Acne: what to try first and when to see a doctor online

What causes acne

The NHS explains that acne can happen when hair follicles become blocked with excess oil and dead skin cells, and bacteria grow in them, causing inflammation and pus. It usually affects the face, chest and back. Spots can be whiteheads, blackheads, raised papules, pus-filled pustules, or larger nodules and cysts under the skin that may be painful.

Causes include hormone changes during puberty, periods, menopause and pregnancy, conditions such as rosacea and polyendocrine metabolic ovarian syndrome (PMOS, previously called PCOS), certain medicines, and skin or hair products that make your skin greasy. If irregular periods or extra hair growth come with your acne, read about PCOS.

What you can do at home

• Wash your skin twice a day with a gentle cleanser, and remove make-up at the end of the day.
• Choose skin care and make-up labelled non-comedogenic, which means they will not clog pores.
• Try treatments you put on your skin, such as salicylic acid or benzoyl peroxide. A pharmacist can advise.
• Wear loose, breathable clothing if you have acne on your body, especially when exercising or sweating.
• Do not pick or squeeze spots, which can cause scars, and do not scrub your skin.

When a video consultation suits acne

Acne is well suited to a video visit, because a doctor can see a great deal from clear photos and a good history. The DHA telehealth standard lists a high resolution photograph or video examination as mandatory for skin conditions treated through teleprescribing. Take photos in daylight, without make-up or filters, from the front and each side, plus close-ups of the worst areas.

See a doctor if you have tried treating acne yourself and it is not getting better, you have lots of spots, or they are deep, painful or leaving scars. The doctor will ask how long you have had it, what you have tried and for how long, your skin and hair products, your periods if relevant, your medicines, and whether you are pregnant or planning to be. Prescription treatments, as creams, gels or tablets, are stronger than shop products, and the doctor will decide which, if any, suits you.

When you need to be seen in person

Hot, swollen, red skin can be a sign of infection, so get it checked by a doctor promptly. If acne is severe or has not responded to treatment, a GP may refer you to a dermatologist, who may want to see you in person.

Acne can affect your mental health, causing anxiety, depression and low self-esteem. That on its own is a good reason to see a doctor, and our page on anxiety and stress explains where else to turn.

Signs that need 998

Acne does not usually need emergency care. Call 998 if, after using a new product or medicine, your lips, mouth, throat or tongue suddenly swell, you are struggling to breathe, your throat feels tight, or you feel suddenly confused, drowsy or faint. These can be signs of anaphylaxis. If acne is affecting your mood so much that you do not feel you can keep yourself safe, call 998 or go to the nearest emergency department.

Which doctor to see

A dermatologist specialises in skin, and a general practitioner can also start treatment and refer you on. Dermatologists listed on medicAI work at clinics and hospitals licensed by DHA or DoH, and the doctor and their facility provide your care. medicAI is the app that lets you find one, compare fees and join the call from your phone.