The picture is mixed. The AAD describes studies linking skim milk to acne; in one, women who drank two or more glasses of skim milk a day were 44% more likely to have acne. Evidence on high-glycaemic foods is inconsistent. Noticing your own triggers is reasonable; cutting out whole food groups isn’t needed.
- “A steroid cream will calm it down.” It does the opposite. In a study across 12 Indian dermatology clinics, acne or worsening acne was the most common side effect among people using steroid creams on their faces, and nearly a quarter of users had applied them to treat acne in the first place (IJDVL, 2011). Check the label of any “pimple cream” for clobetasol, betamethasone or similar.
- “It’ll clear on its own, so wait.” Mild acne may, but deeper acne can leave permanent scars. The AAD says you don’t have to wait it out.
Scars and dark marks
Two kinds of mark can follow acne. Flat dark spots are common on brown skin after a pimple heals; they aren’t true scars, and daily sunscreen and a dermatologist’s advice on creams help them fade. True scars change the skin’s texture: shallow pits, sometimes called ice-pick or boxcar scars, which the NHS describes.
The best scar treatment is preventing scars by treating moderate and severe acne early. Once scars form, dermatologists can offer procedures; our overview of skin rejuvenation treatments, their benefits and risks explains the common options.
When to see a dermatologist
Based on NHS advice, see a doctor if:
- pharmacy treatments haven’t helped after a couple of months of regular use
- you have many spots, or deep, painful lumps (nodules or cysts)
- acne is leaving scars or dark marks
- spots look infected, hot or swollen
- acne is affecting your mood, confidence or daily life
Acne can be linked to anxiety and low mood. If you’re struggling, call Tele-MANAS on 14416 for free mental health support. If you or someone else is in immediate danger, call 112.
Frequently asked questions
How long does acne treatment take to work?
At least 6 to 8 weeks before you see fewer breakouts, according to the AAD. Keep using it daily before deciding it has failed.
Is benzoyl peroxide or adapalene better?
Both are strongly recommended and work in different ways, so they’re often used together. Start one at a time if your skin is sensitive, and ask your doctor or pharmacist which suits you.
Is isotretinoin dangerous?
It’s very effective but must be prescribed and monitored by a doctor. The main risks are birth defects, so contraception is essential for anyone who could become pregnant, plus mood changes and dryness.
Do antibiotics cure acne?
They help inflammatory acne, but guidelines say to use tablets for the shortest time possible and always with a topical treatment such as benzoyl peroxide to reduce resistance.
Can I treat acne during pregnancy?
Yes, carefully. Benzoyl peroxide and azelaic acid are considered safe, while isotretinoin and topical retinoids must be avoided. Check every product with your doctor.
This article is for general information and is not a substitute for advice from a doctor. If you have symptoms or a health condition, please consult a qualified healthcare professional.