Dermatological treatment of acne

Acne is one of the most common skin conditions worldwide and affects teenagers and adults alike. A dermatologist uses a structured, medical approach to identify the root cause of acne and tailor treatments that calm inflammation, unblock pores, prevent scarring, and restore long-term skin health.

Below, Dr Alvin HY Lee — Consultant Dermatologist — explains how acne is diagnosed, what treatments are most effective, and when specialist care can make a significant difference.

What causes acne and how do dermatologists diagnose it?

Acne occurs when pores become blocked with excess oil, dead skin cells, and bacteria. Hormonal fluctuations, genetics, stress, skincare products, and certain medications can all play a role.

A dermatologist begins by analysing:

The type of acne — blackheads, whiteheads, papules, pustules, cysts or nodules
The severity — mild, moderate, or severe
The pattern — whether it affects the face, back, chest or jawline
Contributing factors — skincare routine, lifestyle, diet, supplements or previous treatments

For women, dermatologists also assess signs of hormonal imbalance such as irregular cycles or symptoms of polycystic ovary syndrome (PCOS). This ensures a precise diagnosis and a treatment plan tailored to the individual, rather than a “one-size-fits-all” approach.

What treatments do dermatologists use for acne?

Dermatologists follow evidence-based, stepwise treatment pathways and often combine therapies for optimal results.

Topical treatments

Prescription creams and gels containing:

Retinoids
Benzoyl peroxide
Azelaic acid
Antibiotic combinations

These help to unblock pores, reduce inflammation, and target acne-causing bacteria. They form the foundation of treatment for many patients.

Oral antibiotics

Used for moderate and severe inflammatory acne. Dermatologists always combine them with topical treatments to reduce antibiotic resistance and improve outcomes.

Hormonal treatments

For women with hormone-driven acne, especially along the lower face and jawline, dermatologists may recommend:

The combined contraceptive pill
Anti-androgen therapy

These treatments help stabilise hormonal fluctuations that trigger breakouts.

Isotretinoin

Isotretinoin is the gold-standard treatment for severe or persistent acne.

It works by:

Reducing oil production
Shrinking sebaceous glands
Preventing pore blockage
Halting new acne formation

Dermatologists monitor patients closely during isotretinoin treatment to ensure safety and effectiveness.

When are dermatology procedures recommended?

Procedures can significantly speed up recovery and improve stubborn or scar-prone acne.

Common dermatology procedures include:

Chemical peels — to exfoliate, brighten, and reduce blocked pores
Comedone extraction — for blackheads and whiteheads
Laser and light therapies — to reduce inflammation and bacterial load
Intralesional steroid injections — ideal for painful cysts to prevent scarring
Cryotherapy — helpful for inflammation or persistent marks in selected cases

These targeted procedures complement medical therapy and enhance clinical improvement.

How do dermatologists prevent and treat acne scarring?

Preventing scars is one of the highest priorities in acne management. Dermatologists focus on rapidly controlling deep, cystic, or nodular acne — the types most likely to cause permanent damage.

Alongside medical treatment, patients receive guidance on:

Avoiding squeezing or picking
Using appropriate moisturisers and cleansers
Managing post-inflammatory pigmentation

Once acne is stable, dermatologists can treat existing scars using:

Microneedling
Fractional laser resurfacing
Chemical peels
Subcision
Targeted procedures for individual scars

The choice depends on the type of scar — rolling, boxcar, ice-pick, or mixed.

When should someone see a dermatologist for acne?

You should consider specialist assessment if:

Acne is leaving pigmentation or scars
Spots are deep, painful, or cystic
Over-the-counter products aren’t helping
Acne is affecting confidence or quality of life
You suspect hormonal acne or have persistent adult acne
You are considering or have been advised to start isotretinoin

A dermatologist can create a personalised treatment plan based on skin type, severity, and long-term goals, using the most advanced and effective acne treatments available.