Acne — what works, what doesn't, and why most over-the-counter routines disappoint

About this guide

Acne is one of the most common and most under-treated conditions we see in primary care. By the time most patients come to us, they have usually tried several over-the-counter products, switched routines every few weeks, and concluded that “nothing works.” The much more accurate read is that most over-the-counter routines aren’t strong enough or aren’t given enough time to work — and the right combination of treatments, used consistently for at least 8 to 12 weeks, controls acne for the great majority of patients.

This guide covers:

• What acne actually is — and why hygiene framing is unhelpful
• What it looks like at different ages — adolescent acne is not the same as adult-onset acne
• The Asian-skin angle — post-inflammatory hyperpigmentation (PIH) is often what distresses our patients more than the acne itself
• The treatments that actually work — topical first line, oral antibiotics for moderate disease, oral isotretinoin for severe or scarring acne, hormonal therapy for adult women
• Isotretinoin honestly — what it does, the safety conditions we insist on, and why many patients are over-cautious about a treatment that genuinely works
• Acne scarring — types, prevention, and what helps after the fact
• Things that may not help — diet myths, OTC tools, and the cycle of switching products
• When to come and see us

It sits alongside our eczema series for general skincare principles. The two conditions are different, but the discipline of choosing the right product, using it consistently, and being patient applies to both.

What acne actually is

Acne is a chronic inflammatory disease of the pilosebaceous unit — the small structure in the skin made up of a hair follicle and its sebaceous gland. There are four contributors that together cause the spots and inflammation patients see:

1. Increased oil (sebum) production, driven by androgens (male hormones, present in both sexes from puberty onwards)
2. Plugging of the follicle with skin cells and oil, forming a comedone (the basic non-inflammatory acne lesion — a blackhead or whitehead)
3. Overgrowth of Cutibacterium acnes, a normal skin bacterium that thrives in the plugged, oily environment
4. Inflammation triggered by the bacterial overgrowth and immune response, producing the red papules, pustules, and deeper nodules

Worth understanding plainly:

• Acne is not caused by dirty skin. Washing harder, scrubbing, or “deep cleaning” makes the inflammation worse, not better. The plug is inside the follicle; surface scrubbing doesn’t reach it.
• Acne is not a phase to wait out. It is true that many adolescents grow out of acne, but in the meantime — sometimes for years — uncontrolled acne damages skin, causes scarring, and leaves pigmentation that long outlasts the spots themselves. Treating early is a better strategy than waiting.
• Acne is a chronic condition. It behaves more like asthma or eczema than like a one-off rash. Most patients need a maintenance routine even after the visible spots have settled, otherwise it returns.

What acne looks like at different ages

Adolescent acne (typically ages 11–18)

Usually starts around puberty, often earlier in girls than boys. The classic pattern:

• Comedones (blackheads and whiteheads) on the T-zone — forehead, nose, chin
• Then inflammatory lesions (red papules, pustules) spreading outwards over the cheeks
• In more severe cases, deep nodules and cysts on the face, upper chest, and back
• Often worse around examinations, sports, hot weather, and during periods (in girls)

Boys tend to have more severe acne than girls in adolescence (higher androgen levels), and back/chest involvement is more common in boys. Girls are more likely to have a mixed pattern with comedones and inflammation together.

Adult acne (typically ages 25–40s)

A real and increasingly common pattern, particularly in adult women:

• Lower face, jawline, and chin distribution (the “U-zone”)
• More inflammatory papules than comedones; often deep, tender, slow to resolve
• Cyclical worsening in women — often premenstrually
• May coexist with adult-onset rosacea (different condition, may need different treatment)
• Sometimes triggered or worsened by stopping the combined oral contraceptive pill, by PCOS, or by stress and sleep deprivation

Adult acne is sometimes mistaken for “old acne that didn’t go away” but it can also start in adulthood without a teenage history. It is not a sign of being unclean or applying the wrong products. It is mostly hormonal and inflammatory.

Late adult-onset acne (40s and beyond)

Less common, and worth a closer look. New-onset acne in this age group may be triggered by:

• Hormonal changes — perimenopause; rarely, androgen-secreting conditions
• Medications — corticosteroids (oral or inhaled), lithium, certain anti-epileptics, anabolic steroids, some immunosuppressants, hormonal supplements bought online
• PCOS that has been low-grade for years and is becoming clinically apparent
• Cushing’s syndrome (rare, but worth thinking about if other features are present)

If you develop acne for the first time in your 40s or later, please come in for a proper assessment rather than reaching for over-the-counter products. The treatment depends on the cause.

