The approach to acne treatment differs greatly according to the severity of acne, the types of acne lesions that are present and whether which treatments you have had for your acne in the past.

You can think of the treatments for acne as a ladder - starting with non prescription over the counter treatments, moving through prescription topical treatments and then on to first line oral treatments such as antibiotics and the oral contraceptive pill (for women). Where these are not effective next steps include spironolactone (for women) or isotretinoin (roaccutane).

Mild acne: This can often be treated effectively either with over the counter products or with topical acne treatments (see previous posts). Comedomal acne (dominated by whiteheads and blackheads) is more likely to respond to topical retinoids and retinol.

Moderate acne: This rarely will respond to over the counter products and often requires systemic (e.g. tablet) treatments.

Hormonal acne: Hormonal acne fluctuates along with the menstrual cycle. There is a prediliction for the lower face and jawline. Treatment options include the combined oral contraceptive pill - particularly brands which contain an anti-androgen such as Yasmin or spironolactone.

Severe acne: WIth severe acne, particularly where there are nodules or cysts it is important to rapidly find an effective treatment to minimize scarring - this usually requires a prescription tablet treatment.