Prescription treatments work far better than anything on a shop shelf — and scarring is preventable.
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Acne is inflammation of the hair follicle and its oil gland. Four things drive it: the gland produces more sebum under hormonal influence, the follicle lining sheds abnormally and blocks the pore, a skin bacterium called Cutibacterium acnes multiplies in the blocked follicle, and the immune system responds with inflammation.
That sequence explains why the treatments work the way they do — and why washing harder does not help. Acne is not caused by poor hygiene, dirt, or chocolate. Over-washing and scrubbing strip the barrier, provoke more oil production and make acne worse, which is the opposite of what almost everyone tries first.
It affects around 95% of people to some degree between 11 and 30, and it is far from a teenage-only condition — adult acne, particularly in women along the jawline and chin, is common and often persists into the forties.
The two things most worth knowing before you start: treatment takes six to eight weeks before it can be judged, and it frequently looks slightly worse in the first fortnight. Almost everyone who says a treatment failed stopped inside that window. And where acne is leaving scars, treatment should not be delayed — scarring is permanent, and preventing it is far easier than correcting it.
Face, chest, upper back and shoulders — the areas with the highest density of oil glands.
Chocolate and greasy food are not causes, despite decades of being told otherwise. There is moderate evidence for high-glycaemic-load diets and for skimmed milk in particular, but the effect is modest and dietary change is not a substitute for treatment. We would not ask you to eliminate food groups on this evidence.
Acne in an adult woman alongside irregular periods, excess facial or body hair, or difficulty losing weight raises the question of polycystic ovary syndrome, which is worth testing for rather than treating the skin in isolation.
Acne is diagnosed by looking at it. No test confirms it, and photographs are usually sufficient — which makes it one of the conditions best suited to remote assessment.
What the assessment establishes is not whether it is acne but which type and how severe, because that determines the entire treatment plan:
Not routinely. They are indicated where the history suggests an underlying hormonal cause — an adult woman with acne plus irregular periods or hirsutism, or acne of sudden severe onset. In that case hormone testing including testosterone, and assessment for PCOS, is worthwhile.
Monitoring bloods are required for isotretinoin — liver function and lipids before and during treatment — but that is specialist-led.
Send clear photographs in natural daylight before your appointment — a wide shot and a close-up. See our guide to photographing a skin problem.
For moderate inflammatory acne, lymecycline or doxycycline are effective. Three rules apply:
The combined oral contraceptive pill is genuinely effective for acne in women and is often the better option where acne is jawline-distributed, flares premenstrually, or comes with irregular periods. It takes three to six months to show its full effect.
Isotretinoin is specialist-only and requires dermatology supervision, monthly review, blood monitoring, and — for anyone who can become pregnant — a strict pregnancy prevention programme, because it causes severe birth defects. We do not prescribe it, and we refer promptly for severe, nodulocystic or scarring acne rather than cycling you through another antibiotic course. Delay is what causes permanent scarring.
Seek same-day medical assessment if you develop:
Seek urgent advice if you are taking isotretinoin and develop low mood or thoughts of self-harm, severe headache with visual disturbance, or severe abdominal pain.
Book a consultation promptly rather than continuing to treat at home if:
Do not pick or squeeze. A spot left alone settles in days. A squeezed spot pushes inflammation deeper, lasts weeks, and is the main way ordinary acne becomes permanent scarring. If picking is compulsive rather than occasional, that is worth raising — it is common, it is treatable, and nobody should feel awkward about mentioning it.
Benzoyl peroxide and adapalene are available over the counter and are genuinely first-line. They cost a few pounds, they work, and for mild acne there is no reason to pay for a consultation before trying them properly. Your NHS GP treats acne free.
Where a consultation earns its fee is acne that has not responded — and the commonest reason is not that the treatment was too weak. It is that a topical was used for three weeks rather than three months, or that an oral antibiotic was given without a topical alongside, which is poor practice: the antibiotic is temporary and the topical is what holds the result.
The genuinely valuable conversation is about hormonal acne in women — the jawline pattern that flares before periods. Spironolactone and the combined pill both work well and are consistently under-offered, with people cycling through antibiotic courses instead.
Where we will refer rather than treat is scarring acne. That needs isotretinoin, which is specialist-only, and time spent on treatment that is not working has a permanent cost. We will say so early rather than prescribe another three months.
NICE NG198, Acne vulgaris: management, is the governing guideline. It recommends a 12-week course of a fixed combination topical treatment as first-line for all severities, and is explicit that oral antibiotics should not be used as monotherapy or for longer than six months.
NG198 recommends topical treatment continues alongside and after any oral antibiotic, which is the basis for what this page says about maintenance.