The Asian-skin angle — post-inflammatory hyperpigmentation (PIH)

This is genuinely the most important part of the guide for many of our local patients.

In Asian and other deeply-pigmented skin, every inflammatory acne lesion — even one that doesn’t leave a scar — has a high chance of leaving a brown, grey, or violet mark that can persist for weeks to many months after the spot itself has resolved. This is post-inflammatory hyperpigmentation (PIH), and for many of our patients it is the more distressing problem.

A few important points:

• PIH is not the same as scarring. It is a flat, pigmented patch in skin that is otherwise structurally normal. It will fade over time. Scars are textural changes (depressions, raised tissue) and behave differently.
• PIH responds to treatment, but slowly — typically 3 to 6 months with consistent topical treatment and sun protection, sometimes longer.
• The single best PIH prevention is good acne control. Less inflammation = less pigmentation. This is one of the clearest arguments for treating acne properly rather than tolerating “a few spots”.
• Sun protection matters more than any treatment. UV light worsens PIH at every stage — driving new pigmentation, slowing fading, and undoing topical treatment. Daily broad-spectrum SPF 50+ sunscreen, applied generously and re-applied every 2–3 hours outdoors, with hats and shade where possible, is foundational.

We treat PIH actively in clinic — the options we use and refer for are covered in the section below on acne scarring and pigmentation.

What you can do day-to-day

The skincare basics for acne are surprisingly minimal. The mistake most patients make is doing too much, not too little.

A simple routine that supports treatment

• Wash twice a day — morning and evening — with a gentle, fragrance-free cleanser. Avoid alkaline bar soaps (drying), avoid scrubs and exfoliating brushes (worsen inflammation), and avoid foaming “deep cleanse” products with menthol or alcohol (transient feel-good, longer-term irritation).
• Pat dry — don’t rub.
• Apply your prescribed treatment to the whole affected area, not just on the visible spots. Acne treatments work on the follicles, not on individual pimples.
• Moisturise if your skin is dry from treatment. A non-comedogenic, fragrance-free moisturiser is fine. We are not trying to “starve the skin of oil” — that’s a misconception that leads to over-drying and rebound.
• Sunscreen every morning — broad-spectrum, SPF 50+, non-comedogenic. This is non-negotiable, especially in Singapore, especially if you are on a topical retinoid or oral doxycycline (both make skin sun-sensitive). It is also the most important PIH prevention measure you have.

What to actively avoid

• Don’t squeeze, pick, or “extract” spots at home. This drives inflammation deeper, creates scarring, and dramatically increases PIH. The single biggest difference between patients with and without scarring is often whether they were able to leave their spots alone.
• Don’t switch products every 2 weeks if you don’t see results. Acne treatments take 6 to 12 weeks of consistent use to show real benefit. Anyone who promises faster results is selling you something rather than treating you.
• Don’t apply spot treatments to broken or recently popped lesions — high-strength benzoyl peroxide or salicylic acid on broken skin worsens inflammation and PIH.
• Don’t layer multiple actives without guidance — vitamin C in the morning, retinoid at night, AHA/BHA on weekends, and a “brightening serum” mid-week is a recipe for irritation. Less, used correctly, is more.

Singapore-specific considerations

• Heat and humidity worsen oiliness; mid-day blotting paper is fine, but resist the urge to wash repeatedly.
• After exercise, rinse face with water if you can; full cleansing is only needed once at the end of the day.
• Sweating under helmets, masks, or sports gear drives forehead and cheek acne (“mask acne” or “maskne”). Use breathable fabrics, change covered headgear if reusable, and clean before re-wearing.
• Sunscreen choice matters in our climate — patients often dislike heavy creams. Lightweight gel or fluid sunscreens (Asian and European brands) are widely available; ask us for specific recommendations if you struggle to find one you’ll wear daily.

The treatments that actually work — topical first line

Topical treatment is the foundation for almost every acne patient, regardless of age or severity. Even patients on oral antibiotics or isotretinoin continue topical therapy for maintenance.

Topical retinoids — the single most useful drug class

Retinoids are vitamin A derivatives that work directly on the follicle — normalising the skin-cell turnover that produces comedones, reducing inflammation, and improving texture and tone over time. Used consistently, they are the most effective long-term acne treatment short of isotretinoin.

