Acne: Do lotions, tablets or light-based treatment help?

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There are many treatment options for acne, including medication that is applied to the skin or swallowed, and over-the-counter or prescription-only products. But which treatment is most suitable for you? And can treatments like phototherapy improve your complexion?

The treatment options for acne will depend on a number of different things. For instance:

  • How severe is your acne?
  • What is your skin type (dry, oily or combination)?
  • How much does your acne bother you?
  • Do you have other health problems?
  • Are you male or female?
  • Are you susceptible to acne scarring?
  • Which treatments have you already tried out and how well did they work?
  • How important are their effects – and their side effects – to you?

Practically all acne treatments require patience to get results. But it can be worth the wait, and is certainly better than constantly switching treatments, which can sometimes make you feel like nothing will help.

Do topical medications help?

There are a variety of creams, lotions and gels that can be applied directly to the skin (topically) with different drugs in them. All of these treatments need to be used for several weeks or months before they start working. To prevent new pimples from forming, they have to be applied to the skin surrounding existing pimples too.

Some medications can irritate the skin, causing things like redness and itching. You can reduce this risk by starting with a low dose and then gradually increasing it. If your skin is already irritated, it may help to use a lower dose. If the medication still hasn't worked after some time, you could try a different medication.

Benzoyl peroxide

In Germany and other countries, benzoyl peroxide can be bought over the counter (without a prescription). It is available in the form of gels, lotions and creams. Benzoyl peroxide is meant to help remove the layer of dead cells on the outer surface of the skin. This makes it easier for oil (sebum) to leave the pore, preventing the sebaceous glands from clogging. It has an antibacterial effect as well. Unlike , there is no risk that will become resistant if you use it a lot.

In mild to moderate acne, benzoyl peroxide can lead to an improvement within a few weeks. But it can also cause problems like redness and itching. If benzoyl peroxide comes into contact with clothes and hair it may bleach them, so it is advisable to be cautious when applying it. The effectiveness of benzoyl peroxide doesn't depend on which form it is used in. It is available in various concentrations: 2.5%, 5% and 10%. Products with higher concentrations don't work better than those with lower concentrations, but side effects are more common when 10% benzoyl peroxide is used.


In inflammatory forms of acne, the skin is infected with bacteria. Antibiotics that are applied to the skin have an anti-inflammatory effect and can reduce inflammatory forms of acne. It is recommended to only use in combination with effective medications like benzoyl peroxide or a retinoid. Antibiotics aren't effective in the treatment of non-inflammatory acne.

Topical need to be used for quite some time before they can have an effect. In Germany and other countries, they are only available on prescription. The treatment takes at least three weeks, and many people only see an improvement after three to six months. One problem with is that there's always a risk of bacteria becoming resistant. In other words, the may get used to the drug if it's used too often. As a result, the don't work as well the next time you use them, or they may not work at all. So aren't suitable for repeated long-term use. Skin irritations and diarrhea are possible, but generally rare. The creams are usually well tolerated.


Retinoids are derivatives of vitamin A. The retinoids used in the topical treatment of acne include adapalene, isotretinoin and tretinoin. In Germany and other countries, these medications are prescription-only and are available as creams, gels or solutions. They can help in both inflammatory and non-inflammatory acne. Treatment with retinoids can lead to a visible improvement within a few weeks.

Side effects such as redness, burning and itching may occur. Retinoids haven't been approved for use in women who are pregnant or breastfeeding.

Other products for topical (external) use

Azelaic acid helps prevent oil glands in the skin from becoming clogged and can improve acne. It has an antibacterial and anti-inflammatory effect. The possible side effects include skin irritations such as itching and burning.

Many acne products, such as cleansing toners and creams, contain salicylic acid. This ingredient is believed to work by removing dead skin cells from blocked pores. It is not clear whether products containing salicylic acid help reduce acne. They can have side effects such as redness, dryness and peeling.

Fruit acid peels remove the top layer of skin, which is made up of dead skin cells. These peels usually contain glycolic acid. Some research suggests that they could be effective. They may cause mild skin irritations.

When are oral medications considered?

Oral (swallowed) medications are usually considered in people with moderate to severe acne, or if topical treatment hasn't led to a big enough improvement. These medications have to be prescribed by a doctor, too.


Antibiotic tablets can help improve inflammatory acne when taken for several weeks or months.

Oral can have side effects, including dizziness, digestive problems and allergic reactions such as rashes. The called tetracycline and minocycline aren't suitable for anyone who is pregnant or breastfeeding. People who take minocycline for longer than three weeks should have blood tests before and during the treatment. This is done in order to detect any problems with the liver, kidneys or the formation of blood as soon as possible.

As with topical , there is a risk that the may become resistant and that oral will then stop working if they are used too often.


One of the main causes of acne is higher levels of, or an increased sensitivity to, the hormone androgen. Certain hormone products can reduce the production and effect of androgen, leading to better skin.

Some hormone products can be prescribed especially for the treatment of acne. These medicines also have a contraceptive effect. Three combinations have been approved for the treatment of acne in girls and women in Germany:

  • Ethinyl estradiol / cyproterone acetate
  • Ethinyl estradiol / chlormadinone acetate
  • Ethinyl estradiol / dienogest

In women with moderate to severe acne, these hormone products are often used together with a topical treatment in order to improve the overall effect. The combination of ethinyl estradiol / dienogest is considered to be "second-line" treatment. This means that they should only be taken by women or girls who would like to use birth control pills as contraception anyway and whose creams and tablets aren't effective enough.

