Treatment–Acne

Treatment for acne depends on how severe it is. It can take several months of treatment before acne symptoms improve.

If you just have a few blackheads, whiteheads and spots, a pharmacist should be able to advise you on how to treat them successfully with over-the-counter gels or creams (topical treatments) that contain benzoyl peroxide.

Treatments from a GP

See a GP if your acne is moderate or severe, or medicine from your pharmacy has not worked, as you probably need prescription medicine.

Prescription medicines that can be used to treat acne include:

topical retinoids
topical antibiotics
azelaic acid
antibiotic tablets
in women, the combined contraceptive pill

If you have severe acne, or prescription medicines are not working, your GP can refer you to an expert in treating skin conditions (dermatologist).

For example, if:

you have a large number of papules and pustules on your chest and back, as well as your face
you have painful nodules
you have scarring, or are at risk of scarring
your condition is making you feel very low or anxious

For mild to moderate or moderate to severe acne, you’ll usually be started on a combination of topical treatments, or antibiotic tablets combined with topical treatments.

Hormonal therapies or the combined oral contraceptive pill can also be effective in women who have acne.

But the progestogen-only pill or contraceptive implant can sometimes make acne worse.

Many of these treatments can take 2 to 3 months before they start to work.

It’s important to be patient and persist with a recommended treatment, even if there’s no immediate effect.

Topical treatments (gels, creams and lotions)

Benzoyl peroxide

Benzoyl peroxide works as an antiseptic to reduce the number of bacteria on the surface of the skin.

It also helps to reduce the number of whiteheads and blackheads, and has an anti-inflammatory effect.

Benzoyl peroxide is usually available as a cream or gel. It’s used either once or twice a day.

It should be applied after washing to all of the parts of your face affected by acne.

It should be used sparingly, as too much can irritate your skin.

It also makes your face more sensitive to sunlight, so avoid too much sun and sources of ultraviolet (UV) light (such as sunbeds), or wear sun cream.

Benzoyl peroxide can have a bleaching effect, so avoid getting it on your hair or clothes.

Common side effects of benzoyl peroxide include:

dry and tense skin
a burning, itching or stinging sensation
some redness and peeling of the skin

Side effects are usually mild and should pass once the treatment has finished.

Most people need a 6-week course of treatment to clear most or all of their acne.

You may be advised to continue treatment less frequently to prevent acne returning.

Topical retinoids

Topical retinoids work by removing dead skin cells from the surface of the skin (exfoliating), which helps prevent them building up within hair follicles.

Tretinoin and adapalene are topical retinoids used to treat acne. They’re available in a gel or cream and are usually applied once a day before you go to bed.

Apply to all the parts of your face affected by acne 20 minutes after washing your face.

It’s important to apply topical retinoids sparingly and avoid excessive exposure to sunlight and UV.

Topical retinoids are not suitable for use during pregnancy, as there’s a risk they might cause birth defects.

The most common side effects of topical retinoids are mild irritation and stinging of the skin.

A 6-week course is usually required, but you may be advised to continue using the medicine less frequently after this.

Topical antibiotics

Topical antibiotics help kill the bacteria on the skin that can infect plugged hair follicles. They’re available as a lotion or gel that’s applied once or twice a day.

A 6- to 8-week course is usually recommended. After this, treatment is usually stopped, as there’s a risk that the bacteria on your face could become resistant to the antibiotics.

This could make your acne worse and cause additional infections.

Side effects are uncommon, but can include:

minor irritation of the skin
redness and burning of the skin
peeling of the skin

Azelaic acid

Azelaic acid is often used as an alternative treatment for acne if the side effects of benzoyl peroxide or topical retinoids are particularly irritating or painful.

Azelaic acid works by getting rid of dead skin and killing bacteria.

It’s available as a cream or gel and is usually applied twice a day (or once a day if your skin is particularly sensitive).

The medicine does not make your skin sensitive to sunlight, so you do not have to avoid exposure to the sun.