The main retinoids used in Singapore:

What to expect:

• Apply at night, on dry skin, a pea-sized amount for the whole face. More is not better — more is just more irritating.
• The first 2 to 6 weeks are often worse before they get better — flushing, mild peeling, sometimes a brief flare of comedonal activity (“retinisation”). This settles. Push through it; don’t quit at week 3.
• Real improvement is at 8 to 12 weeks. Schedule your follow-up around this timeline, not earlier.
• Sun-sensitivity — apply sunscreen religiously every morning. This is also, separately, your best PIH prevention.
• Pregnancy: tretinoin and tazarotene are contraindicated in pregnancy and planning pregnancy. Adapalene has limited data; we usually pause it during pregnancy as a precaution. If there is any chance you are pregnant, please tell us before starting.

Benzoyl peroxide (BPO)

A topical antimicrobial that kills C. acnes and reduces inflammation, without driving antibiotic resistance. Available over the counter at most local pharmacies in 2.5% and 5% strengths (e.g. Benzac AC, Brevoxyl).

Use:

• 2.5% strength is usually enough for most patients. Higher strengths cause more irritation without much extra benefit.
• Apply once or twice daily as a thin layer to the affected areas.
• Bleaches fabric — pillowcases, towels, and clothing collars. Use white linen during BPO therapy or swap to a different colour scheme you don’t mind fading.
• Common side effects: dryness, redness, peeling. Manage by reducing frequency (every other day), using a thinner layer, or pairing with a non-comedogenic moisturiser.
• Pregnancy: considered relatively safe in standard topical doses, but discuss with us if pregnant.

Topical antibiotics — only with benzoyl peroxide

Topical clindamycin (and historically erythromycin) was once a routine standalone acne treatment. Modern guidance is clear: use them only in combination with benzoyl peroxide, because C. acnes develops antibiotic resistance rapidly with monotherapy. Combination products like Duac (clindamycin 1% + BPO 5%) make this easy.

We rarely prescribe topical antibiotics on their own anymore. If you are on one, ask us whether it should be paired with BPO.

What about salicylic acid, glycolic acid, niacinamide, and other “active” ingredients?

These have a place — particularly salicylic acid for comedonal acne (it gets into the follicle and helps unblock it) — but they are not the heart of effective acne treatment. They are useful adjuncts, not replacements for retinoid + BPO. The specific brands and concentrations matter less than people assume.

When topicals aren’t enough — oral treatments

If you have moderate-to-severe inflammatory acne, or topicals at 12 weeks haven’t given the response we want, the next step is usually oral therapy alongside continued topical treatment.

Oral antibiotics

The standard SG choice is doxycycline 100 mg once daily, usually for 8 to 12 weeks. Doxycycline works partly as an antibiotic and partly as an anti-inflammatory.

How we use it:

• Always with continued topical retinoid + BPO — this gives the best response and prevents bacterial resistance.
• Maximum 12 weeks as a rule. Beyond that, the resistance risk outweighs the marginal extra benefit.
• Take with food and a full glass of water, sit upright for 30 minutes after — doxycycline can cause oesophagitis if it sticks in the gullet.
• Significant sun-sensitivity — sunscreen is essential.
• Other side effects to know: occasional GI upset, vaginal thrush, photosensitivity, and rarely benign intracranial hypertension (severe headache and visual changes — stop and see us).
• Avoid in pregnancy and breastfeeding and in children under 8 (effects on tooth enamel).

If doxycycline is not suitable, alternatives include lymecycline, minocycline (we use it less commonly because of rare but serious side effects), and erythromycin in pregnancy.

Hormonal therapy in women — combined oral contraceptive pill

For adult women with hormonal-pattern acne (lower-face, jawline, premenstrual flares) — particularly those who would also like contraception — combined oral contraceptive pills (COCPs) can be a strong option.

The two most-used in Singapore for acne are:

• Ethinylestradiol + cyproterone acetate (Diane-35) — historically marketed for acne and contraception together. Effective for hormonal acne; should not be used purely for contraception in patients without acne or hyperandrogenism.
• Ethinylestradiol + drospirenone (Yasmin, Yaz) — drospirenone has anti-androgenic properties; well-tolerated for many patients.

We would do a proper assessment before initiating — blood pressure, BMI, smoking history, migraine history, family history of venous thromboembolism (VTE), and any breast cancer or significant liver disease. The COCP carries a real (if small) increased risk of VTE; we would talk through this honestly before prescribing. There is no benefit in starting one without a clear conversation about that risk.

