Acne in adult women: prescription creams and gels for the skin

Why acne starts or comes back after your teens

Adult acne has the same mechanism as teenage acne: pores block with skin cells and oil, skin bacteria multiply in them, and inflammation turns a blocked pore into a red or painful spot. What tends to differ in women is the pattern: spots gather on the jawline, chin and around the mouth, are deeper and more tender, and can follow the menstrual cycle, because the oil glands respond to hormones. Heavy or oily make-up, picking at spots and some medicines can keep it going.

Acne that comes with irregular periods, new hair growth on the face or body, thinning hair on the scalp or weight gain can point to a hormonal condition such as polycystic ovary syndrome, which needs a GP to examine you and arrange blood tests. Redness in the centre of the face with flushing, small visible blood vessels and bumps but no blackheads is more likely to be rosacea, a different condition with partly different treatment.

Treatments applied to the skin that a doctor may prescribe

Adapalene is a retinoid, a vitamin A derivative applied to the skin. It loosens the build-up of skin cells that blocks pores, so it treats blackheads and whiteheads as well as inflamed spots, and it is often prescribed in a fixed combination with another acne ingredient. It is applied thinly to the whole affected area, usually in the evening, and dryness, redness, stinging and sun sensitivity are common in the first weeks.

Clindamycin gel or lotion is an antibiotic that reduces inflamed spots. NICE guideline NG198 advises against using a topical antibiotic on its own for acne, because that encourages resistance, so it is prescribed together with another acne treatment, often in a combination product.

Azelaic acid acts on both blocked pores and inflammation and is used for acne as well as for rosacea; it can sting or itch for the first few weeks. Ivermectin cream is used for the bumps of rosacea rather than for acne, so it only comes into the picture if the doctor thinks rosacea is the better explanation for what you describe.

How long treatment takes and how to give it a fair trial

These treatments work gradually. NG198 recommends a 12-week course of first-line treatment followed by a review, and that is a realistic horizon: spots may look slightly worse in the first weeks of a retinoid before they improve, and stopping early is a common reason a treatment seems not to work. Using it every day matters more than using a lot of it.

If irritation is a problem, using it less often for a while, a moisturiser that does not block pores and sun protection usually help; ask a pharmacist before stopping altogether. Acne can return once treatment stops, so after the skin has cleared the doctor may suggest continuing a treatment applied to the skin to keep it under control.

Pregnancy, breastfeeding and plans for pregnancy

Pregnancy changes the choice of treatment. After its 2018 review of retinoid medicines, the European Medicines Agency stated that retinoids applied to the skin must not be used during pregnancy or by women planning to have a baby. If you are pregnant, trying to conceive or breastfeeding, say so in the questionnaire: the doctor will choose a different treatment or decline and suggest you discuss it with your GP or the team looking after your pregnancy. If you become pregnant while using adapalene, stop using it and tell a doctor or pharmacist.

Isotretinoin tablets are a different matter altogether. They can seriously harm an unborn baby, they are prescribed only within a strict pregnancy prevention programme, and they are not prescribed through this route.

When acne needs a dermatologist rather than a questionnaire

A questionnaire suits mild to moderate acne with spots and blocked pores. It is not the right route when spots are deep, painful lumps or cysts, when they are leaving scars or dark marks that persist, or when acne is getting worse quickly. NICE suggests considering referral to a dermatology team when mild to moderate acne has not responded to two completed courses of treatment. These situations may need tablets, including isotretinoin, which is prescribed and monitored by specialists. We do not issue isotretinoin.

Acne that affects how you feel about yourself to the point of low mood or distress is also a reason to be seen in person, whatever its severity. So are the signs of a hormonal condition described above.

How the assessment works here

The assessment is a written questionnaire, without a video call, a phone appointment or live chat. It asks whether you are pregnant, planning a pregnancy or breastfeeding; whether the spots are painful or lumpy, leave scars or are getting worse quickly; whether the problem has lasted longer than three months; and whether you have used a prescription treatment for it before. Describe what you have already tried and list your other medicines. The doctor may ask for a photograph of the affected skin in daylight, which also helps him tell acne from rosacea, may advise you to see a GP or dermatologist, or may decline. Prescriptions are issued by lek. Damian Wojno, a doctor registered in Poland, PWZ no. 3211301.

If treatment is appropriate, you receive a cross-border prescription as a PDF by email. Print it and bring it to a pharmacy with photo identification; there is no PIN code. The pharmacist decides whether to dispense, and the cream or gel is priced and paid for at the pharmacy, separately from the assessment.