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Acne - Mild to Moderate
Acne - Mild to Moderate
The Doctor Service offers the most commonly GP reocmmended prescription-only treatment products: Duac, Epiduo, Adapalene and Isotrex. These products help to reduce the severity of acne and formation of spots for mild to moderate acne. If your acne is severe we recommend using treatments for moderate to severe acne. 

The information here should enable you to select the treatment that is right for you.
  • Adapalene 0.1% (Differin)
  • Duac Once Daily 3%
  • Duac Once Daily 5%
  • Epiduo 2.5%
  • Isotrex Gel
Adapalene 0.1% 
Adapalene 0.1%
Adapalene 0.1%
  • £32.00
     
  • £32.00
     
  • £55.00
     
  • £55.00
     
 
  • Key Information
  • Effectiveness
  • Side Effects
  • Full patient info leaflet
  • Key Information
    Adapalene comes as a cream or gel and is licensed for the treatment of mild to moderate acne. Most people will see an improvement of their acne with Adapalene. Adapalene is also part of the product Epiduo, which also contains the Benzoyl Peroxide, an antiseptic.
     
  • What is Adapalene?
    Adapalene is a substance that is part of the retinoid family, which are derivatives of Vitamin A. Retinoids are prescription only medications. Milder version of retinoids, known as retinols can be bought in non-prescription forms. The body needs to convert these to retinoids so can take much longer to work.
     
  • How to Use Adapalene
    Wash your face before applying, and apply thinly, once daily in the evening.
     
  • Gel or Cream?
    It's your choice as to which you prefer to use. They should both be equally effective and have the same risk of side effects.
     
  • Effectiveness
    Adapalene has been shown to be very effective in the treatment of mild to moderate acne.
     
  • Time To Work
    Most people will start to see improvements in their skin within 6-8 weeks but the biggest benefits are usually seen after 12 weeks of treatment.
     
  • Effectiveness
    If the treatment is not effective for you, a different topical preparation should be considered, or if your acne is moderate to severe, you should consider oral (tablet-based) treatments.
     
  • Common Side Effects (less than 1 in 10)
    Dry, mild skin irritation, redness or mild burning of the skin.
     
  • Uncommon Side Effects (less than 1 in 100)
    More severe skin reactions include sensitivity to sunlight (sunburn), skin itching, peeling, worsening of acne.
     
  • Side Effects not tolerated
    These side effects above are usually tolerated quite well and tend to settle down after a few weeks. If they are worsening or not settling down throughout the treatment, you should consider stopping and seeking further advice.
     
  • Allergy
    If you develop signs of a serious allergy using this medication then you should stop using the gel. If you notice swelling of face, eyes, lips, tongue or difficulty breathing, develop diarrhoea, cramps, severe burning, peeling of skin or itching then these could be signs of a severe allergic reaction and you should seek medical attention from a health professional as soon as possible. This is a precautionary message for people taking any medicine.
     
  • Advice for Women & Contraception
    You should not use this medicine if you are pregnant or breast feeding, as the medication could harm your baby. It there is a chance you could be pregnant you should also not use this medication. If you are sexually active then we recommend that you use long-term contraception to help prevent pregnancy. For example the use of pills, coil or an implant.
     
  • Further Information
    For further information on the medication including potential side effects please see the patient information leaflet.
     
  • Reporting Side Effects
    You can report side effects directly to the Medicines and Healthcare products Regulatory Agency (MHRA) via the link www.mhra.gov.uk/yellowcard
     
Duac Once Daily 3% 
Duac Once Daily 3%
Duac Once Daily 3%
  • £24.00
     
  • £42.50
     
 
  • Key Information
  • Effectiveness
  • Side Effects
  • Full patient info leaflet
  • Key Information
    Duac is a medication containing two ingredients: Clindamycin and Benzoyl Peroxide. It comes in two strengths - 3% and 5%. The strength is related to the amount of Benzoyl Peroxide within the treatments. This treatment is for the 3% strength.
     