We follow up at 3 and 6 months, with response usually seen by 3 months. If COCP is the right choice for you, we usually continue it as long as it is working and tolerated.

A note: spironolactone is widely used internationally for adult female acne (off-label, for its anti-androgenic effect). We do not currently prescribe spironolactone for acne at KTMC. Patients who are interested in this option are referred to a dermatologist or relevant specialist for a fuller discussion.

Oral isotretinoin (Roaccutane, Acnotin) — the most effective oral treatment

Isotretinoin is a vitamin A derivative that taken orally produces deep, durable improvement in moderate-to-severe acne in the great majority of patients — often with long-term remission after a single course. Most patients who complete a full course do not need ongoing oral acne therapy afterwards.

We would consider isotretinoin when:

• Severe acne at presentation — nodulocystic, scarring, or with significant psychological impact
• Moderate acne that has not responded to a proper course of topicals + at least one oral antibiotic course
• Acne with significant scarring or risk of scarring — early intervention reduces the lifelong cosmetic damage
• Recalcitrant, frequently-recurring acne that needs control beyond what topicals alone can provide

How we prescribe isotretinoin at KTMC

We prescribe isotretinoin ourselves rather than referring routinely, but we are uncompromising on the safety conditions because the drug is genuinely teratogenic and has real systemic effects. Before starting, every patient agrees to:

• Baseline blood tests — full blood count, liver function tests (ALT/AST), fasting lipid panel, fasting glucose. For women of child-bearing age — pregnancy test (urine or serum).
• Repeat blood tests at month 1, then approximately every 1–2 months during treatment, depending on how the dose is going. For women of child-bearing age, pregnancy test at every visit.
• A signed consent form — covering the risks, side effects, the absolute requirement for contraception, and the obligation to attend follow-up appointments. We keep this on file.
• Effective contraception throughout treatment, AND for 1 month after the last dose. This is not negotiable. Pregnancy on isotretinoin carries a high risk of severe birth defects. Methods we accept include: combined oral contraceptive pill (often used together with isotretinoin), progestogen-only contraception, IUD/IUS, partner vasectomy (with confirmed effectiveness), or genuine abstinence with a clear understanding that abstinence is the chosen method.
• An understanding of common side effects — dry lips and skin (universal — moisturiser and lip balm constantly), dry eyes (artificial tears as needed; tell us if you wear contact lenses), occasional muscle aches, transient flare in the first 4–6 weeks (sometimes severe), rare changes in mood. Any persistent low mood or thoughts of self-harm — contact us same day.
• Avoid blood donation during treatment and for 1 month afterwards.
• No vitamin A supplements or “skin booster” products while on isotretinoin — risk of hypervitaminosis A.
• Avoid waxing, dermabrasion, and laser procedures during treatment and for 6 months afterwards (risk of unusual scarring).
• Avoid pregnancy planning during treatment and the month after.

A typical course is 6 to 9 months, with cumulative dose targets used to maximise the chance of long-term remission. We adjust dose based on response and tolerability rather than rushing to the highest dose.

If you have significant medical comorbidities (significant depression history, severe dyslipidaemia, liver disease, pregnancy planning) or you would prefer specialist-led care, we would refer you to a dermatologist instead. The goal is the right treatment for you, not the most convenient one for the clinic.

Procedures and adjuncts — a brief honest assessment

A range of procedures are marketed alongside acne treatment. The honest assessment:

• Comedone extraction by a trained provider (in a clinic, not at home) can help with persistent comedonal acne. Done badly, it scars. We do this in clinic when indicated.
• Intralesional steroid injection for a single large painful cyst can settle it within 24–48 hours and reduce scarring risk. We offer this in clinic — it takes about 10 minutes.
• Chemical peels — superficial salicylic acid peels can help comedonal acne and PIH; medium-depth peels are aesthetic-clinic territory.
• Light-based treatments (BLU-U blue light, IPL, photodynamic therapy) — modest evidence base; expensive; rarely the right first or second step.
• Lasers (e.g., low-fluence Q-switched Nd:YAG) for PIH and some scarring — evidence-supported for select indications, but specialist-led.
• “Acne facials” at beauty salons — quality varies enormously; some help, many cause more inflammation. We are cautious about recommending these and would rather see you in clinic.
• Microneedling, dermarolling at home — in inflammatory acne, this can spread inflammation and worsen PIH. Not recommended for active acne. Has a role in scar treatment in trained hands.

