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In student healthcare, acne (acne vulgaris) is a common reason to see a GP. Patients with acne are also a significant patient group at the dermatologist’s office. Acne is not always restricted to puberty or adolescence. Neither is it always a short-term cosmetic problem; if left untreated, it may persist throughout adolescence and adulthood.

Based on the severity and nature of the skin changes, acne may be classified into three main types. There are different treatment lines and medication choices for each of the main types.

Acne types and their characteristic features

Non-inflammatory Blackheads and whiteheads, or open and closed comedones, non-inflamed pimples
Inflammatory Blackheads and inflamed pustules
Severe, deep acne Deep nodules, abscesses, scarring

Self-management of acne

  • Acne-affected skin usually tolerates normal washing with water or skin pH-lowering cleansers. However, excessive washing will dry out the skin and may also aggravate the acne.
  • It’s not necessary to avoid all cosmetics, but you should select the products carefully; greasy, occluding, oily or pore-clogging lotions and sunscreens can aggravate acne.
  • Skin cleansing by a cosmetologist may offer short-term benefits in conjunction with other acne treatment.
  • You should not empty blackheads on your own or squeeze inflamed skin lesions – in most cases this only worsens the inflammation of the skin.
  • Topical care products are an important part of acne self-management.
    • Topical care products are usually applied to the entire affected skin area.
    • Symptoms of irritation are very common in the beginning. They usually pass when the skin gets used to the topical care product.
    • If your skin gets dry or red, you can treat the skin less frequently or pause the treatment. You can also apply moisturiser as soon as the acne care product has dried.
    • Topical care products are available over the counter from your pharmacy. However, for some products, a doctor’s prescription is needed.

When should I seek treatment

You should seek a doctor’s help for acne when your symptoms are bothersome and interfere with your everyday life. Acne can usually be treated by a general practitioner. If necessary, the GP may refer you to a dermatologist for further treatment.

Treatment of acne

The treatment always depends on the type of acne involved, taking into account the treatment methods considered best by the doctor and the patient together. The aims of acne treatment are to control sebum production, to soften keratin plugs and to reduce bacterial growth and skin inflammation. There are many different medicines and other treatment options for acne. Once a suitable product has been found, acne improves in most patients.

  • Mild forms of acne are treated with topical products. If these do not work well enough in a few months, a different product should be chosen or the patient switched to tablet medication. If the topical product is working well, it should be continued as maintenance treatment for several months or even years. If you are planning a pregnancy, you should talk to your doctor about continuing the topical treatment during pregnancy.
  • For the most severe forms of acne, oral medication should be chosen right at the start of treatment. The most common tablet medication is an antibiotic course lasting several months. This kind of treatment is always combined with topical treatment that is continued after the end of the antibiotic treatment.
  • Both antibiotics and topical products have a temporary effect – the product only helps as long as it is used.
  • Contraceptive pills alleviate acne in women, and thus may be used for the treatment of acne. In other words, the same medicine may be used for both skin problems and birth control.
  • Dermatologists have another option besides those already mentioned in difficult or persistent acne or forms of acne that do not respond to other treatments: this is an effective medication in tablet form called isotretinoin. During isotretinoin use, certain restrictions should be carefully observed, including absolute contraindication for pregnancy throughout the course of treatment and for a month after its end. Isotretinoin also causes adverse effects such as dry skin and dry eyes. A dermatologist will monitor isotretinoin treatment throughout the course. Responses to isotretinoin-containing medicines are usually excellent, and adverse effects can be controlled by adjusting the dosage appropriately.

Information sources: The Finnish Medical Society Duodecim: Terveysportti, Lääkärin tietokanta database

FSHS Dermatologist / 1 December 2019