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Acne - Moderate to Severe
Acne - Moderate to Severe
The Doctor Service offers the most commonly GP reocmmended prescription-only moderate-severe acne treatment products: Lmecycline, Doxycycline, Tetracycline and Oxytetracycline. These treatments help to reduce the severity and are indicated for moderate to severe acne, and are combined with cream or gel-based treatments. 
If you have milder symptoms visit our page on mild acne treatments.

The information on this page will enable you to select the treatment that is right for you.
  • Doxycycline
  • Lymecycline
  • Oxytetracycline
  • Tetracycline
Doxycycline 100mg only 
Doxycycline 100mg only
Doxycycline 100mg only
  • £20.00
     
  • £35.00
     
  • £45.00
     
 
Doxycycline 100mg & Benzoyl Peroxide 5% 
Doxycycline 100mg & Adapalene (Cream) 0.1% 
Doxycycline 100mg & Adapalene (Gel) 0.1% 
  • Key Information
  • Effectiveness
  • Side Effects
  • Full patient info leaflet
  • Key Information
    Doxycycline is an antibiotic and is particularly effective at treating acne.
     
  • How to Take Doxycycline
    Doxycycline should be taken once daily. We recommend that you take during the day with a meal - e.g. breakfast or lunch to reduce the risk of stomach-related side effects. See Side Effects for further information. The length of treatment is a minimum trial period of 12 weeks, with significant results usually seen by about 6 weeks of treatment.
     
  • Prescribed with a Non-antibiotic topical treatment (Epiduo, Adapalene or Isotrex)
    The Doctor Service prescribes this medication with topical treatments which is in-line with best practice guidance in the UK. The total charge includes the topical treatments. If you already have a topical treatment then you can order the antibiotic without topical treatments.
     
  • Information on topical treatments
    You should check all the information available by The Doctor Service on topical treatments here: bit.ly/acnetopicaltreatments
     
  • How to use topical treatments
    Topical treatments should be applied, once daily at night after using a face wash.
     
  • Effectiveness
    Doxycycline along with topical treatment, has been shown to be more effective than using a topical treatment on its own. if you have moderate to severe acne then this would be the best treatment option for you, particularly if you have tried topical treatments on their own without much success.
     
  • 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.
     
  • Iron, Magnesium & Zinc
    If you are taking Iron, Magnesium or Zinc then you should take this at a different time to Doxycycline, at least 3 hours apart as they can reduce the absorption and effectiveness of Doxycycline if taken at the same time.
     
  • Common side effects (less than 1 in 10)
    Doxycycline is a well tolerated medication for most people, however some people can develop stomach-related side effects including nausea and heartburn. We recommend you take this medication during the day with food to reduce the risks of this occurring.
     
  • Uncommon Side Effects (less than 1 in 100)
    Gastritis, worsening heartburn and reflux. Vaginal infections
     
  • Rare Side Effects (less than 1 in 1,000 people affected)
    Diarrhoea, stomach pain, difficulty swallowing, red skin, inflammation of liver. There are other different types of side effects reported, all which are rare. To see the full list please see the Patient Information Leaflet.
     
  • Very rare side effects (less than 1 in 10,000 people affected)
    Very rare side effects include abdominal pain, discolouration of teeth (usually long term use only), increased sensitivity to sunlight and muscle or joint pain. If you develop any changes with your vision you should stop the medication and seek further health advice urgently.
     
  • Allergy
    You should stop using this medication if you develop signs of a serious allergy. Symptoms include swelling of the face, eyes, lips, tongue or difficulty breathing. Other symptoms may include diarrhoea, cramps, severe burning, peeling of skin or itching. You should seek medical attention from a health professional as soon as possible. This is a precautionary message for people taking any new 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.
     
  • Check the Patient Information Leaflet
    Check the Patient Information Leaflet for more information on potential side effects, including the Patient Information Leaflet for the topical treatment you are selecting from bit.ly/acnetopicaltreatments
     
  • 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
     
Lymecycline 408mg only 
Lymecycline 408mg only
Lymecycline 408mg only
  • £19.50
     
  • £28.50
     
  • £38.50
     
 
Lymecycline 408mg & Benzoyl Peroxide 5% 
Lymecycline 408mg & Adapalene (Cream) 0.1% 
Lymecycline 408mg & Adapalene (Gel) 0.1% 
  • Key Information
  • Effectiveness
  • Side Effects
  • Full patient info leaflet
  • Key Information
    Lymecycline is an antibiotic and particularly effective at treating acne, and is also known by the brand name Tetralysal.
     
