Acne is one of the most common skin conditions in the UK, and it can be troublesome to clear up. Most people looking for an acne treatment option find a combination of over-the-counter or prescription products works well, once they understand which ingredients and treatments are best suited to them.
This guide explains how the main topical treatments work, what to expect from each, and when it's worth speaking to your GP for further advice.
What causes acne?
Acne vulgaris develops when hair follicles become blocked with excess oil (sebum) and dead skin cells, creating conditions where the skin bacterium Cutibacterium acnes can multiply and trigger inflammation. Hormonal changes are a major driver of this process, which is why breakouts are so closely linked to puberty, the menstrual cycle, pregnancy and conditions such as polycystic ovary syndrome (PCOS).1 This hormonal link is particularly relevant for teenage acne treatment, but it's just as important in adult and hormonal acne, which can appear for the first time well into your twenties or thirties. Genetics also play a role, which is why acne often runs in families.
Because these factors overlap, most effective treatments work by targeting one or more of them directly: unblocking pores, slowing oil production, reducing acne-causing bacteria, or calming inflammation.
What acne treatments are available in the UK?
There's no single best acne treatment option available in the UK that suits everyone. The right choice depends on whether your acne is mainly blackheads and whiteheads, inflamed spots, or a mix of both, and most people need to use a treatment consistently for a few months before judging whether it's working.
As a general guide, mild acne treatment usually starts with a single topical ingredient such as a retinoid or benzoyl peroxide alone. Moderate acne, with more widespread inflamed spots, often responds better to a combination product. Severe acne treatment, involving painful nodules or cysts, is more likely to need input from a GP or dermatologist alongside anything used topically.
Topical retinoids
Differin contains adapalene, a retinoid-like ingredient available as both a gel and a cream, which works by speeding up skin cell turnover to help unblock pores and stop new spots from forming.2 It's applied once daily, usually in the evening, and is recommended by NICE as a first-line topical option for mild to moderate acne.1
Combination gels
Pairing a retinoid with benzoyl peroxide targets more than one cause of acne at once. Epiduo and the generic adapalene and benzoyl peroxide gel both combine adapalene with benzoyl peroxide, which works as an antiseptic to reduce bacteria on the skin's surface and has an anti-inflammatory effect of its own.3 NICE recommends this fixed combination as a first-line maintenance option, and it's often considered one of the best over-the-counter acne treatments for mild to moderate breakouts that haven't responded to a single ingredient alone.1
Antibacterial gels
Duac combines benzoyl peroxide with the topical antibiotic clindamycin and is generally used for spots with more visible inflammation. Because benzoyl peroxide can bleach hair, clothing and towels, try to let it dry fully before it comes into contact with any fabric.
Cleansers
A gentle, non-drying cleanser won't clear acne on its own, but it supports whichever active treatment you're using. Products such as the Cetaphil Gentle Cleanser are formulated to avoid stripping the skin, which matters because over-washing or scrubbing can make irritation from active treatments worse.
When treatment needs to go further
Persistent or cystic acne treatment usually needs to go beyond topical products. A GP may prescribe oral antibiotics alongside a topical treatment, or in women, the combined contraceptive pill as a hormonal acne treatment, which can help by reducing the hormonal drive behind breakouts.3 These options sit outside Pharmica's online range and need a face-to-face or GP consultation.
How long do acne treatments take to work?
This is one of the most frequently asked questions about any acne treatment and the honest answer is: longer than most people expect. Topical treatments such as Differin, Epiduo and Duac typically need 8 to 12 weeks of consistent daily use before you see a meaningful improvement, and it's common for skin to look slightly worse in the first couple of weeks as underlying blockages come to the surface.1 Hormonal treatments, including the combined contraceptive pill, can take considerably longer, sometimes up to a year for the full effect to show.3
Switching products too early, before a full course has had the chance to work, is one of the most common reasons an acne treatment appears to fail when it hasn't been given the time to work properly.
What side effects can acne treatments cause?