You’ll usually need to use azelaic acid for a month before your acne improves.

The side effects of azelaic acid are usually mild and include:

burning or stinging skin
itchiness
dry skin
redness of the skin

Antibiotic tablets

Antibiotic tablets (oral antibiotics) are usually used in combination with a topical treatment to treat more severe acne.

In most cases, a class of antibiotics called tetracyclines is prescribed, unless you’re pregnant or breastfeeding.

Pregnant or breastfeeding women are usually advised to take an antibiotic called erythromycin, which is known to be safer to use.

It usually takes about 6 weeks before you notice an improvement in your acne.

Depending on how well you react to the treatment, a course of oral antibiotics can last 4 to 6 months.

Tetracyclines can make your skin sensitive to sunlight and UV light, and can also make the oral contraceptive pill less effective during the first few weeks of treatment.

You’ll need to use an alternative method of contraception, such as condoms, during this time.

Hormonal therapies

Hormonal therapies can often benefit women with acne, especially if the acne flares up around periods or is associated with hormonal conditions such as polycystic ovary syndrome.

If you do not already use it, a GP may recommend the combined oral contraceptive pill, even if you’re not sexually active.

This combined pill can often help improve acne in women, but may take up to a year before the full benefits are seen.

Co-cyprindiol

Co-cyprindiol is a hormonal treatment that can be used for more severe acne that does not respond to antibiotics. It helps to reduce the production of sebum.

You’ll probably have to use co-cyprindiol for 2 to 6 months before you notice a significant improvement in your acne.

There’s a small risk that women taking co-cyprindiol may develop breast cancer in later life.

For example, out of a group of 10,000 women who have not taken co-cyprindiol, you’d expect 16 of them to develop breast cancer by the time they were 35.

This figure rises to 17 or 18 for women who were treated with co-cyprindiol for at least 5 years in their early 20s.

There’s also a very small chance of co-cyprindiol causing a blood clot. The risk is estimated to be around 1 in 2,500 in any given year.

It’s not thought to be safe to take co-cyprindiol if you’re pregnant or breastfeeding. Women may need to have a pregnancy test before treatment can begin.

Other side effects of co-cyprindiol include:

headaches
sore breasts
mood changes
loss of interest in sex
weight gain or weight loss

Isotretinoin

Isotretinoin is a treatment for severe acne that comes in capsules. It has a number of beneficial effects:

it helps normalise sebum and reduce how much is produced
it helps prevent follicles becoming clogged
it decreases the amount of bacteria on the skin
it reduces redness and swelling in and around spots

But the drug can also cause a wide range of side effects. It’s only recommended for severe cases of acne that have not responded to other treatments.

Because of the risk of side effects, isotretinoin can only be prescribed by a specialist doctor.

Read all about isotretinoin, including who can take it, side effects and the risks in pregnancy.

Non-pharmaceutical treatments

Several treatments for acne do not involve medicine.

You may be recommended to have photodynamic therapy, where light is applied to the skin in an attempt to improve symptoms of acne.

Other non-pharmaceutical treatments include:

comedone extractor – a small pen-shaped instrument that can be used to clean out blackheads and whiteheads
chemical peels – where a chemical solution is applied to the face, causing the skin to peel off and new skin to replace it

But these treatments may not work and cannot be routinely recommended.

Acne Papules

Acne papules are small, inflamed bumps caused by excess oil in your skin, bacteria, hormones and some medications. They don’t have a pus-filled tip like other forms of acne. Treatments include over-the-counter and prescription medications.

What are acne papules?

Acne papules are solid, inflamed bumps in your skin that are usually cone-shaped (conical). They don’t have a white or yellow pus-filled tip. They’re usually smaller than one centimeter (cm), and they may be the same color as your skin or red, brown or purple.

Who do acne papules affect?

Papules typically affect teenagers (adolescents) and young adults undergoing hormonal changes. But many adults continue having papules into their 20s, 30s and beyond. Some even develop papules for the first time as adults.

