Acne
Blocked, inflamed hair follicles. Very treatable, not caused by being dirty, and not a personality flaw. Here’s what works, what it costs and how long it takes.
The acne ladder
Start at the bottom, climb only if you need to. Give each step 8 to 12 weeks of actually using it before you judge it.
- Step 1 · PharmacyBenzoyl peroxide wash or gelThe classic. Kills acne bacteria, calms redness, and germs can’t become resistant to it.
- Works
- Spots down roughly 40–50% by 12 weeks (dummy gel: about 30%)
- Cost
- About $10–20 a tube (lasts 1–2 months)
- How long
- 8–12 weeks to judge, then keep going
- Watch for
- Dryness and stinging at first. Bleaches towels and pillowcases: your linen will never forgive you.
Start at 2.5%. Stronger isn’t better, just angrier.
- Step 2 · PrescriptionRetinoid gel or cream (adapalene or tretinoin)Unclogs pores. The best thing for blackheads and whiteheads, and it helps stop new spots forming.
- Works
- Spots down roughly 40–50%, similar to benzoyl peroxide; best for blackheads
- Cost
- About $20–50 a tube on a private script
- How long
- 8–12 weeks to judge; often used long term
- Watch for
- Dry, red, flaky skin for the first few weeks (the ‘retinoid uglies’). Sun sensitivity. Not in pregnancy.
Pea-sized amount, whole area, every second night to start. More is not more.
- Step 3 · PrescriptionCombination gel (adapalene + benzoyl peroxide)Two of the best in one tube, so it does more than either alone.
- Works
- About half the spots gone by 12 weeks; about 1 in 3 clear or nearly clear (vs 1 in 10 on dummy gel)
- Cost
- $25 on the PBS for severe acne ($7.70 concession), otherwise about $20–30 private
- How long
- 8–12 weeks to judge; long term to keep it away
- Watch for
- Dryness and irritation, worse in week 2. Bleaches fabric. Not in pregnancy.
If this hasn’t worked after 3 months of actually using it, it’s time to climb.
- Step 4 · PrescriptionAntibiotic tablets (usually doxycycline) plus a gelFor moderate acne with lots of red, angry spots. The tablet calms inflammation while the gel does the long-term work.
- Works
- Often 50–70% fewer spots after 3 months, clearly more than the gel alone
- Cost
- Under the $25 PBS co-payment, about $15–25 a month
- How long
- About 3 months, then stop and keep the gel going. Never on its own.
- Watch for
- Sun sensitivity (sunscreen!), nausea, heartburn if taken lying down. Not in pregnancy or under 8.
Antibiotics alone breed resistant bacteria. The gel is not optional.
- Step 5 · PrescriptionHormonal options for women: some contraceptive pills or spironolactoneCalm the hormone surges behind jawline and pre-period flares.
- Works
- Spironolactone: 8 in 10 improved by 6 months (vs 6 in 10 on a dummy treatment). The pill also clearly beats a dummy treatment
- Cost
- Pill: about $10–30 a month. Spironolactone: under the PBS co-payment, about $10–20 a month
- How long
- 3–6 months to judge; fine long term
- Watch for
- Pill: nausea, spotting, small clot risk (not if you get migraine with aura or smoke over 35). Spironolactone: tender breasts, irregular periods, needs a potassium check in some people. Neither in pregnancy.
Slow but steady. The tortoise of acne treatment.
- Step 6 · SpecialistIsotretinoin tabletsThe big gun for severe, scarring or stubborn acne. Prescribed by a dermatologist.
- Works
- About 8 in 10 people clear after one course; roughly 3 in 4 stay clear
- Cost
- $25 per script on the PBS ($7.70 concession), plus specialist fees
- How long
- About 5–6 months, with monthly check-ins
- Watch for
- Very dry lips, skin and eyes. Possible mood changes: tell someone if you feel low. Causes severe birth defects, so pregnancy must be avoided during treatment and for 1 month after.
The closest thing acne has to an off switch. Needs respect, regular check-ups and no surprises.
Save your money
Popular, heavily marketed or often asked about, but the evidence is weak or says no.
- Scrubs and washing three times a dayAcne isn’t dirt. Harsh scrubbing irritates skin and can make spots angrier, not cleaner.
- Antibiotic cream on its ownClindamycin gel alone breeds resistant bacteria. Guidelines say always pair it with benzoyl peroxide or a retinoid.
- Toothpaste on spotsNo evidence it works, and it burns and irritates skin. Save it for your teeth.
- LED light masksSmall, low-quality studies and modest effects at best, for a price tag that would buy years of benzoyl peroxide.
- Tea tree oilMay help mild acne a little in small trials, but it’s slower than the real thing and can cause irritation and allergy.
What you can do
- Gentle cleanser, twice a day max. Scrubbing harder doesn’t help.
- Oil-free (“non-comedogenic”) moisturiser and sunscreen.
- Don’t pick or squeeze. Scars last longer than spots.
- Pick one treatment and stick with it for 8 to 12 weeks. Product-hopping is how bathroom cabinets fill up.
See your GP if
- No better after 3 months of pharmacy treatment
- Deep painful lumps, scarring or dark marks
- It’s affecting your mood
Some acne treatments are unsafe in pregnancy. Tell your doctor if you’re pregnant or planning to be.
Common questions
How long does acne treatment take to work?
Most treatments take 8 to 12 weeks to make a clear difference, so give one a fair trial before switching. Starting a retinoid every second night helps your skin get used to it.
What is the most effective acne cream?
For most people, a gel combining adapalene with benzoyl peroxide works best. Benzoyl peroxide washes and gels from the pharmacy are a good place to start.
Does diet cause acne?
Acne isn’t caused by poor hygiene, and diet plays a small role at most. A low-sugar (low-GI) diet may help some people, but the evidence is limited.
Which acne treatments are safe in pregnancy?
Isotretinoin and spironolactone must not be used in pregnancy, and some creams are avoided too. Azelaic acid is a suitable option. Tell your doctor if you’re pregnant or planning to be.
Does acne go away on its own?
Teenage acne often settles by the early to mid 20s, but it can last into adulthood, especially for women: around 1 in 4 women in their 40s still get some. Treating it early lowers the chance of scarring, so it’s worth not just waiting.
Can stress cause acne?
Stress doesn’t cause acne by itself, but it can make existing acne worse. Studies of students around exam time found flares that tracked with stress levels. Poor sleep and picking at spots during stressful times add to it.
What causes hormonal acne?
Androgen hormones make oil glands more active, which is why acne often flares before periods and sits along the jaw and chin. Irregular periods with extra hair growth can point to PCOS. The combined pill or spironolactone can help hormonal acne in women.
Should I pop my pimples?
Best not. Squeezing pushes inflammation deeper and raises the risk of infection, dark marks and scarring. A warm compress or a hydrocolloid pimple patch is a gentler option.
Helpful resources
- Acne SupportImpartial acne advice from the British Association of Dermatologists (a charity), including scarring, covering up and emotional support. Free.
- Medicare Mental Health (1800 595 212)Free phone service with mental health nurses, for when acne is getting you down. Australia only.
Evidence and more information
- Healthdirect: Acne
- NICE: Acne vulgaris
- ACD: Acne
- BMJ: SAFA trial of spironolactone for acne (2023)
- JCAD: Adapalene–benzoyl peroxide trials pooled (2016)
maladywise.com/acne/