Topical acne treatments are generally well tolerated, but some irritation is common, especially in the first few weeks:
- Dryness and skin irritation - common (affects up to 1 in 100 people) with retinoids and benzoyl peroxide. A fragrance-free moisturiser applied a little while after the active treatment can help.
- Redness and a burning sensation - common, particularly when starting treatment. Using it on alternate nights to begin with, then building up to daily use, can reduce this.
- Sunburn or sun sensitivity - uncommon (affects up to 1 in 1,000 people) but reported with adapalene. A daily SPF is still recommended as a precaution while using any topical retinoid.
- Bleaching of hair or fabric - a known property of benzoyl peroxide rather than a skin side effect. Avoid contact with towels, pillowcases and coloured clothing until the product has dried.
Topical retinoids such as adapalene must not be used during pregnancy or if you're planning a pregnancy, as they are contraindicated at this time. Speak to a pharmacist about suitable alternatives if this applies to you.2
When should you see a GP about acne?
Speak to a GP or dermatologist if:
- Your acne hasn't improved after two full 12-week courses of topical treatment
- You have nodules, cysts, or acne that's starting to scar
- Acne is affecting your mental health or self-confidence
- You suspect an underlying hormonal cause, such as PCOS
A GP can prescribe oral antibiotics, hormonal treatments, or refer you to a dermatologist for options such as isotretinoin in more severe or scarring cases.4
Frequently Asked Questions
How long does acne treatment take to work?
Most topical treatments, including Differin, Epiduo and Duac, need 8 to 12 weeks of consistent
daily use before you see a real improvement. It's common for skin to look slightly worse in the
first couple of weeks as blockages come to the surface, so try not to judge a treatment too early.
Can Differin (adapalene) make acne worse before it gets better?
Yes, and this is expected. Adapalene speeds up skin cell turnover, so in the first few weeks it
can bring underlying blockages to the surface before skin starts to clear. Mild redness, dryness
or a short-lived flare are common early on and usually settle with continued use.
What's the difference between Epiduo and Duac?
Epiduo combines adapalene (a retinoid) with benzoyl peroxide, while Duac combines benzoyl peroxide
with the antibiotic clindamycin. Epiduo tends to suit a broader mix of blackheads, whiteheads and
inflamed spots, while Duac is generally used for more visibly inflamed, bacterial-driven breakouts.
Is benzoyl peroxide safe to use every day?
For most people, yes, though it's best to start on alternate days or with short-contact use
(washing it off after an hour) to reduce irritation, then build up to daily use as your skin
tolerates it. It can bleach hair and fabric, so let it dry fully before it touches towels or clothing.
What is the best acne treatment UK pharmacies offer without a prescription?
Topical retinoids such as Differin and combination gels such as Epiduo are among the most
effective over-the-counter and pharmacy options for mild to moderate acne, though which one
suits you best depends on your acne type and how sensitive your skin is.
Can I use adapalene during pregnancy?
No. Topical retinoids, including adapalene, are contraindicated during pregnancy and when
planning a pregnancy. Speak to a pharmacist or GP about pregnancy-safe alternatives.
Does Duac help with acne scars?
Duac treats active, inflamed acne rather than existing scarring. Treating breakouts early and
consistently reduces the risk of new scars forming, but established scarring usually needs a
separate approach from a dermatologist.
When should I see a GP instead of using over-the-counter treatment?
See a GP if your acne hasn't improved after two full 12-week courses of treatment, if you have
nodules, cysts or scarring, if it's affecting your mental health, or if you suspect a hormonal
cause such as PCOS.
References
- National Institute for Health and Care Excellence. Acne vulgaris: management. NICE guideline NG198; 2021. nice.org.uk
- Electronic Medicines Compendium. Differin Gel Summary of Product Characteristics. eMC. medicines.org.uk/emc
- NHS. Acne - Treatment. nhs.uk
- GPnotebook. Referral criteria from primary care: acne vulgaris. gpnotebook.com
This article is intended for informational purposes only and does not replace professional medical advice. Always read the patient information leaflet supplied with your medication and speak to a healthcare professional if you have specific concerns.