Acne Creams and Gels Compared
Every prescription and pharmacy acne cream and gel side by side: what each contains, how fast it works, the side effects, and which suits which kind of acne.
Part of our acne health guides.
Key fact: NICE recommends a gel that combines two treatments as the first choice for most acne: adapalene with benzoyl peroxide (Epiduo), tretinoin with clindamycin (Treclin), or benzoyl peroxide with clindamycin (Duac). Single-ingredient creams and gels are used when those don't suit you, or to keep skin clear afterwards.
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See acne treatments →At a glance
| Treatment | What's in it | How often | Contains an antibiotic? | Prescription? |
|---|---|---|---|---|
| Epiduo | Adapalene 0.1% or 0.3% with benzoyl peroxide 2.5% | Once a day, evening | No | Yes |
| Treclin | Tretinoin 0.025% with clindamycin 1% | Once a day, bedtime | Yes | Yes |
| Duac | Benzoyl peroxide 3% or 5% with clindamycin 1% | Once a day, evening | Yes | Yes |
| Differin | Adapalene 0.1% (gel or cream) | Once a day, bedtime | No | Yes |
| Acnecide | Benzoyl peroxide 5% (gel or wash) | Once or twice a day | No | No (pharmacy medicine) |
| Finacea / Skinoren | Azelaic acid 15% gel / 20% cream | Twice a day | No | Yes |
| Zindaclin / Dalacin T | Clindamycin 1% (gel / lotion) | Once / twice a day | Yes: only used with benzoyl peroxide or a retinoid | Yes |
Skinoren cream and Dalacin T are currently out of stock at our pharmacy. Azelaic acid is available as Finacea gel, and clindamycin as Zindaclin gel.
The four main ingredients
Almost every acne cream or gel is built from four ingredients, alone or in pairs. Each works on a different part of how acne forms.
Retinoids (adapalene, tretinoin)
Unblock pores and stop new blackheads, whiteheads and spots forming. The mainstay of keeping skin clear long term. Not used in pregnancy.
Benzoyl peroxide
Kills acne bacteria, loosens blocked pores and stops bacteria becoming resistant to antibiotics. Can bleach fabric and hair.
Clindamycin (an antibiotic)
Reduces acne bacteria and inflammation. Never used on its own, because bacteria become resistant; always paired with benzoyl peroxide or a retinoid.
Azelaic acid
Reduces bacteria and inflammation, helps unblock pores and acts on dark marks. Gentler than most, but slower.
Combining two of these covers more of the process at once, which is why combined gels work better for most people than either ingredient alone.
Combined gels: Epiduo, Treclin and Duac
These are NICE's three first-choice treatments, used for 12 weeks and then reviewed.
| Epiduo | Treclin | Duac | |
|---|---|---|---|
| Combination | Retinoid + benzoyl peroxide | Retinoid + antibiotic | Benzoyl peroxide + antibiotic |
| Best for | Most acne, including blackheads and whiteheads; any severity (NICE) | Blackheads, whiteheads and inflamed spots; any severity (NICE) | Mild to moderate acne with inflamed spots (NICE) |
| Can use with an antibiotic tablet? | Yes: NICE's choice for moderate to severe acne | No | No |
| How long you can use it | Can continue to keep skin clear | 12 weeks, then review | No more than 12 weeks at a time |
| Bleaches fabric? | Yes | No | Yes |
| Pregnancy | Must not be used | Must not be used | Only after a doctor weighs the risks |
Epiduo or Duac? Both contain benzoyl peroxide. Epiduo pairs it with a retinoid and has no antibiotic, so it can be used for longer and alongside an antibiotic tablet. Duac pairs it with an antibiotic, which can calm inflamed spots well, but it is limited to 12 weeks.
Duac or Treclin? Both contain clindamycin. Duac adds benzoyl peroxide, which is better at preventing resistance and treating inflamed spots; Treclin adds a retinoid, which is better for blackheads and whiteheads and doesn't bleach fabric. Treclin must not be used in pregnancy.
Single-ingredient treatments
- Differin (adapalene): a retinoid gel or cream for blackheads, whiteheads and mild spots, and the usual choice for keeping skin clear after a course. Used alongside an antibiotic tablet for more inflamed acne.
- Acnecide (benzoyl peroxide): available without a prescription. Useful on its own for mild acne, or alongside an antibiotic tablet or clindamycin lotion. The wash suits the back and chest.
- Azelaic acid (Finacea gel, Skinoren cream): the gentlest of the effective options and helpful for dark marks, but slower. A good choice if retinoids or benzoyl peroxide irritate your skin. See our azelaic acid guide.
- Clindamycin (Zindaclin, Dalacin T): never on its own. We only supply it together with benzoyl peroxide or a retinoid, and never with an antibiotic tablet.
How long each takes to work
None of these work overnight. Most people see some change within a few weeks, but NICE reviews treatment at 12 weeks, because that is how long it takes to judge fairly.
| Treatment | What the product information says |
|---|---|
| Epiduo | First signs of improvement are usually seen after 1 to 4 weeks |
| Azelaic acid (Skinoren) | A clear improvement usually after about 4 weeks |
| Zindaclin | A response may not be seen for 4 to 6 weeks |
| Differin | Assess after 3 months |
| Duac, Treclin | Up to 12 weeks, then review |
Skin often gets a little drier, redder or more spotty in the first few weeks. That usually settles; see our guide to acne treatment side effects.
