Be patient. Improving acne takes a long time, even with the most powerful treatments from your doctor. Do not expect much improvement in the first few weeks of any treatment.
Do not squeeze! Discipline yourself not to squeeze or fiddle with your spots, because this encourages scarring. Relaxation techniques may help you break the habit (cassettes, videos or books may be useful).
If you have a large yellow spot containing pus that you feel you really must get rid of, pierce it with a needle and gently squeeze the pus out using a tissue. Wash your hands and sterilize the needle in a flame beforehand.
For blackheads, you can buy a ‘comedone spoon’. It has a hole in it, which you press onto the blackhead to release it from the pore; abandon the attempt if the blackhead does not come out easily.
Wash carefully. Wash the affected area twice a day with a pH-balanced, unperfumed soap. Antibacterial soap is no better than ordinary soap, and harsh soaps can irritate some skins. Alternatively, use a gentle antibacterial facewash; a variety of brands are available, and can usually be found alongside the anti-acne products in pharmacies and supermarkets. Avoid facial scrubs and abrasive cleansers, which might increase the inflammation of the skin and make scarring more likely.
Spot creams, gels and lotions. Do not waste your money on anti-acne preparations that simply describe themselves as medicated. Most have very little effect. They are also expensive, and you are likely to need to continue your anti-acne treatment for months or even years. Similarly, expensive creams containing alpha hydroxy acids (also called AHAs or fruit acids) are sometimes advertised for treating acne, but there is little scientific evidence in their favour. The Acne Support Group (see Useful contacts) says that some cosmetic companies are preying on the vulnerability of acne sufferers, and wants tighter regulation of the cosmetic industry.
Tea tree oil has antibacterial properties, and might be worth trying if your acne is only mild. Apply a small amount of the 5% strength twice a day after washing, taking care to avoid your eyes.
Nicotinamide gel (available from pharmacies) may be helpful if the spots are inflamed, but not very severe.
Apply the treatment thinly twice a day after washing, avoiding the lips and eyes. Its main action is to prevent new spots, so apply it over the whole area – do not just dab it on individual spots that are already there. After a week or two, upgrade to the 4% and then the 5–10% strengths, unless you have excessive peeling and redness; some slight peeling is usual. If your skin feels very dry, use the treatment every other day, and use an oil–free moisturizer (for example, Neutrogena Clear Pore, Johnson & Johnson's Clean & Clear) on the alternate days. Keep benzoyl peroxide away from your clothes as it has a bleaching effect; you may also find bleach marks on coloured bed–linen.
After about 2 months, decide whether your spot count has improved by about a third. If it has, continue with the benzoyl peroxide. You may need to continue it for several months. If there has not been improvement, see your family doctor for some stronger treatment.
In 60% of people with acne, their back as well as their face is affected. Applying a cream or gel to the back can be tricky. Acne specialist Professor William Cunliffe suggests applying the cream on your back as far as you can, putting an old T-shirt on, sitting on a hard-backed chair and rubbing your back up and down.
Pore strips. Be cautious with pore strips. These are not really a treatment for acne; they do more harm than good if used on red, inflamed spots. But they can lift out blockages at pore openings (blackheads) and may prevent an inflamed spot developing, in addition to improving the appearance of the skin. The problem is that the adhesive is powerful and can damage sensitive skin. So:
•do not use pore strips more than once a week
•after use, wash your face with a gentle antibacterial wash.
Avoid greasy make-up. If you wear make-up, avoid heavy and greasy make-up; oil-free make-up is available in some ranges. Remove it at night with a gentle cleanser before washing. If your acne is all over the face, with lots of blackheads, your make-up might be the cause, so try different brands. To disguise an individual spot, use a medicated spot concealer stick or cream a couple of shades lighter than your normal skin tone to counteract any redness. Apply it with a tiny brush to just cover the spot, removing any excess by tapping the area gently with your finger. Do not apply it to a large area or you may make the skin sensitive.
Check your contraceptive pill. The label will tell which progestin it contains. The newer progestins – gestodene, desogestrel and norgestimate – are least likely to worsen acne. The pill containing drospirenone (Yasmin) also seems to be a particularly good choice for women with acne. In the USA, the Food and Drug Administration has approved a contraceptive pill containing norgestimate (Ortho Tri-Cyclen) for treating acne in women.