Acne scarring and post-inflammatory marks

A common and important question: what can be done about marks left after acne settles?

The first thing to understand is the difference between:

• Post-inflammatory hyperpigmentation (PIH) — flat, pigmented marks (brown, grey, or violet). Skin is structurally normal. Will fade over time.
• Post-inflammatory erythema — flat, pink-red marks, more common in lighter skin tones. Often confused with PIH.
• Atrophic scars — depressions in the skin (ice-pick, boxcar, rolling). Tissue loss; permanent without intervention.
• Hypertrophic and keloid scars — raised scars; more common on chest, shoulders, jawline; greater risk in some ethnicities and in some individuals regardless of skin colour.

PIH treatment — what we use, what we refer for

For PIH, we approach it on three fronts at the same time:

1. Stop new pigmentation forming

• Treat any active acne aggressively. Less inflammation = less new PIH.
• Daily SPF 50+ broad-spectrum sunscreen, generously applied, re-applied every 2–3 hours outdoors. Tinted sunscreens with iron oxide give additional protection against visible light, which contributes to pigmentation in darker skin.
• Stop picking and squeezing.

2. Topical lightening — what we use in clinic

• Hydroquinone 2–4% — the most effective topical depigmenting agent. Used in short courses (8 to 12 weeks at a time) with treatment-free intervals; long-term continuous use carries a small risk of paradoxical pigmentation (ochronosis). We supervise this.
• Azelaic acid 15–20% — gentler alternative; can be used long-term; reasonable in pregnancy.
• Topical tranexamic acid — newer option, increasingly available in cosmeceutical-grade formulations.
• Vitamin C (ascorbic acid) serum — adjunct; modest evidence; pleasant to use.
• Continued topical retinoid — speeds turnover of pigmented cells; helps for PIH as well as the underlying acne.
• Combination “Kligman-type” formulations (hydroquinone + tretinoin + low-potency steroid) — potent, short-course only, in supervised settings. Effective but needs careful use.

3. Procedures — generally referred out

The procedural options for PIH treatment beyond topicals — chemical peels at higher strengths, low-fluence Q-switched laser, picosecond laser, microneedling for scarring — are areas we do not offer routinely at our clinic. We would refer you to a dermatologist or aesthetic doctor for these where appropriate. We will give you our honest opinion of whether the procedure is likely to be worth the cost and downtime in your specific case.

Scar treatment — referral territory

For genuine atrophic acne scarring (ice-pick, boxcar, rolling), the treatment options — fractional CO2 laser, fractional radiofrequency microneedling (Morpheus8 and similar), TCA CROSS, subcision, dermal fillers — are specialist procedures. We are happy to discuss what’s likely to work for your particular pattern of scarring and refer to colleagues we trust.

For hypertrophic and keloid scarring, intralesional steroid injection (which we can do in clinic) is often first-line; advanced cases may go to a plastic surgeon.

The single most reliable way to avoid acne scarring is to treat acne early and properly, before scarring develops. This is one of the most concrete arguments for not “waiting it out.”

Things that may not help

A few areas where popular advice and clinical evidence diverge. These are not absolute — some patients clearly benefit from specific changes, and we don’t dismiss experience — but the population-level evidence is much weaker than the marketing suggests.

• Diet — chocolate and oily food causing acne. The evidence here is genuinely mixed. There is some evidence linking high-glycaemic-index diets (sugary drinks, white rice in large portions, high-glycaemic snacks) and dairy to acne severity in some patients. Cutting these out alone rarely fixes acne; combining sensible dietary patterns with proper medical treatment is more useful than restrictive elimination. Chocolate specifically? No good evidence.
• “Detox” diets, supplements, and cleanses — no evidence for any specific acne benefit; some carry risk.
• Toothpaste on spots — old advice; can cause irritant dermatitis and PIH.
• Aggressive scrubbing, exfoliating brushes, “deep cleaning” salons — usually worsen inflammation.
• Frequent face washing (more than twice a day) — strips the skin and can rebound oily.
• Hot water and very hot showers — drying; not helpful.
• Switching products every 2–4 weeks — the single most common reason patients say “nothing works.” Acne treatments need 8–12 weeks before judgement.
• DIY extraction tools sold online — even with the right intent, untrained extraction drives PIH and scarring.
• Probiotic supplements for acne — some marginal evidence at best; not a substitute for proper treatment.

If you have tried something specific and it has genuinely helped your skin, please tell us — we’d rather know than have you stop mentioning it.