  • How it works
    The 2 ingredients: Clindamycin is an antibiotic. It helps to prevent growth and kill bacteria. Benzoyl peroxide helps to prevent pores becoming clogged and also kills acne-causing bacteria.
     
  • How to use duac
    Wash your face before applying, apply thinly, once daily in the evening.
     
  • Should you use 5% or 3%?
    5% is a slightly stronger preparation but puts you at slightly higher risk of side effects including skin irritation and dryness of the skin.
     
  • Effectiveness
    Most people taking Duac will notice a significant improvement in the frequency of new acne spots. It usually doesn't completely stop new acne spots, but there is usually a significant reduction.
     
  • Time to work
    Most people will start to see significant results within 6-8 weeks, sometimes earlier. However for some people it can take up to 12 weeks to see improvements.
     
  • Effectiveness
    It is a milder form of prescription only medication, and in some people it does not work very well. In these cases, a different topical preparation should be considered, but if acne is particularly bad, then other treatments may be required, for example tablet based treatments.
     
  • Very common side effects (more than 1 in 10)
    Dry skin is the most commonly reported side effect. The 3% preparation is less likely to cause this. If you suffer from oily skin then this can be beneficial, but dry skin doesn't always occur. Some people experience some mild skin irritation which may feel like a mild burning sensation or some redness of skin. These symptoms happen most commonly in the first few weeks of use but usually improve. We recommend the regular use of a moisturiser to reduce the discomfort of this if it occurs. If it doesn't settle down we recommend a further review or changing the treatment.
     
  • Common side effects (less than 1 in 10)
    Some people report a headache with use of the cream. If you think your headache is a result of the treatment or not settling then you should seek further health advice.
     
  • Rare side effects (less than 1 in 100)
    Rarely some people may find worsening of acne.
     
  • Allergy
    If you develop signs of a serious allergy using this medication then you should stop using the gel. If you notice swelling of face, eyes, lips, tongue or difficulty breathing, develop diarrhoea, cramps, severe burning, peeling of skin or itching then these could be signs of a severe allergic reaction and you should seek medical attention from a health professional as soon as possible. This is a precautionary message for people taking any medicine.
     
  • Check the Patient Information Leaflet
    Please check the Full Patient Information Leaflet for further information on the medication including less common side effects.
     
  • Reporting Side Effects
    You can report side effects directly to the Medicines and Healthcare products Regulatory Agency (MHRA) via the link www.mhra.gov.uk/yellowcard
     
Duac Once Daily 5% 
Duac Once Daily 5%
Duac Once Daily 5%
  • £30.50
     
  • £55.00
     
 
  • Key Information
  • Effectiveness
  • Side Effects
  • Full patient info leaflet
  • Key Information
    Duac is a medication containing two ingredients: Clindamycin and Benzoyl Peroxide. It comes in two strengths - 3% and 5%. The strength is related to the amount of Benzoyl Peroxide within the treatments. This treatment is for the 5% strength.
     
  • How it works
    The 2 ingredients: Clindamycin is an antibiotic. It helps to prevent growth and kill bacteria. Benzoyl peroxide helps to prevent pores becoming clogged and also kills acne-causing bacteria.
     
  • How to use duac
    Wash your face before applying, apply thinly, once daily in the evening.
     
  • Effectiveness
    Most people taking Duac will notice a significant improvement in the frequency of new acne spots. It usually doesn't completely stop new acne spots, but there is normally a significant reduction.
     
  • Time to work
    Most people will start to see significant results within 6-8 weeks, sometimes earlier. However, some people can take up to 12 weeks to see improvements.
     
  • Effectiveness
    If the treatment is not effective for you, a different topical preparation should be considered, or if your acne is moderate to severe, you should consider oral (tablet-based) treatments.
     
  • Should you use 5% or 3%?
    5% is a slightly stronger preparation but puts you at slightly higher risk of side effects including skin irritation and dryness of the skin.
     
