Patient support

All acne treatments need to be used for eight to 12 weeks for the maximum effects to be apparent (although some effects will be visible sooner). This can be dispiriting for patients, especially if advertising claims have led them to expect instant effects. Manage expectations by explaining and supporting.

Acne treatment should be applied to the whole of the acne-prone area and not just dabbed on to spots, since comedones are not palpable in the early stages but could be forming in the skin.

Both BPO and retinoids can have drying and irritant effects on the skin. These can be minimised by starting with alternate day or short-contact application (e.g. washing off after an hour). Treatment should be started with the lowest concentration of BPO (2.5%) and may be increased if tolerated. Alternatively, a BPO wash product could be used. 

Mild wash products should be recommended for skin cleansing. These have neutral to slightly acidic pH value, similar to the skin, in contrast to soap which is strongly alkaline. As such, they cause less disruption of the skin barrier and less drying of the skin. Containing a blend of synthetic surfactants (detergents) – often described as ‘syndets’, they are widely available in both solid and liquid forms as skin cleansing products.

Examples include (liquids) Sebamed liquid, Purifide pH Control Face Wash, Lipikar Syndet AP+ Cream Wash, and (bars) Sebamed cleansing bar, Cerave Hydrating Cleanser Bar, Eucerin Ph5 Sydet for Sensitive Skin.

Acne patients may need facial moisturisers to balance the effects of drying treatments such as BPO – oil-free, non-comedogenic products are suitable. Oil-free moisturisers use dimethicone (or similar) in place of conventional oils for the lipid component. 

Acne can have profound psychological effects, so consider signposting patients to patient support groups for additional support. Keep a supply of acne information leaflets (e.g. the Self-Care Forum acne factsheet: selfcareforum.org/wp-content/uploads/2024/10/8-Acne-202410-V5.pdf) ideally as QR codes for patients.