  • How to Take Lymecycline
    Lymecycline comes in 408mg capsules, taken once daily. We recommend that you take during the day with a meal - e.g. breakfast or lunch to reduce the risk of stomach-related side effects. See Side Effects for further information. The length of treatment is a minimum trial period of 12 weeks, with significant results usually seen by about 6 weeks of treatment.
     
  • Prescribed with a Non-antibiotic topical treatment (Epiduo, Adapalene or Isotrex)
    The Doctor Service prescribes this medication with topical treatments which is in-line with best practice guidance in the UK. The total charge includes the topical treatments. If you already have a topical treatment then you can order the antibiotic without topical treatments.
     
  • Information on topical treatments
    You should check all the information available by The Doctor Service on topical treatments here: bit.ly/acnetopicaltreatments
     
  • How to use topical treatments
    Topical treatments should be applied, once daily at night after using a face wash.
     
  • Effectiveness
    Lymecycline when used with a topical treatment has been shown to be more effective than using a topical treatment on its own. If you have moderate to severe acne then this would be the best treatment option for you, particularly if you have tried topical treatments on their own without much success.
     
  • 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.
     
  • Iron, Magnesium & Zinc
    If you are taking Iron, Magnesium or Zinc then you should take this at a different time to Lymecycline, at least 3 hours apart as they can reduce the absorption and effectiveness of Lymecycline if taken at the same time.
     
  • Common Side Effects (less than 1 in 10)
    Lymecycline is a well tolerated medication for most people, however some people can develop stomach-related side effects including nausea, abdominal pain and diarrhoea. We recommend you take this medication during the day with food to reduce the risks of this occurring. Headaches can sometimes occur too.
     
  • Rare Side Effects (unknown frequency)
    There are many rare side effects that have been reported which include increased sensitivity to sunlight, itching, fever and liver changes. A full list is provided within the Patient Information Leaflet, which includes side effects reported by the class of medicines Lymecycline belongs to - Tetracyclines.
     
  • 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.
     
  • Topical Treatment Side Effects
    Please ensure you check the side effects of the topical treatments, which are highlighted on the topical treatments page, and within the information provided below.
     
  • Patient Information Leaflet
    Check the Patient Information Leaflet for more information on potential side effects, including the Patient Information Leaflet for the topical treatment you are selecting from bit.ly/acnetopicaltreatments
     
  • 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
     
Oxytetracycline 250mg only 
Oxytetracycline 250mg only
Oxytetracycline 250mg only
  • £20.00
     
  • £25.00
     
  • £35.00
     
 
Oxytetracycline 250mg & Benzoyl Peroxide 5% 
Oxytetracycline 250mg & Adapalene (Cream) 0.1% 
Oxytetracycline 250mg & Adapalene (Gel) 0.1% 
  • Key Information
  • Effectiveness
  • Side Effects
  • Full patient info leaflet
  • Key Information
    Oxytetracycline is an antibiotic which is particularly effective at treating acne
     
  • How To Take Oxytetracycline
    Oxytetracycline comes as 250mg tablets. 2 tablets need to be taken four times per day as a treatment regime, and usual treatment length is for 12 weeks. Significant results are usually seen 4-6 weeks after starting treatment.
     
  • Prescribed with a Non-antibiotic topical treatment (Epiduo, Adapalene or Isotrex)
    The Doctor Service prescribes this medication with topical treatments which is in-line with best practice guidance in the UK. The total charge includes the topical treatments. If you already have a topical treatment then you can order the antibiotic without topical treatments.
     
  • Information on topical treatments
    You should check all the information available by The Doctor Service on topical treatments here: bit.ly/acnetopicaltreatments
     
  • How to use topical treatments
    Topical treatments should be applied, once daily at night after using a face wash.
     
  • Effectiveness
    Oxytetracycline along with topical treatment, has been shown to be more effective than using a topical treatment on its own. if you have moderate to severe acne then this would be the best treatment option for you, particularly if you have tried topical treatments on their own without much success.
     
  • 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.
     
  • Iron, Magnesium & Zinc
    If you are taking Iron, Magnesium or Zinc then you should take this at a different time to Doxycycline, at least 3 hours apart as they can reduce the absorption and effectiveness of Doxycycline if taken at the same time.
     
  • Common side effects
    Oxytetracycline has similar side effects to doxycycline and lymecycline as they are part of the same group of antibiotics known as lymecyclines. Most common side effects are stomach-related, including nausea and heartburn. We recommend you take this medication during the day with food to reduce the risks of this occurring.
     