  • Very common side effects (more than 1 in 10)
    Dry skin is the most commonly reported side effect. The 5% preparation is slightly more likely to cause this. If you suffer from oily skin then this can be beneficial, but dry skin doesn't always occur. Some people experience some mild skin irritation which may feel like a mild burning sensation or some redness of skin. These symptoms happen most commonly in the first few weeks of use but usually improve. We recommend the regular use of a moisturiser to reduce the discomfort of this if it occurs. If it doesn't settle down, we recommend a further review or changing the treatment.
     
  • Common side effects (less than 1 in 10)
    Some people report a headache with use of the cream. If you think your headache is a result of the treatment or not settling then you should seek further health advice.
     
  • Rare side effects (less than 1 in 100)
    Rarely some people may find worsening of acne.
     
  • Allergy
    If you develop signs of a serious allergy using this medication then you should stop using the gel. If you notice swelling of face, eyes, lips, tongue or difficulty breathing, develop diarrhoea, cramps, severe burning, peeling of skin or itching then these could be signs of a severe allergic reaction and you should seek medical attention from a health professional as soon as possible. This is a precautionary message for people taking any medicine.
     
  • Check the Patient Information Leaflet
    Please check the Full Patient Information Leaflet for further information on the medication including less common side effects.
     
  • Reporting Side Effects
    You can report side effects directly to the Medicines and Healthcare products Regulatory Agency (MHRA) via the link www.mhra.gov.uk/yellowcard
     
Epiduo 0.1%/2.5% 
Epiduo 0.1%/2.5%
Epiduo 0.1%/2.5%
  • £33.00
     
  • £52.50
     
  • £76.50
     
 
  • Key Information
  • Effectiveness
  • Side Effects
  • Full patient info leaflet
  • Key Information
    Epiduo gel contains 2 active ingredients: Adapalene 0.1% and Benzoyl Peroxide 2.5%.
     
  • How it works
    Adapalene helps with skin regeneration and reduces growth of keratin surface skin cells which can block pores and in turn reduces the formation of black and whiteheads. Benzoyl Peroxide is an antiseptic which helps to kill acne-causing bacteria.
     
  • How to use epiduo
    Wash your face before applying, and apply thinly, once daily in the evening.
     
  • Effectiveness
    Most people taking Epiduo will notice a significant improvement in the frequency and severity of new acne spots. It usually doesn't completely stop new acne spots, but there is normally a significant reduction.
     
  • Effectiveness
    Most people see significant results within 6-8 weeks, but it can take up to 12 weeks.
     
  • Effectiveness
    If the treatment is not effective for you, a different topical preparation should be considered, or if your acne is moderate to severe, you should consider oral (tablet-based) treatments.
     
  • Common Side Effects (less than 1 in 10)
    Epiduo is a well-tolerated medication but potential common side effects including dry, red or peeling skin. It can sometimes cause irritation and increased sensitivity to light. If you stop using the medication these side effects do go away, and usually improve with on-going use of the medication. If they are severe or not improving then you should stop using the product and get reviewed by a health professional.
     
  • Uncommon Side Effects (less than 1 in 100)
    There is a small risk that you could develop itching or have increased sensitivity to the sun, increasing the chance of sunburn.
     
  • Allergy
    If you develop signs of a serious allergy using this medication then you should stop using the gel. If you notice swelling of face, eyes, lips, tongue or difficulty breathing, develop diarrhoea, cramps, severe burning, peeling of skin or itching then these could be signs of a severe allergic reaction and you should seek medical attention from a health professional as soon as possible. This is a precautionary message for people taking any medicine.
     
  • Advice for Women & Contraception
    You should not use this medicine if you are pregnant or breast feeding, as the medication could harm your baby. It there is a chance you could be pregnant you should also not use this medication. If you are sexually active then we recommend that you use long-term contraception to help prevent pregnancy. For example the use of pills, coil or an implant.
     
  • When Not To Use
    As mentioned do not use this medication if you are pregnant. You should also not use this medication if you've had a serious adverse reaction to retinoid or benzoyl peroxide containing medications in the past. This includes developing severe side effects described above, as well as difficulty breathing or swelling of the throat, mouth, tongue or lips.
     
