In short: Acne is a condition of the skin's sebaceous glands. There are several types, for example acne vulgaris, late-onset acne and comedonal acne. Treatment depends on the type and severity and usually starts with creams. Tablets are added for more severe acne. Preventing scars is a goal. After about twelve weeks, we check whether the treatment needs to be adjusted.

Overview

Acne is a skin condition in which the sebaceous glands become inflamed. Blackheads and whiteheads, pimples, nodules or pustules appear, mostly on the face, chest or back. The causes are increased sebum production, clogged pores and bacteria on the skin.

Treatment depends on the type of acne. Important goals are to calm the skin and to prevent scars. The following sections explain the three most common types.

Treatment options

Acne vulgaris

The most common type. It usually begins in puberty and shows blackheads, pimples and pustules, sometimes also painful nodules. Treatment starts with creams. For moderate to severe acne, tablets are added.

Late-onset acne (acne tarda)

Acne that first appears after the age of 25 or persists beyond that age. Typical are inflamed nodules and pustules on the chin, jawline and neck, often varying with the menstrual cycle. The creams are the same as for acne vulgaris. In women, hormonal tablets often play a larger role.

Comedonal acne

Here blackheads and whiteheads are the main feature, with little inflammation and few pustules. Creams are usually enough. Antibiotic tablets do not help sufficiently here.

Creams and gels (topical treatment)

Retinoids (e.g. tretinoin, adapalene) open clogged pores and reduce inflammation. In comedonal acne they are the most important cream. They are sometimes combined with benzoyl peroxide or azelaic acid.
Benzoyl peroxide kills bacteria and has a mild effect on blackheads and whiteheads. It is also available without a prescription.
Azelaic acid acts against bacteria and inflammation and helps with dark marks after acne.
Antibiotics applied to the skin (e.g. clindamycin) are used only together with benzoyl peroxide, never alone.

Tablets (systemic treatment)

Antibiotic tablets (e.g. doxycycline, minocycline) are an option for moderate to severe acne. They are given for as short a time as possible, as a rule for no more than about three months, and always together with a cream treatment.
Hormonal treatment (certain birth control pills, spironolactone) can help women when the acne is partly hormonal. The effect appears after about three months at the earliest (pill) or over about six months (spironolactone). Spironolactone is not approved for acne. The pill is prescribed after possible risks have been assessed.
Isotretinoin is a vitamin A derivative taken by mouth. It is intended for severe, scarring or treatment-resistant acne and carries important risks (see below).

For pure comedonal acne, tablets are rarely needed.

How quickly does treatment work?

After about twelve weeks, your skin should have improved noticeably. If it has not, we will offer to adjust the treatment. Please be patient: treatment does not work overnight.

Skin care tips

Wash your face twice a day with lukewarm water and a mild, soap-free cleanser.
Do not scrub, and do not use harsh peels, brushes or washcloths. They irritate the skin further.
Do not squeeze or pick pimples. This can cause scars and dark marks.
Make-up, sunscreen and skin care products should be labelled “non-comedogenic” or “oil-free”.
An oil-free moisturising cream can ease skin irritation caused by acne treatment.
Change your pillowcase regularly, especially if you use hair care products.

Important information about isotretinoin

Pregnancy: Isotretinoin must not be taken during pregnancy. It harms the unborn child. Women who could become pregnant must use reliable contraception, starting one month before treatment until one month after it ends, and have regular pregnancy tests (every four weeks).
Common side effects: dry skin, dry lips, dry eyes and muscle pain.
Check-ups: Liver values and blood fats are checked before treatment and after about three months, with further checks as needed.
Mood: Before treatment we ask about earlier depressive episodes. Please report any mood changes during treatment to your doctor right away.

If you have questions about your individual treatment, please speak to your dermatologist or family doctor.

Sources

German Society of Dermatology (DDG), S2k guideline “Therapie der Akne” (Treatment of Acne), AWMF register no. 013-017, version 3.0 (as of 1 August 2026). The guideline is in German.

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This is literature-based patient education. It does not replace a medical consultation and is not to be understood as a treatment recommendation.