  • Rare Side Effects (frequency unknown)
    Gastritis, worsening heartburn or reflux, sensitivity to sunlight, inflammation of the liver and red skin. To see the full list please see the Full Patient Information Leaflet
     
  • Very rare side effects (frequency unknown)
    Very rare side effects include abdominal pain, discolouration of teeth (usually long term use only), Muscle or joint pain. If you develop any changes with your vision you should stop the medication and seek further health advice urgently.
     
  • Allergy
    You should stop using this medication if you develop signs of a serious allergy. Symptoms include swelling of the face, eyes, lips, tongue or difficulty breathing. Other symptoms may include diarrhoea, cramps, severe burning, peeling of skin or itching. You should seek medical attention from a health professional as soon as possible. This is a precautionary message for people taking any new 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.
     
  • Check the Patient Information Leaflet
    Check the Patient Information Leaflet for more information on potential side effects, including the Patient Information Leaflet for the topical treatment you are selecting from bit.ly/acnetopicaltreatments
     
  • 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
     
Tetracycline 250mg only 
Tetracycline 250mg only
Tetracycline 250mg only
  • £20.00
     
  • £35.00
     
  • £50.00
     
 
Tetracycline 250mg & Benzoyl Peroxide 5% 
Tetracycline 250mg & Adapalene (Cream) 0.1% 
Tetracycline 250mg & Adapalene (Gel) 0.1% 
  • Key Information
  • Effectiveness
  • Side Effects
  • Full patient info leaflet
  • Key Information
    Tetracycline is an antibiotic and is particularly effective at treating acne.
     
  • How to Take Tetracycline
    Tetracycline comes in 250mg tablets, with 2 tablets taken twice daily. The length of treatment is a minimum trial period of 12 weeks, with significant results usually seen by about 6 weeks of treatment.
     
  • Prescribed with a Non-antibiotic topical treatment (Epiduo, Adapalene or Isotrex)
    The Doctor Service prescribes this medication with topical treatments which is in-line with best practice guidance in the UK. The total charge includes the topical treatments. If you already have a topical treatment then you can order the antibiotic without topical treatments.
     
  • Information on topical treatments
    You should check all the information available by The Doctor Service on topical treatments here: bit.ly/acnetopicaltreatments
     
  • How to use topical treatments
    Topical treatments should be applied, once daily at night after using a face wash.
     
  • Effectiveness
    Tetracycline along with topical treatment, has been shown to be more effective than using a topical treatment on its own. if you have moderate to severe acne then this would be the best treatment option for you, particularly if you have tried topical treatments on their own without much success.
     
  • 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.
     
  • Iron, Magnesium & Zinc
    If you are taking Iron, Magnesium or Zinc then you should take this at a different time to Doxycycline, at least 3 hours apart as they can reduce the absorption and effectiveness of Doxycycline if taken at the same time.
     
  • Side Effects
    There are no modern clinical studies available that can be used to determine the frequency of undesirable effects. Tetracycline is a similar antibiotic to doxycycline, lymecycline and oxytetracycline, and they make up a family of antibiotics known as tetracyclines.
     
  • Common side effects
    Most common side effects are stomach-related, including nausea and heartburn. We recommend you take this medication during the day with food to reduce the risks of this occurring.
     
  • Rare Side Effects (frequency unknown)
    Gastritis, worsening heartburn or reflux, sensitivity to sunlight, inflammation of the liver and red skin. To see the full list please see the Full Patient Information Leaflet
     
  • Very rare side effects (frequency unknown)
    Very rare side effects include abdominal pain, discolouration of teeth (usually long term use only), Muscle or joint pain. If you develop any changes with your vision you should stop the medication and seek further health advice urgently.
     
  • Allergy
    You should stop using this medication if you develop signs of a serious allergy. Symptoms include swelling of the face, eyes, lips, tongue or difficulty breathing. Other symptoms may include diarrhoea, cramps, severe burning, peeling of skin or itching. You should seek medical attention from a health professional as soon as possible. This is a precautionary message for people taking any new 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.
     
  • Check the Patient Information Leaflet
    Check the Patient Information Leaflet for more information on potential side effects, including the Patient Information Leaflet for the topical treatment you are selecting from bit.ly/acnetopicaltreatments
     
  • 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.
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. All treatments below should be trialled for a minimum of 8 weeks and we recommend treatment plans of 12 weeks (3 months), but most individuals will see a response within 3-4 weeks and sometimes earlier when using the medications.
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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