  • Further Information
    Please check the Full Patient Information Leaflet for further information on the medication including less common side effects.
     
  • Reporting Side Effects
    You can report side effects directly to the Medicines and Healthcare products Regulatory Agency (MHRA) via the link www.mhra.gov.uk/yellowcard
     
Isotrex Gel 0.05% 
Isotrex Gel 0.05%
Isotrex Gel 0.05%
  • £19.50
     
  • £32.50
     
  • £42.50
     
 
  • Key Information
  • Effectiveness
  • Side Effects
  • Full patient info leaflet
  • Key Information
    Isotrex is the brand name for Isotretinoin gel.
     
  • What is Isotrex?
    Isotrex is a substance that is part of the retinoid family, which are derivatives of Vitamin A. Retinoids are prescription only medications. Milder version of retinoids, known as retinols can be bought in non-prescription forms. The body needs to convert these to retinoids so can take much longer to work.
     
  • How To Use Isotrex
    Wash your face before applying, and apply thinly, once daily in the evening.
     
  • Effectiveness
    Isotrex has been shown to be very effective in the treatment of mild to moderate acne.
     
  • Time To Work
    Most people will start to see improvements in their skin within 6-8 weeks but the biggest benefits are usually seen after 12 weeks of treatment.
     
  • Effectiveness
    If the treatment is not effective for you, a different topical preparation should be considered, or if your acne is moderate to severe, you should consider oral (tablet-based) treatments.
     
  • Very common Side Effects (more than 1 in 10)
    The medication can sometimes cause dry, red or peeling skin. It can sometimes cause irritation and increased sensitivity to light. If you stop using the medication then these side effects do go away. You can reduce the frequency or give a few days break to see if this helps with these side effects.
     
  • Other Rare Side Effects (unknown frequency)
    Darkening or lightening of the skin and sensitivity to sunlight
     
  • Allergy
    If you develop signs of a serious allergy using this medication then you should stop using the gel. If you notice swelling of face, eyes, lips, tongue or difficulty breathing, develop diarrhoea, cramps, severe burning, peeling of skin or itching then these could be signs of a severe allergic reaction and you should seek medical attention from a health professional as soon as possible. This is a precautionary message for people taking any medicine.
     
  • Advice for Women & Contraception
    You should not use this medicine if you are pregnant or breast feeding, as the medication could harm your baby. It there is a chance you could be pregnant you should also not use this medication. If you are sexually active then we recommend that you use long-term contraception to help prevent pregnancy. For example the use of pills, coil or an implant.
     
  • Patient Information Leaflet
    For further information on the medication including potential side effects please see the patient information leaflet.
     
  • Reporting Side Effects
    You can report side effects directly to the Medicines and Healthcare products Regulatory Agency (MHRA) via the link www.mhra.gov.uk/yellowcard
     
How severe is your acne?
Mild acne
  • Mostly whiteheads and blackheads which are not significantly inflamed. 
  • The spots are on the surface rather than deep within the skin. 
  • Occasional larger red pimples.
  • You do not get cysts or large nodular or painful breakouts. 
  • You do not get scars. 
Moderate acne
  • Like mild acne but an increase in severity. 
  • More obvious with more whiteheads and/or blackheads. 
  • More common breakouts with inflamed papules and pustules. 
  • Some nodules may be present, some deeper feeling spots. 
  • Over-the-counter treatments do not work well. 
  • Occasional scar formation and/or dark spots. 
If your acne is mild to moderate, we recommend topical treatments as these are easier to take, better tolerated and with less chance of side effects. 

Severe acne
  • A progression from moderate acne. 
  • Widespread blemishes, often seeming to form over each other. 
  • Often deep and painful. 
  • Significant inflammation. 
  • Scarring present. 
  • Over-the-counter treatments are very unlikely to help. 
If your acne is mild to moderate, we recommend topical treatment options.  Topical options are commonly used first if you've not had any treatment for acne before. 