NG198 also covers hormonal treatment — the combined oral contraceptive as an alternative to oral antibiotics in women — and lists spironolactone within specialist and off-label practice.
The referral criteria for isotretinoin are set out in NG198: acne with scarring, nodulo-cystic acne, or acne not responding to two completed courses of treatment. Isotretinoin is prescribed only under consultant dermatologist supervision in the UK.
British Association of Dermatologists guidance covers the isotretinoin pregnancy prevention programme.
Six to eight weeks before treatment can be judged, and up to twelve for full effect. A retinoid commonly makes things look slightly worse for the first two to three weeks as blocked follicles clear. Stopping during that phase is the single commonest reason acne treatment appears not to work.
No. There is moderate evidence linking high-glycaemic diets and skimmed milk to acne, but the effect is small and no dietary change substitutes for treatment. Nobody should be cutting out food groups to treat acne.
Almost certainly the opposite. Acne is not dirt — blackheads are oxidised pigment, not trapped grime. Washing more than twice daily, scrubbing, or using harsh toners strips the barrier, drives up oil production and inflames active spots.
Adult acne is common, particularly in women, and typically sits along the jawline and chin and flares before periods. It is not a failure to grow out of something — it is a recognised pattern, it often responds to hormonal treatment, and it is worth treating properly rather than enduring.
No, and they are not meant to. Oral antibiotics reduce inflammation for a defined course of three to six months, always alongside a topical treatment. What keeps acne away afterwards is the topical maintenance, not the antibiotic. Long-term antibiotic use drives resistance without long-term benefit.
No. Isotretinoin requires dermatology supervision with monthly review, blood monitoring and a formal pregnancy prevention programme, and it is not appropriate to prescribe remotely by any provider. What we can do is assess whether you need it and refer you quickly — which for severe or scarring acne is exactly what should happen.
Post-inflammatory pigmentation fades, though it can take six to twelve months. It is not scarring. Daily sunscreen speeds it up considerably, and topical retinoids and azelaic acid both help. True scarring — a change in the texture and contour of the skin — is different and does not fade on its own.
The combined pill is genuinely effective for acne in women and is a reasonable choice if you also want contraception, have jawline acne, or flare before your period. It is not suitable for everyone — migraine with aura, clot history, smoking over 35 and high blood pressure all matter — so it is a conversation rather than a default.
August 23, 2026
Ongoing
Time to be seen
Appointment length
Your NHS record in the room
Written treatment plan
Told when a test isn’t needed
Cost
Same day, usually
20 minutes
Yes, with your consent
Included
Yes, and told why
£40 for 20 minutes
Varies by practice
Typically 10 minutes
Yes, your full record
Not routinely
Usually
Free
Same day
Often 10 to 15 minutes
Usually not
Sometimes charged
Varies by provider
Often a subscription
Same-day access is usually available, from 6am to 10pm, seven days a week. You choose a time that suits you rather than waiting on hold at 8am.
Yes. Care is led personally by Dr Mohammad Khan, so you are not passed between clinicians. Continuity is the point of a small practice: someone who knows your history and is listening attentively rather than working through a checklist.
Yes, with your consent. We can access your Summary Care Record during the consultation, so your current medications, allergies and significant history are in the room. That means fewer questions you have already answered elsewhere, and safer prescribing.
No. We are not here to replace GPs, only to support them. Your NHS practice remains responsible for your ongoing care, and with your consent we write to them after the consultation. We are useful when you need to be seen sooner, or want more time than a standard appointment allows.
Twenty unhurried minutes and a comprehensive assessment. A written treatment plan is included, along with any prescription, sick note or referral letter arising from the consultation, at no extra charge.
£40 for 20 minutes, self-pay. Membership is optional and never required. Priced for fairness, because we are not here to charge extortionate amounts for access to a doctor.
It means the diagnosis can usually be made from your history and photographs, and that treatment can be arranged safely without examining you. Where a condition is not marked treatable online, it is because examination is the diagnosis — listening to a chest, feeling an abdomen, examining an ear or a joint — or because a procedure or device is needed.
Yes, where there is a genuine bacterial infection — cellulitis, impetigo, bacterial urine infections, confirmed strep throat. We will also frequently tell you that you do not need one. Most sore throats, coughs, colds and earaches are viral, and an antibiotic gives you the side effects with none of the benefit.
If your problem turns out to be genuinely outside what we can do remotely, the doctor will tell you straight away, point you to the right service, and refund your fee in full. We would rather do that than fill twenty minutes to justify the charge.
Call 999 or go to A&E — do not book an online appointment and do not wait for a reply to an email. For urgent problems that are not emergencies, NHS 111 is available 24 hours a day, online or by phone, and can direct you to the right service.
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