Acne.Care & specialists in France

Acne is not curable in the strict sense because the underlying tendency to oily skin and follicular plugging persists, but it is highly controllable. Mild and moderate acne usually clears or near-clears within 3-6 months of consistent topical therapy. A 5-7 month course of oral isotretinoin produces durable remission in roughly 70% of severe patients at 2 years, with about a quarter needing a second course. Most adolescents see active disease decline through their early twenties.

Acne is caused by four interacting processes inside the hair follicle: excess sebum production driven by androgens, abnormal shedding of keratinocytes that plugs the follicle, overgrowth of Cutibacterium acnes biofilms, and inflammation through Toll-like receptor 2 and the NLRP3 inflammasome. Genetics set susceptibility (heritability around 80%), and hormones, certain medications, diet, and mechanical occlusion modify expression.

Early acne presents as small skin-coloured or whitish bumps (closed comedones) and dark-tipped pores (open comedones, or blackheads) across the forehead, nose, and chin in early adolescence. Visible inflammation, red papules and pus-tipped pustules, usually follows within months. Early treatment with a topical retinoid plus benzoyl peroxide at this stage prevents progression to inflammatory and scarring disease.

Acne is diagnosed clinically. A dermatologist or primary-care clinician examines the face, chest, and back, counts lesion types, and grades severity using scales such as the Investigator's Global Assessment. Blood tests are reserved for women with sudden-onset or treatment-resistant acne plus hirsutism, irregular cycles, or hair thinning, where polycystic ovary syndrome or other androgen excess is suspected, and for children with acne before age 7.

There is no single best treatment; the right regimen depends on severity and lesion type. Mild comedonal acne responds to a topical retinoid plus benzoyl peroxide. Moderate inflammatory disease usually adds a topical antibiotic in a fixed combination and, when needed, an oral tetracycline for 3-4 months. Adult women often benefit from spironolactone or a combined oral contraceptive. Severe nodulocystic or scarring acne is treated with oral isotretinoin under close monitoring.

Most topical and oral regimens take 8-12 weeks of consistent daily use before meaningful improvement, and full benefit at 4-6 months. The first 2-4 weeks can actually look worse as deeper lesions surface, and pushing through this period is essential. Isotretinoin courses run 5-7 months, with continued improvement for up to 4 months after the last dose.

Yes. Adapalene, tretinoin, tazarotene, and trifarotene are safe for years of nightly use when paired with sunscreen and moisturizer. Mild redness and peeling are common in the first 4-6 weeks and ease with a slower titration. Tazarotene is contraindicated in pregnancy and pregnancy planning; adapalene is the preferred retinoid for women trying to conceive.

Isotretinoin is an oral retinoid (Accutane, Roaccutane, Absorica, Claravis) that reduces sebum output by 80-90% and addresses all four pathogenic steps of acne. It is indicated for severe nodulocystic acne, scarring acne, treatment-resistant moderate acne, and acne with major psychosocial impact. Typical dosing is 0.5-1.0 mg/kg/day to a cumulative dose of 120-150 mg/kg over 5-7 months. It is a category X teratogen managed under iPLEDGE in the United States.

iPLEDGE is the US FDA risk-management programme for isotretinoin, designed to prevent in-utero exposure. Women of reproductive potential need monthly pregnancy tests, two reliable contraceptive methods, and monthly clinic visits to obtain each 30-day prescription. Men and women of non-reproductive potential have a lighter monitoring schedule but still require monthly visits.

A causal link has not been established. Large meta-analyses, including population-level pharmaco-epidemiologic studies, have not shown a consistent increase in depression or suicide risk among patients on isotretinoin, and treatment of severe acne typically improves mood scores. Pre-existing mental-health conditions should be monitored throughout the course and any change in mood reported promptly.

Yes. Persistent or late-onset acne affects roughly 12% of women and 3% of men over age 25. Adult female acne is typically distributed along the jawline and chin with premenstrual flares. Hormonal therapy with combined oral contraceptives and spironolactone works particularly well in this group, with the SAFA trial confirming spironolactone's effectiveness at 24 weeks.

Diet has a modest but real effect in some patients. Low-glycaemic-load eating patterns reduce lesion counts by 20-30% in randomized trials, and observational data link skim-milk and whey-protein intake to higher acne prevalence. Chocolate, oily food, and individual culprits beyond glycaemic load have weaker evidence. Diet is an adjunct, not a substitute for guideline-directed therapy.

Hormonal acne is the term used for adult female acne distributed along the jawline, chin, and lower face with premenstrual flares. Treatment options endorsed by the AAD 2024 guideline include combined oral contraceptives with a low-androgenic progestin and spironolactone 50-200 mg daily. Both take 3-6 months to reach peak effect and are often used alongside a topical retinoid.

No. Squeezing inflammatory papules, pustules, and nodules deepens the lesion, increases the chance of scarring, and prolongs healing. Painful nodules and cysts can be flattened in 48-72 hours with an in-office intralesional steroid injection, which is far safer than self-extraction. Comedone extraction with a sterile loop is performed by clinicians where appropriate.

The single best way to prevent scarring is early effective treatment of inflammatory and nodulocystic acne, escalating to systemic therapy when topical regimens fail rather than waiting for visible scars to appear. Avoid squeezing lesions, treat post-inflammatory hyperpigmentation actively in skin of colour, and use daily sunscreen to prevent darkening. Scar revision lasers and microneedling are used once active acne has been controlled for at least 6-12 months.

Most adolescent acne improves through the early twenties as androgen output stabilizes, but waiting it out risks permanent scarring and prolonged post-inflammatory pigmentation, especially in skin of colour. Roughly 12% of women and 3% of men carry persistent or recurrent acne into adulthood. Effective treatment shortens the active phase and prevents long-term complications.

No. Acne is driven by hormones, follicular plugging, bacteria, and inflammation, not by surface dirt. Over-washing, scrubbing, and harsh cleansers strip the skin barrier and can worsen acne. Gentle non-soap cleansing twice daily plus a fragrance-free moisturizer is the right cleansing routine for nearly every patient.

Stress does not cause acne but is a recognized trigger for flares. Cortisol-driven sebum output, sleep disruption, and skin-picking during stressful periods all contribute. Adolescents commonly flare around exam periods. Sleep hygiene, regular exercise, and where indicated cognitive-behavioural support reduce flare frequency in chronic disease.

Generic topical retinoids, benzoyl peroxide, and clindamycin together cost roughly USD 30-80 per month in the US and similar in the UK; in India and other emerging markets, generic topical regimens are widely affordable. Oral antibiotics and isotretinoin generics cost USD 20-150 per month. Brand-name and newer agents (clascoterone, trifarotene, sarecycline, the fixed triple-combination gel) run several hundred dollars per month at US list price, with insurance coverage variable.

Yes, with care. Safe options in pregnancy include topical azelaic acid, topical erythromycin or clindamycin (combined with benzoyl peroxide), and oral erythromycin for severe inflammatory disease. Topical retinoids and tazarotene, oral tetracyclines, isotretinoin, hormonal therapy, and spironolactone are contraindicated. Discuss any regimen with the prescribing clinician early in pregnancy or pregnancy planning.

See a dermatologist for moderate-to-severe inflammatory or nodulocystic acne, any scarring or significant pigmentation, treatment failure after 12 weeks of consistent first-line therapy, suspected hormonal disease, and acne with significant psychosocial impact. Adolescent boys with rapidly progressive severe disease and adult women with sudden-onset persistent acne especially benefit from early specialist review to prevent permanent scarring.