The Acne Visual Dictionary will help you to understand the severity of your acne.

Scarring
If you are getting frequent scarring you might need stronger medications, and due to the increased risk of side effects we are not able to prescribe these for you.If you are getting frequent scarring you might need stronger medications, and due to the increased risk of side effects we are not able to prescribe these for you.
What causes acne?

There are multiple factors that can cause acne to occur. Listed below are some of the main known common causes. 
  • Excess sebum production in skin follicles, which is stimulated due to specific hormones in the body, which are higher during puberty. With acne-affected skin, the dead cells accumulate which then lead to spots of acne. Specific types of bacteria cause acne as they stimulate the production of substances that cause inflammation.

  • An excess immune response leads to more inflammatory cells entering the follicles which lead to the develop of acne-type lesions including papules, pustules, nodules and cysts. 
  • External factors may also affect the development of acne, for example trauma to the skin, use of make-up, topical steroid application and certain medicines. There are other hormonal medical disorders that may also increase the chance of acne developing too.
  • If your mother, father or siblings have suffered from acne, then there is a higher chance you will suffer from acne too, as there is a strong genetic component to acne. A typical Western Diet has been associated with developing more severe acne, however, these findings are difficult to fully interpret due to the different genetic make-up when comparing populations and also separating diet from other aspects in the environment that could potentially affect acne developing.
  • Being significantly overweight (obese) also increases the incidence of acne in people above the age of 20.
Do I need any tests for acne?
Acne is simply diagnosed by its appearance and rarely are hormones tested for acne unless there were other signs or symptoms present. Swabs taken of sites often do not help to determine the type of treatment.
Acne treatments available
For full information on each treatment, including effectiveness and side effects, please select the medication at the top of the page, and click through the headings: Key information, effectiveness, side effects and patient information leaflet. 

Non-prescription products such as face washes may help to treat acne, and products that contain salicylic acid may help to reduce skin cell waste build up in follicles. Products containing Tea Tree Oil may also work in a similar way. 

However, there is a lack of clear evidence that these work well in persistent acne. If you are using any products from The Doctor Service, topical or tablets, we do recommend using a regular face wash, but it is important not to over wash, (maximum twice a day with lukewarm water). 

Chemist.net have face washes for acne available for delivery.

Listed below is a summary of the treatments available with The Doctor Service, and we recommend use of these treatments if the above treatments are not helping on their own. 
Optimising your treatment
Check out our blog post on Optimising Acne Treatments by London & Sao Paulo dermatologist Dr Murakami. 

We recommend all treatments should be used for 3 months for best results, and sometimes there are limited results until at least 6 weeks of treatment. Some creams such as retinoids tend to cause skin sensitivity earlier on in treatments, and this tends to improve during the treatment.
Other Treatment Options
Check the antibiotic oral treatments we have available if your acne is moderate to severe. 

The Combined Oral Contraceptive pill is another option to help manage acne in women as it helps to manage hormonal causes of acne, however this option is of course only available for women, and does not work for all women who try the pill. 

Isotretinoin, also known as Roaccutane is a medication that can be prescribed only by dermatologists and it comes at a significant risk of side effects. Regular blood tests need to be taken every 3 months to ensure that it is not toxic to the body. In cases of particularly severe acne this may be the only effective option.
Other types of Acne
There are other types of Acne which these medications may not be suitable for. If you have been diagnosed with other types of acne, for example Acne Rosacea which tends to affect older adults then you should seek further medical advice.
The use of antibiotics
Antibiotics can do more harm than good when prescribed or taken incorrectly and do not discriminate between good and bad bacteria in the body. By killing the beneficial bacteria in our body, this can given an opportunity for dangerous disease-causing bacteria to grow in their place. 

Antibiotics may also have a number of side effects including vomiting, thrush and diarrhoea, so therefore should only be taken or prescribed when needed. You should complete the entire course of antibiotics.

We take any allegations of inappropriate use of antibiotics seriously at The Doctor Service. You can read more about The Doctor Service commitment to the appropriate use of antibiotics.
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