Acne treatment

Medical information

Written and reviewed by a team of doctors. Dr Fox is regulated by the CQC, GPhC, & MHRA. Service rated 'Excellent' by patients.

Acne is common, potentially distressing, and usually treatable.

Many young people have some acne, usually lasting about 4-5 years, although acne is not uncommon in adults and can last longer. The face is the most commonly affected area, although it can also occur on the chest and back and less frequently on the buttocks and in other places. Severe acne with pustules, nodules, and scarring needs to be assessed with a doctor face-to-face and possible specialist referral.

Acne arises when skin pores become blocked leading to a build-up of secretions (sebum) within the skin. Sometimes in more severe forms, infection, pustules, and cysts may occur. Acne is not the same as rosacea, which sometimes appears similar, although there are no blackheads with pure rosacea.

Untreated, acne usually clears up without scarring. Acne can be treated with non-prescription topical preparations (creams, gels and solutions) bought from chemists/pharmacies or alternatively with prescription topical preparations and prescription tablets, including antibiotics. Prescription treatments can be obtained only through doctors, including online doctors.

Acne treatment from Dr Fox

Dr Fox does NOT supply medicines for under-18s.

Dr Fox is able to supply a range of prescription topical preparations (Differin, Zineryt, Duac, and Epiduo) and antibiotic tablets (Lymecycline) for the treatment of acne.

Treatment is usually stepped-up, starting with lower dose single component topical preparations, moving on to dual component (more than one active ingredient) topical preparations. Antibiotic tablets ought to be taken at the same time whilst using topical treatments. See Acne treatment plans on this page.

If antibiotic tablets (lymecycline) or topical antibiotics (Zineryt, Duac) are used long-term (more than 3 months), bacteria may possibly build-up resistance, and treatment can become less effective. Doctors are likely to decline orders for repeats of lymecycline beyond 3 months.

Not all treatments work well in all people. It may be necessary to try different treatments to find the right one.

There are some acne treatments not available from Dr Fox, particularly isotretinoin and specialist contraceptive pills such as Dianette, Yasmin, or Cilest.

Severe acne with scarring needs to be treated promptly in face-to-face consultations with GPs or skin specialists. Where there is psychological distress or the diagnosis is unclear, the same applies.

Zineryt, Differin, Duac, Epiduo, and Lymecycline 408mg are only available on prescription.

Ordering online

You must read the manufacturer's 'patient information leaflets' (links below) before ordering.

You will need to complete a short Yes/No questionnaire before ordering.

Sometimes different topical preparations contain the same active ingredients. Some topical preparations contain two active ingredients. You should not usually use more than one topical treatment at the same time, without discussing this with a doctor.

• Zineryt – antibiotic
• Differin – retinoid
• Epiduo – retinoid with peeling agent (benzoyl peroxide)
• Duac – antibiotic with peeling agent (benzoyl peroxide)

Antibiotic tablets (Lymecycline) should be taken whilst using topical Differin, and Epiduo, but should NOT be taken whilst using Zineryt or Duac (topical antibiotics).

Multiple ordering

After the consultation you can choose your order option, although it is not possible to order more than one item per consultation. This is for medical reasons.

If more than one item is required, a separate questionnaire must be completed for each item.

If more than one item has been ordered, you should message the doctors from your account to explain why.

If the doctors approve more than one item, email info@doctorfox.co.uk or message from your account and we will refund additional postage and consultation fees.

Declined orders are automatically refunded.

Diagnosis of acne

It is important that people obtaining treatment online for acne have previously seen a doctor about it. There are other causes of spots and rashes apart from acne. These other skin problems might require investigations, and might not respond to acne treatment. In some rare cases acne is associated with hormonal disturbance requiring investigation. This is rare. Women with acne and facial hirsutism, and irregular periods should be checked for polycystic ovaries.

Length of treatment

Creams, solutions or gels and antibiotic tablets for acne take time before they start to work, usually at least 8 weeks and sometimes up to 4 months. It is best to use one new treatment at a time, and allow 8 weeks of continuous treatment before switching to, or adding a new one. If a treatment works well, stick with it.

The best response to treatment is usually seen after 3 to 6 months. If acne has completely gone or very much improved after 3 to 6 months, treatment should be stopped. Treatment may need to restarted if the acne comes back. If acne comes back, maintenance long-term treatment may be needed, possibly with a lower or less frequent amounts being required. If antibiotic tablets (lymecycline) or topical antibiotics (Zineryt, Duac) are used long-term (more than 3 months), bacteria may possibly build-up resistance, and treatment can become less effective.

If there is no improvement or a worsening of acne after 8 weeks, a different treatment can be tried, or a new acne treatment can be added.

If acne is scarring or you are distressed by your skin problems, consult your GP promptly. A specialist referral may be needed and this should not be delayed.

Acne treatment plans

See a doctor face-to-face for diagnosis and advice before you start treatment.