How common are acne papules?

Acne papules are very common. Some researchers suggest that acne papules affect nearly everyone at some time during their lives. They’re most common during adolescence, but adults may have them, too.

How do acne papules affect my body?

Your face (especially your nose, chin and forehead), neck, back, chest, shoulders and upper arms are most likely to develop papules. But they may appear on other parts of your body, as well.

Symptoms and Causes

What are the symptoms of acne papules?

Papules are an inflammatory form of acne. They don’t have a pus-filled tip, but they’re still noticeable. They may be red, tender, painful or irritating.

What causes acne papules?

Acne papules have many causes:

Your oil (sebaceous) glands produce too much oil.
An increased presence of bacteria on your skin.
An increased presence of androgens, which are a group of sex hormones. They help start puberty and play a role in reproductive health and body development. All people have androgens, but people assigned male at birth (AMAB) make more of them. Testosterone is the most common androgen.
Some medications, including corticosteroids and anabolic steroids.

Are acne papules contagious?

Papules aren’t contagious. You can’t spread them to another person through skin-to-skin contact.

Diagnosis and Tests

How are acne papules diagnosed?

Acne papules are easy to recognize visually, so you don’t necessarily need a healthcare professional to diagnose them. However, your healthcare provider can diagnose and help treat acne papules during a skin exam.

They may ask if you’re undergoing significant stress or if you have a family history of papules, which are risk factors. If you menstruate, your healthcare provider may ask about your menstrual cycles, as the appearance of acne papules is sometimes related and may flare with your menstrual cycles.

If you have severe papules, see a dermatologist for treatment. Dermatologists are doctors who specialize in conditions that affect your skin, hair and nails.

Management and Treatment

How do I get rid of acne papules?

Nonprescription medications can get rid of milder cases of papules. Some medications include:

Azelaic acid: This is a natural acid found in various grains such as barley, wheat and rye. It kills microorganisms on your skin and reduces swelling.
Benzoyl peroxide: This is available as an over-the-counter product (such as Clearasil®, Stridex® and PanOxyl®) as a leave-on gel or as a wash. It targets surface bacteria, which often aggravate papules. Lower concentrations and wash formulations are less irritating to your skin. Irritation (dryness) is a common side effect.
Retinoids (vitamin A derivatives): Retinoids, such as Retin-A®, Tazorac® and Differin® (now available without a prescription), break up papules and help prevent clogged pores. You may notice a change in skin color, drying or peeling. Using a retinoid every other day or using it at the same time as a moisturizer can reduce these side effects.
Salicylic acid: This is available over-the-counter for papules as a cleanser or lotion. It helps remove the top layer of damaged skin. Salicylic acid dissolves dead skin cells to prevent your hair follicles from clogging.

If your acne papules don’t go away with nonprescription medications, your healthcare provider may recommend the following prescription medications:

Antibiotics: Your healthcare provider may prescribe antibiotic pills or tablets that you swallow with water. Effective prescriptions include a tetracycline or a macrolide.
Anti-androgens: Anti-androgens block the effects of androgens, which are sex hormones that may worsen acne papules.
Dapsone: This is a topical gel that has antibacterial properties. Apply dapsone to your papules twice a day.
Oral contraceptives: Oral contraceptives, such as Estrostep®, Beyaz®, Ortho Tri-Cyclen® and Yaz®, can help with acne papules.

Are there any home remedies for acne papules?

Several home remedies may help treat acne papules.

While home remedies are safe for most people, it’s a good idea to check with your healthcare provider before trying some of the following options. You may be at risk of developing an allergic reaction.

