Acne Treatment in Ireland — What Works at Each Severity Level

Why treat acne early?

Acne is the most common skin condition affecting teenagers and many adults in Ireland. The case for early effective treatment is clear: untreated inflammatory acne significantly increases the risk of permanent scarring (atrophic ice-pick scars, hypertrophic scars), pigmentation changes (especially in darker skin), and psychological impact. Acne is also a frequent cause of low mood and anxiety in young people — and effective treatment helps both the skin and the mood.

Severity assessment — what guides treatment

Per NICE CKS, treatment is stepped by severity:

• Mild — predominantly comedones (blackheads, whiteheads), few inflammatory lesions
• Moderate — inflammatory lesions (papules, pustules) prominent; some early scarring
• Severe — extensive inflammation, nodules, cysts, scarring; significant psychological impact

Important: photograph-based assessment by an Online Doctor works well for most acne. Severe nodulocystic acne or suspected acne fulminans (sudden inflammation with systemic symptoms) warrants in-person assessment.

Treatment by severity

Mild acne

• Fixed-combination topical retinoid + benzoyl peroxide (e.g. adapalene + benzoyl peroxide) applied once daily at night — first-line per NICE
• Gentle skincare: non-comedogenic cleanser, fragrance-free moisturiser
• Daily sunscreen — retinoids increase photosensitivity
• Avoid picking and squeezing — worsens scarring
• 8–12 week trial before judging response

Moderate inflammatory acne

• Topical retinoid + benzoyl peroxide as above PLUS one of:
• Topical antibiotic (clindamycin) combined with benzoyl peroxide to reduce resistance
• Short-course oral antibiotic (lymecycline, doxycycline) for up to 12 weeks per antimicrobial stewardship guidance
• Hormonal therapy for women — combined oral contraceptive pill (after suitability review) or spironolactone (off-label, established practice)

Severe acne

• Referral to dermatology — public (via your treating doctor) or private
• Oral isotretinoin (Roaccutane) — the most effective treatment for severe acne but consultant-only in Ireland, with mandatory pregnancy prevention programme and monitoring per HPRA requirements
• Adjunctive treatments: chemical peels, intralesional steroids for nodules, laser for scarring (after acne controlled)

What does not help

• Over-scrubbing or harsh exfoliation — worsens inflammation
• Toothpaste, baking soda, or other unproven home remedies
• Eliminating food groups without evidence — diet has a modest role in some patients, but no universal "acne diet"
• Sunbeds or excessive sun exposure — temporary symptom improvement but worsens long-term skin health and scarring

Online Doctor pathway

An acne consultation covers: photograph-based assessment, severity grading, prescription of appropriate topical and/or oral treatments, hormonal therapy discussion for women where relevant, advice on skincare and sun protection, and structured follow-up. Where isotretinoin is being considered, the Online Doctor will arrange the appropriate referral.