Acne-prone skin: Mild acne at the counter; the rest, to the doctor

What it is

Acne combines excess sebum, blocked pores (comedones: blackheads and whiteheads), a bacterium normally found on the skin, and the inflammation that causes red spots and pustules. In its mild forms — mainly comedones and the odd inflamed spot — the pharmacy can help with a suitable routine.

Once there are many inflamed spots, painful nodules, scarring or a significant emotional impact, acne needs medical treatment. Topical retinoids (such as adapalene or tretinoin) and antibiotics are prescription medicines, and cosmetic retinol does not replace them.

What it needs

Three things:

Keeping pores clear: salicylic acid, which is oil-soluble and exfoliates inside the pore
Reducing inflammation and bacteria: benzoyl peroxide acts on the bacterium; niacinamide helps with inflammation and oil
Not irritating: a light non-comedogenic moisturiser and sun protection, because the marks spots leave behind darken in the sun

At the counter

When to recommend it

Blackheads and whiteheads with the occasional inflamed spot
Mild acne in teenagers and adults
As a complementary routine to medical treatment, if the doctor advises it
To teach not to squeeze spots

When not to

Many inflamed spots, painful nodules or cysts, or scarring: refer
Acne that strongly affects mood: refer
Acne appearing suddenly in an adult, with other symptoms (excess hair, irregular periods): refer
Retinoids (retinol included) in pregnancy or when trying to conceive

What to say at the counter. For your acne: a gentle cleanser, a light cream and one active at night, starting on alternate nights. Do not squeeze the spots: it leaves marks. If it has not improved in two or three months, or you get large painful spots, see the doctor: there are treatments that work.

Warnings

Important Nodules, cysts, scarring, or acne not improving in two or three months: refer to a doctor.
Important Retinoids, topical and oral, are contraindicated in pregnancy: always ask women of childbearing age.
Caution Benzoyl peroxide can bleach towels, clothing and hair.
Caution Stacking actives (peroxide, acids, retinol) at the start usually irritates and leads people to give up.
Worth knowing Results are judged at 8-12 weeks, not in days.

The routine, step by step

Morning

Cleanse. Gentle gel, which may contain salicylic acidCleans without drying; scrubbing does not help.
Moisturise. Non-comedogenic gel or fluid, with niacinamide if toleratedOffsets the dryness of actives.
Sunscreen. Non-comedogenic fluid or gel, SPF 30 or higherStops spot marks from darkening.

Evening

Cleanse. The same gelRemoves sunscreen, make-up and oil.
Active. Benzoyl peroxide or salicylic acid, starting on alternate nightsOne at a time; together at first they irritate.
Moisturise. Light non-comedogenic gel-creamHelps the skin tolerate the actives.

Cosmetic retinol vs prescription retinoid

Aspect	Cosmetic retinol	Prescription topical retinoid
Examples	Retinol, retinal	Adapalene, tretinoin
Effect on acne	Limited	Proven: first-line treatment
Who decides	Over the counter	The doctor
Irritation	Less	More, especially at first
Pregnancy	Avoid	Contraindicated

Cosmetic retinol is not the treatment for acne: if a retinoid is needed, it is the one the doctor prescribes.

Self-assessment

Three questions. When you check your answers you will see the explanation for each one.

Which acne should a doctor assess? Acne with nodules, cysts or scarring A few blackheads A single spot before a period
Which active exfoliates inside the pore and helps with comedones? Coconut oil Salicylic acid Vitamin C
What should always be asked of a woman of childbearing age before a retinoid? Whether she is pregnant or trying to conceive Whether her skin is oily Whether she wears make-up

Training content. It does not replace the summary of product characteristics or clinical judgement.

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