Some home remedies include:

Apple cider vinegar: The acetic acid in apple cider vinegar kills off bacteria (antibacterial). If you have sensitive skin, apple cider vinegar can cause dryness and irritation, so it’s a good idea to mix it with an equal amount of water. Apply a small amount of the mixture to a cotton applicator and rub it on your papules.
Green tea: Wet green tea leaves have anti-inflammatory properties and can help reduce oil production in your skin. Mix dry green tea leaves with water and massage the wet leaves onto your papules in small, circular motions for up to 30 seconds. Rinse your face with water when you’re finished.
Honey: Honey contains an enzyme called catalase, which relieves minor inflammation. Apply enough unprocessed honey to cover your papules lightly. To avoid accidentally causing a sticky mess, you can also put a bandage on top of your honey-covered papules.
Ice: Ice slows down the amount of blood that flows to an area, reducing inflammation and pain. Apply an ice cube or ice pack covered in a light towel over your papules for at least 10 minutes. Apply ice to your papules up to two to three times a day.
Lemon juice: The citric acid in lemon juice is antibacterial. Apply a small amount of lemon juice to a cotton applicator and rub it on your papules. Lemon juice may cause stinging or further irritation if you have sensitive skin, especially when exposed to the sun.
Tea tree oil: Tea tree oil can prevent or stop the growth of bacteria. Apply a small amount of tea tree oil to a cotton applicator and rub it on your papules.

Should you squeeze papules?

When acne papules cause a lot of pressure under your skin, you may want to squeeze them. However, it would be best if you didn’t squeeze your papules. There isn’t any pus to remove, and squeezing can several problems:

You may open your skin and introduce bacteria into the opening. Bacteria can cause an infection.
You may irritate your skin. Your skin is sensitive, and your nails are stronger than your skin. When you use your nails to apply a lot of pressure to your skin to try to pop a papule, you can cause inflammation.
You may scar your skin. You can seriously damage your skin and cause permanent scarring if you apply too much pressure.

Do papules go away on their own?

Most acne papules go away on their own, but it may take some time — usually between three and seven days, though it may take up to several weeks.

How should I manage my acne papules?

If you have papules, be careful managing them to avoid irritation. The following will help you avoid irritating your papules:

Avoid touching or picking at them.
Be careful shaving around them.
Regularly clean items that touch your face, including your cell phone, sports helmets, sunglasses, clothing and pillowcases.

Prevention

How can I reduce my risk of developing acne papules?

Preventing papules is difficult, if not impossible, during normal hormonal changes. But the following tips might help:

Wash your face daily with warm water and a mild facial cleanser.
Routinely use non-comedogenic (non-pore-clogging) moisturizer.
You don’t have to stop using makeup, but try to use “non-comedogenic” products and remove your makeup at the end of each day.
Routinely wash your hair.
Keep hair products away from your face.
Keep your hands away from your face.

Outlook / Prognosis

What can I expect if I have acne papules?

Papules often go away in early adulthood, though some people will continue experiencing them throughout their lives. Your healthcare provider, medical aesthetician or dermatologist can help you manage your acne papules.

Living With

When should I see my healthcare provider?

See your healthcare provider as soon as you notice acne papules to start treatment immediately.

What questions should I ask my healthcare provider?

Are my papules severe?
Do I need to see a medical aesthetician or dermatologist?
What over-the-counter medications do you recommend?
What prescription medications do you recommend?
Do I need more serious treatment?

Additional Common Questions

What’s the difference between a papule and a pustule?

Acne papules are solid, inflamed bumps in your skin that don’t have a white or yellow pus-filled tip. Pustules have a white or yellow pus-filled tip.

Papules can develop into pustules.

What’s the difference between a papule and a nodule?

Nodules are a more severe form of acne than papules. They’re larger and more likely to be painful.

What’s the difference between a papule and a macule?

Papules are a form of acne. Macules are smooth areas of discoloration that appear on a person’s skin that may be from a variety of causes.

A note from Cleveland Clinic

Acne papules are a common skin condition that affects most people, especially teenagers. Because they mainly affect teenagers, many people think that papules are part of the transition from childhood to adulthood and don’t see a healthcare provider about them. But a dermatologist can help treat your acne papules and limit any long-term damage to your skin.