When to come and see us

Most acne can be managed well in primary care with a structured approach. Worth a clinic visit if:

• You have not had a proper combined regimen (topical retinoid + benzoyl peroxide ± topical or oral antibiotic) and you have moderate or worse acne
• Your acne hasn’t improved meaningfully after 12 weeks of a consistent regimen
• You have any scarring — current or developing
• You are getting significant post-inflammatory hyperpigmentation that is itself bothering you
• You are an adult woman with hormonal-pattern acne and want to discuss the contraceptive-pill or referred options
• You are considering isotretinoin, or you have heard about it and want a balanced conversation about whether it’s right for you
• Your acne is genuinely affecting your mood, work, study, or social life — this matters and deserves treatment, not minimisation
• Your acne started after age 40, or has changed character abruptly — sometimes acne is a clue to something else

Urgent — same-day attention

• Severe, painful nodulocystic flare with fever or feeling unwell — uncommon, but acne fulminans needs prompt treatment
• Significant low mood, hopelessness, or thoughts of self-harm while on any acne treatment — particularly isotretinoin — please contact us the same day, or call SOS on 1767 if out of hours

Get in touch

Joo Chiat — 172 Joo Chiat Road, #01-01, Singapore 427443 · Tel 6920 1952

Punggol — 658 Punggol East, #01-04, Singapore 820658 · Tel 6312 4589

Email — admin@ktmc.sg

References

Guidelines and consensus statements

• Reynolds RV, Yeung H, Cheng CE, et al. Guidelines of care for the management of acne vulgaris. American Academy of Dermatology. J Am Acad Dermatol. 2024;90(5):1006.e1–1006.e30. jaad.org
• National Institute for Health and Care Excellence (NICE). Acne vulgaris: management. NICE guideline NG198, 2021 (updated 2023). nice.org.uk
• Thiboutot DM, Dréno B, Abanmi A, et al. Practical management of acne for clinicians: An international consensus from the Global Alliance to Improve Outcomes in Acne. J Am Acad Dermatol. 2018;78(2 Suppl 1):S1–S23.e1.
• Goh CL, Noppakun N, Micali G, et al. Meeting the challenges of acne treatment in Asian patients: A review of the role of dermocosmetics as adjunctive therapy. J Cutan Aesthet Surg. 2016;9(2):85–92.

Asian skin and post-inflammatory hyperpigmentation

• Davis EC, Callender VD. Postinflammatory hyperpigmentation: A review of the epidemiology, clinical features, and treatment options in skin of color. J Clin Aesthet Dermatol. 2010;3(7):20–31.
• Sarkar R, Arora P, Garg KV. Cosmeceuticals for hyperpigmentation: What is available? J Cutan Aesthet Surg. 2013;6(1):4–11.
• Chan H, Chan E. A randomized controlled trial of the efficacy of low fluence Q-switched 1064 nm Nd:YAG laser for the treatment of melasma in Asians. Lasers Surg Med. 2010;42(8):712–719.

Isotretinoin — efficacy and safety

• Layton AM, Knaggs H, Taylor J, Cunliffe WJ. Isotretinoin for acne vulgaris — 10 years later: a safe and successful treatment. Br J Dermatol. 1993;129(3):292–296.
• Bremner JD, Shearer KD, McCaffery PJ. Retinoic acid and affective disorders: the evidence for an association. J Clin Psychiatry. 2012;73(1):37–50.
• Pile HD, Sadiq NM. Isotretinoin. StatPearls, 2024. ncbi.nlm.nih.gov

Hormonal therapy in adult female acne

• Arowojolu AO, Gallo MF, Lopez LM, Grimes DA. Combined oral contraceptive pills for treatment of acne. Cochrane Database of Systematic Reviews, 2012.
• Ebede TL, Arch EL, Berson D. Hormonal treatment of acne in women. J Clin Aesthet Dermatol. 2009;2(12):16–22.

Diet and acne

• Bowe WP, Joshi SS, Shalita AR. Diet and acne. J Am Acad Dermatol. 2010;63(1):124–141.
• Smith RN, Mann NJ, Braue A, et al. A low-glycemic-load diet improves symptoms in acne vulgaris patients: a randomized controlled trial. Am J Clin Nutr. 2007;86(1):107–115.

This information is for general education only and is not a substitute for medical advice. Acne severity, treatment choice, and dosing must be individualised — please attend a consultation for assessment. v1.0 · April 2026 · Review due April 2028.