Hormone products such as birth control pills, on the other hand, are intended for contraceptive use and are usually not approved for the treatment of acne. But if girls and women who have acne use the contraceptive pill as a form of contraception anyway, it may also have a positive effect on their acne. This is only true, though, if they take a pill that has the estrogen and progestin in it.

Hormone products can also cause side effects, such as headaches and nausea. Some birth control pills increase the risk of deep vein thrombosis, too.


Retinoid tablets are one of the most effective treatments for acne, but they also have the most side effects. Because of this, they are generally only used if other medications haven't worked. Retinoid tablets can lead to a noticeable improvement, or might even make acne clear up completely. The acne sometimes comes back again after a while, though.

Because retinoids lower the production of oil in the skin, people who take them might have dry lips and skin or dry eyes. Other possible side effects include headaches, achy joints and backache. The higher the dose of retinoids you take, the more likely you are to experience side effects. Serious side effects are rare, though.

People who are pregnant or breastfeeding shouldn’t use retinoids because these medications can harm the child. For instance, they could lead to a birth defect in the unborn child. For this reason, girls and women can only use retinoids if they use at least one contraceptive method, or preferably two at the same time, when having sex with a boy or man – for example, the pill and a condom too. Contraception must be continued for at least four weeks after the treatment ends.

It is thought that there might be a link between using isotretinoin and a higher risk of suicide, but this has not been confirmed in studies. Still, it is important to look out for any unusual changes in mood if you are taking retinoids, and to inform the doctor if you notice any. In any case, it always makes sense to seek medical and/or psychological help if acne is a major problem for someone or if it causes mental health problems.

Can light-based treatment reduce acne?

Besides topical and oral medications, different types of light-based approaches can be used to treat acne. These treatments are usually only a good idea when used in combination with medication because they probably aren't as effective as the medication.

In phototherapy, the skin is treated with (usually blue) light under the supervision of a doctor. Studies suggest that this can improve acne over the short term. But the studies have considerable flaws, so their results are very unreliable. Phototherapy may lead to side effects such as skin redness.

In UV phototherapy, the skin is treated with UV light. Due to the risks for the skin, though, it is not recommended for acne treatment. Phototherapy is not the same as using a tanning bed.

Research suggests that laser treatments can also improve inflammatory acne over the short term. But there's a lack of good-quality research on the long-term effects of this approach, so it's not clear how effective they actually are.

What about other treatments?

People with acne sometimes also use complementary or alternative medicine approaches to try to improve their skin. These include things like herbal and homeopathic products, tea tree oil and purified bee venom. Acupuncture, green tea extracts, cupping and special massages are offered for the treatment of acne too. But none of these products or approaches have been clearly proven to work yet.

Arowojolu AO, Gallo MF, Lopez LM et al. Combined oral contraceptive pills for treatment of acne. Cochrane Database Syst Rev 2012; (7): CD004425.

Barbaric J, Abbott R, Posadzki P et al. Light therapies for acne. Cochrane Database Syst Rev 2016; (9): CD007917.

Cao H, Yang G, Wang Y et al. Complementary therapies for acne vulgaris. Cochrane Database Syst Rev 2015; (1): CD009436.

Chen X, Wang S, Yang M et al. Chemical peels for acne vulgaris: a systematic review of randomised controlled trials. BMJ Open 2018; 8(4): e019607.

Costa CS, Bagatin E, Martimbianco AL et al. Oral isotretinoin for acne. Cochrane Database Syst Rev 2018; (11): CD009435.

De Vries FM, Meulendijks AM, Driessen RJ et al. The efficacy and safety of non-pharmacological therapies for the treatment of acne vulgaris: A systematic review and best-evidence synthesis. J Eur Acad Dermatol Venereol 2018; 32(7): 1195-1203.

Garner SE, Eady A, Bennett C et al. Minocycline for acne vulgaris: efficacy and safety. Cochrane Database Syst Rev 2012; (8): CD002086.

Kim S, Park TH, Kim WI et al. The effects of green tea on acne vulgaris: A systematic review and meta-analysis of randomized clinical trials. Phytother Res 2021; 35(1): 374-383.

Kolli SS, Pecone D, Pona A et al. Topical Retinoids in Acne Vulgaris: A Systematic Review. Am J Clin Dermatol 2019; 20(3): 345-365.

Liu H, Yu H, Xia J et al. Topical azelaic acid, salicylic acid, nicotinamide, sulphur, zinc and fruit acid (alpha-hydroxy acid) for acne. Cochrane Database Syst Rev 2020; (5): CD011368.

Mohd Nor NH, Aziz Z. A systematic review of benzoyl peroxide for acne vulgaris. J DermatologTreat 2013; 24(5): 377-386.

Nast A, Dréno B, Bettoli V et al. European evidence-based (S3) guideline for the treatment of acne - update 2016 - short version. J Eur Acad Dermatol Venereol 2016; 30(8): 1261-1268.

Purdy S, de Berker D. Acne vulgaris. BMJ Clin Evid 2011: pii: 1714.

Romano M, Dellavalle RP, Naldi L. Acne vulgaris. In: Williams H (Ed). Evidence-based dermatology. London: BMJ Publishing Group; 2014.

Yang Z, Zhang Y, Lazić-Mosler E et al. Topical benzoyl peroxide for acne. Cochrane Database Syst Rev 2020; (3): CD011154.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

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Updated on December 5, 2022

Next planned update: 2025


Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

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