See Acne FAQs. A useful guide to acne and its treatment can also be found at patient.info. There is also a longer more detailed NHS guide to help with treatment options.

Plan one

1. For mild acne, start with non-prescription benzoyl peroxide topical preparations bought from chemists/pharmacies without prescriptions. Try this for 8 weeks. Topical benzoyl peroxide is not available from Dr Fox.
2. If step 1 is not working, stop it and try prescription topical treatment, either a topical antibiotic (Zineryt) or topical retinoid (Differin). Try each one in turn for 8 weeks, and if not working, switch to another one for 8 weeks. Both available from Dr Fox.
3. If step 2 is not working, stop it and try a combination topical treatment, either Duac or Epiduo. If one does not work after 8 weeks, switch to the other one for 8 weeks – both available from Dr Fox.
4. If step 3 does not work, start antibiotic tablets (Lymecycline). Antibiotic tablets (Lymecycline) should usually be taken whilst using Differin and Epiduo at the same time, as this reduces the chances of antibiotic resistance. Zineryt and Duac (topical antibiotics) should not be used at the same time as taking Lymecycline. Lymecycline is available from Dr Fox.

• Try different treatments on their own first.
• Only use more than one treatment at a time, if single treatments are not working.
• Antibiotics treatments, either topical or tablets should not be used continuously for more than 3 months, because this leads to antibiotic resistance.

Care should be taken not to use two treatments with the same type of ingredients at the same time, i.e. do not use two topical retinoids at the same time, or two topical antibiotics at the same time.

If acne is well controlled after 3 to 6 months, reduce the frequency of topical applications, or stop using treatment altogether. Acne may not come back, but if it does, treatment can be started again.

Plan two

Same as plan one, except instead of trying the whole range of topical preparations first, add in antibiotic tablets (Lymecycline), at an earlier stage or from the beginning, but do NOT use Zineryt or Duac (topical antibiotics) with antibiotic tablets (Lymecycline) at the same time.

Available treatments for acne

Topical antibiotic for acne: Zineryt & Duac

Acne is associated with infection of the skin which can be reduced by applying creams, lotions or gels which contain antibiotics. Topical antibiotics should NOT be used at the same time as taking antibiotic tablets (Lymecycline).

Topical antibiotics are not normally recommended for more than 6 months at a time because antibiotic resistance could build-up, although Zineryt and Duac are less prone to antibiotic resistance than other topical antibiotics.

Duac is a gel which contains the antibiotic clindamycin combined with an astringent (peeling agent) benzoyl peroxide. See the manufacturer's 'patient information leaflet' of Duac 3% for details, including how to use, side effects, and cautions.
Duac Gel 3% Patient Leaflet

Zineryt contains the antibiotic erythromycin in solution. It is usually applied twice daily. See the manufacturer's patient information leaflet of Zineryt for details, including how to use, side effects, and cautions.
Zineryt Patient Leaflet

Topical retinoid: Differin

Retinoids are good at unplugging blocked pores.

They can cause irritation particularly at the start of treatment. Irritation can be reduced by starting treatment on alternate days, and building up to the prescribed dose as tolerated.

Differin comes as a gel or a cream containing the retinoid, adapalene. It is applied to the skin once daily, usually at night. See the manufacturer's 'patient information leaflet' of Differin Gel and Differin Cream for details, including how to use, side effects and cautions.
Differin Gel Patient Leaflet
Differin Cream Patient Leaflet

Combination topical treatments: Epiduo

Can cause irritation particularly at the start of treatment. Irritation can be reduced by starting treatment on alternate days, and building up to the prescribed dose as tolerated.

Epiduo is a gel containing the retinoid adapalene combined with an astringent (peeling agent) benzoyl peroxide, 2.5%. It is applied once daily. See the manufacturer's 'patient information leaflet' of Epiduo Gel for details, including how to use, side effects and cautions.
Epiduo Gel Patient Leaflet

Antibiotic tablets: Lymecycline 408mg

Lymecycline 408mg is a capsule containing the antibiotic lymecycline of the tetracycline type. The dose used to treat acne is usually one capsule daily. Lymecycline should not normally be taken continuously for more than 3 months because this increases the chances of antibiotic resistance.

NOT to be taken whilst using Zineryt or Duac (topical antibiotics).

See the manufacturer's 'patient information leaflet' of Lymecycline 408mg for details, including how to use, side effects and cautions.
Lymecycline 408mg Patient Leaflet

Antibiotic guardianship

To combat antibiotic resistance please:

• Only use antibiotics when needed
• Never share antibiotics
• Always complete course as instructed
• Take unused medicine to local pharmacy for disposal

Dr Fox supplies acne treatment on prescription – you are required to answer a short medical questionnaire before your order can be completed.

Authored 31 October 2013 by Dr B. Babor
Last updated 3 October 2019

Reviewed by Dr Tony Steele, Dr A. Wood, Dr P. Hunt
Last reviewed 28 February 2019