Which suits which kind of acne
| Your acne | Usually suits |
|---|---|
| Mostly blackheads and whiteheads | A retinoid: Epiduo, Differin or Treclin |
| Red and pus-filled spots, mild to moderate | Epiduo, Treclin or Duac |
| Widespread, moderate to severe, or on the back and chest | An antibiotic tablet with Epiduo (or azelaic acid); see acne antibiotics compared |
| Dark marks as well as spots | Azelaic acid or a retinoid, with daily sunscreen |
| Sensitive or easily irritated skin | Azelaic acid, or a lower-strength retinoid started every other night |
| Keeping skin clear after treatment | Differin, or Epiduo; not an antibiotic |
| Deep, painful lumps or scarring | See a GP: you may need a dermatologist |
Sensitive skin, pregnancy and other situations
Sensitive skin: start every other night, use a plain moisturiser, and give your skin two to three weeks to adjust before deciding a treatment doesn't suit you. Azelaic acid is usually the best tolerated.
Pregnancy and breastfeeding: retinoids (adapalene, tretinoin) must not be used in pregnancy. Benzoyl peroxide, azelaic acid and clindamycin are sometimes used with caution, but it is a decision for your GP or midwife. We don't supply acne treatment online if you're pregnant, trying for a baby or breastfeeding.
Women with hormonal acne: a combined contraceptive pill, or co-cyprindiol (Dianette) for moderate to severe acne, can be used alongside a cream or gel. See Dianette for acne.
Getting the best from any acne cream
- Apply a thin layer to the whole area that gets spots, not just the spots themselves.
- Use it every day for 12 weeks before judging it.
- Use a plain, oil-free moisturiser and daily sunscreen.
- Don't add other active products (scrubs, acids, retinol) without asking.
- Once clear, keep using a retinoid or benzoyl peroxide to stop acne coming back; see acne maintenance and relapse.
For how to fit treatments into a morning and evening routine, see our acne skincare routine.
Frequently asked questions
What is the best cream for acne?
There isn't one best cream for everyone. For most acne, NICE recommends a gel that combines two treatments: adapalene with benzoyl peroxide (Epiduo), tretinoin with clindamycin (Treclin) or benzoyl peroxide with clindamycin (Duac). The best choice depends on your type of acne, your skin and whether you could become pregnant.
Is Duac or Treclin better?
Neither is better for everyone. Both contain the antibiotic clindamycin. Duac adds benzoyl peroxide, which is good for red, inflamed spots and stops bacteria becoming resistant, but it can bleach fabric. Treclin adds tretinoin, a retinoid that is better for blackheads and whiteheads, but it must not be used in pregnancy. Both are used for up to 12 weeks, then reviewed.
Is Epiduo better than Duac?
Epiduo contains a retinoid (adapalene) with benzoyl peroxide and no antibiotic, so it can be used for longer and alongside an antibiotic tablet. Duac contains benzoyl peroxide with an antibiotic, and is limited to 12 weeks. Epiduo is often preferred for blackheads and whiteheads and for long-term use; Duac works well for inflamed spots. Epiduo must not be used in pregnancy.
Which acne cream works fastest?
Most improve acne gradually over several weeks. The Epiduo product information says the first signs of improvement are usually seen after 1 to 4 weeks, and azelaic acid usually shows a clear improvement after about 4 weeks. Any acne treatment needs about 12 weeks before it can be judged fairly.
Can I use two acne creams together?
Only if a prescriber has recommended it. Some pairs work well, such as a clindamycin lotion with benzoyl peroxide, or a retinoid at night with benzoyl peroxide in the morning. Using two products with similar effects, or adding scrubs and acids, mostly increases irritation without clearing acne faster.
Do I need a prescription for acne cream?
Benzoyl peroxide (Acnecide) is a pharmacy medicine, so you can buy it without a prescription. Retinoids (Differin, Epiduo, Treclin), azelaic acid and creams or gels containing an antibiotic are prescription-only. You can get them after an online consultation with a pharmacist prescriber, or from your GP.
Which acne treatment is best for sensitive skin?
Azelaic acid is usually the best tolerated of the effective options. Retinoids can still work on sensitive skin if you start every other night and use a moisturiser. Whatever you use, give your skin two to three weeks to adjust before deciding it doesn't suit you.
Not sure which treatment suits you?
Complete a short online consultation about your skin and any treatments you have tried. A GPhC-registered pharmacist prescriber recommends a treatment and, if it is suitable, we dispatch it from our UK pharmacy. For adults 18 and over.
Start Acne Consultation →References
- National Institute for Health and Care Excellence. Acne vulgaris: management (NG198). nice.org.uk/guidance/ng198
- NICE Clinical Knowledge Summaries. Acne vulgaris. cks.nice.org.uk/topics/acne-vulgaris
- Summaries of product characteristics for each medicine named, electronic medicines compendium. medicines.org.uk/emc
- NHS. Acne. nhs.uk/conditions/acne
Medical disclaimer: This page is for information only and isn't a substitute for medical advice. Most of the treatments mentioned are prescription-only, so a clinical consultation is needed before they can be supplied. Many acne treatments must not be used in pregnancy. Always follow your prescriber's advice and the leaflet. In a medical emergency, call 999.