Acne treatment options and the challenges of managing acne in practice

Sep 27

5 min read

Last reviewed: 27 Sept 2026

Acne is one of the most common skin conditions in the world. It affects around 9.4% of the global population and the large majority of teenagers, and for many people it continues well into adulthood. Because it is so common, acne is easy to underestimate. Yet it can leave permanent scars, affect confidence and mental health, and prove surprisingly difficult to treat well.

This article gives an overview of the main acne treatment options and the challenges clinicians face when managing acne. It draws on themes from Bright Med's Acne Unfiltered workshop, held in London in June 2026 and led by consultant dermatologists Dr Perin Celebi and Dr Jasmine Mann. It also announces the Acne Companion, a new interactive tool for Bright Med members.

What is acne?

Acne is a long-term inflammatory condition of the hair follicle and its oil gland, known together as the pilosebaceous unit. Four processes drive it:

Increased oil (sebum) production, largely influenced by hormones
Blocked follicles, which form blackheads and whiteheads (comedones)
Overgrowth of skin bacteria, mainly Cutibacterium acnes
Inflammation, which produces red spots, pustules and deeper nodules

Acne most often affects the face, and frequently the back and chest. It can range from a few blackheads to widespread, painful nodules that scar.

Why acne matters more than it looks

Acne is sometimes dismissed as a normal part of growing up. The evidence says otherwise:

Scarring is permanent. It is more likely when effective treatment is delayed.
The psychological impact is significant. Studies link acne with higher rates of anxiety, low mood and social withdrawal, and its impact on quality of life can be comparable to other long-term conditions.
Acne often persists into adulthood, particularly in women, and may reflect hormonal factors.
Pigmentation can outlast the spots. Dark marks left behind after acne, especially in people with darker skin, can be as distressing as the acne itself.

Taking acne seriously early is one of the most effective ways to prevent long-term harm.

An overview of acne treatment options

There is no single best treatment for acne. The right choice depends on the type and severity of acne, the person's skin, their age, their health, and what they have already tried. Treatment options fall into a few broad groups.

Skincare and general measures

Every treatment plan starts with the basics: a gentle cleanser, a non-comedogenic moisturiser, daily sunscreen, and avoiding scrubbing or picking. Good skincare reduces irritation from active treatments and lowers the risk of scarring and marks.

Topical treatments

Creams and gels applied to the skin are the foundation of treatment for mild to moderate acne. They include retinoids, benzoyl peroxide, azelaic acid and topical antibiotics, often used in combination. They take several weeks to work and are usually continued long term to keep acne under control.

Oral antibiotics

Tablets may be used for more extensive inflammatory acne. They are always combined with topical treatment and used for a limited period, because of the growing problem of antibiotic resistance.

Hormonal treatments

For some women, particularly those with acne around the jaw, flares linked to their cycle or signs of hormonal imbalance, hormonal treatments can be an effective option.

Oral isotretinoin

Isotretinoin is the most effective treatment for severe acne, acne that is scarring, and acne that has not responded to other treatment. It is prescribed and monitored by specialists because it needs careful safety checks, including strict pregnancy prevention.

Procedures for marks and scars

Once active acne is controlled, treatments such as lasers, chemical peels, microneedling and minor procedures can improve scarring and pigmentation. Most are not available on the NHS.

The challenges of managing acne

Knowing the treatment options is only half the picture. Most of the difficulty lies in matching them to the person in front of you.

Every patient is different

Severity, skin type, age, hormonal factors, other medicines and previous treatment all change what is appropriate. A plan that suits one patient may be unsuitable or unsafe for another.

Skin of colour

Acne in darker skin is more likely to leave pigmentation and, in some people, raised scars. Redness can be harder to see, so inflammation may be underestimated. Treatments that irritate the skin can themselves cause dark marks, so approaches often need adapting.

Pregnancy and planning a pregnancy

Several of the most effective acne treatments are not safe in pregnancy. Managing acne in someone who is pregnant, breastfeeding or planning a family needs particular care.

Children and adolescents

Acne in young children is uncommon and can occasionally signal an underlying hormonal problem. Many treatments are licensed only from certain ages.

Antibiotic resistance

Acne has historically been one of the biggest drivers of long-term antibiotic use in dermatology. Using antibiotics wisely is now an essential part of good acne care.

Adherence and expectations

Most acne treatments take two to three months to show results and can cause dryness or irritation at first. Many people stop too early. Social media adds to the challenge, with fast-moving trends, DIY remedies and unrealistic before-and-after images shaping what patients expect.

Mental health

Acne can have a profound emotional impact that is not always visible in clinic. Asking about mood and wellbeing is an important part of every consultation.

Introducing the Acne Companion (click on the icon below)

Bright Med has launched the Acne Companion, an interactive tool that helps clinicians work through acne treatment options for the individual patient.

Clinicians enter the patient's scenario, including acne severity, skin of colour considerations, pregnancy, age and previous treatment. The Acne Companion then guides them through the options to consider, the treatments to avoid, and the safety points and checks that apply. It is designed to support clinical judgement, not replace it.

The Acne Companion is available exclusively to registered Bright Med members, from the Bright Med Education page and the member dashboard.

Sign in to open the Acne Companion. Not yet a member? Registration is open to UK healthcare professionals.

Frequently asked questions

What are the main treatment options for acne?

Acne treatment options include skincare and general measures, topical treatments such as retinoids, benzoyl peroxide and azelaic acid, oral antibiotics used for a limited time alongside topical treatment, hormonal treatments for some women, and oral isotretinoin for severe or scarring acne. Procedures can help with scars and marks once acne is controlled.

Why is acne difficult to treat?

Treatment has to be matched to the individual, taking into account severity, skin type, age, pregnancy, other medicines and previous treatment. Results take weeks to appear, side effects can lead people to stop early, and antibiotic resistance limits long-term antibiotic use.

Can acne cause permanent scarring?

Yes. Acne can cause permanent scars, and the risk is higher when effective treatment is delayed. Treating acne early is the best way to prevent scarring.

Is acne different in darker skin?

Acne in darker skin is more likely to leave dark marks and, in some people, raised scars. Redness can be harder to see, and irritating treatments can themselves trigger pigmentation, so treatment often needs adapting.

Does acne affect mental health?

Yes. Acne is linked with higher rates of anxiety and low mood and can affect confidence and quality of life. Asking about wellbeing is an important part of managing acne.

What is the Acne Companion?

The Acne Companion is an interactive tool from Bright Med that helps clinicians work through acne treatment options for an individual patient, taking into account severity, skin of colour, pregnancy, age and previous treatment. It is available to registered Bright Med members.

Learn more with Bright Med

Bright Med provides CPD-accredited dermatology education for UK healthcare professionals. Explore our CPD-accredited dermatology courses and look out for future workshops in the Bright Med events calendar.