Acne Treatment Side Effects: What's Normal and What Isn't
The side effects of acne creams, gels and tablets, how to manage them so you can keep going, and the signs that mean you should stop and get help.
Part of our acne health guides.
Key fact: Most acne treatment side effects are mild, happen in the first few weeks and settle: dryness, redness, peeling and stinging. They are the commonest reason people stop a treatment that would have worked. A few side effects, though, mean you should stop straight away and get medical advice.
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See acne treatments →The first few weeks
Creams and gels for acne work by changing how the skin behaves, so the skin needs time to adjust. In the first two to four weeks, it's common to notice:
- dryness, tightness and peeling
- redness and a mild burning or stinging when you apply it
- a short-lived increase in spots
These usually settle as your skin gets used to the treatment. Warned in advance, most people get through it; unwarned, this is where treatment is abandoned.
Side effects by treatment
| Treatment | Common | Worth knowing |
|---|---|---|
| Retinoids: Differin, Epiduo, Treclin | Dryness, redness, peeling, stinging, a temporary flare | Skin burns more easily in the sun. Not in pregnancy |
| Benzoyl peroxide: Acnecide, Epiduo, Duac | Dryness, redness, peeling, burning | Bleaches hair, towels, bedding and clothes |
| Clindamycin creams and gels: Duac, Treclin, Zindaclin, Dalacin T | Dryness, irritation | Rarely, bowel inflammation: stop if you get severe or persistent diarrhoea |
| Azelaic acid: Finacea, Skinoren | Burning, itching, redness at first | Usually the best tolerated; can rarely worsen asthma |
| Antibiotic tablets: lymecycline, doxycycline | Nausea, stomach ache, diarrhoea, headache, thrush | Sun sensitivity; rarely, raised pressure in the head. Minocycline can cause skin pigmentation |
| Dianette (co-cyprindiol) | Nausea, headache, breast tenderness, mood changes | Higher risk of blood clots than some pills: health check needed |
For the full list for any medicine, read its patient information leaflet.
Purging: is my acne getting worse?
"Purging" is a temporary increase in spots in the first weeks of a retinoid (and sometimes other treatments), as blocked pores that were already forming come to the surface faster. It usually happens where you normally get spots, and settles within a few weeks.
It's less likely to be purging, and worth speaking to your prescriber, if:
- spots appear in new areas where you don't usually get them
- the skin is very sore, swollen, blistered or itchy, which suggests irritation or an allergy
- it is still getting worse after 6 to 8 weeks
- bumps are small, itchy and all the same size, which can be fungal acne; see what else looks like acne
For azelaic acid specifically, see Skinoren for acne, week by week.
Managing dryness and irritation
1
Use less, less often
A thin layer is enough. Use it every other night for a week or two, then build back up.
2
Moisturise
A plain, oil-free moisturiser after the treatment has dried, or before it as a buffer.
3
Apply to dry skin
Wait until your skin is completely dry after washing; damp skin stings more.
4
Strip back the rest
Stop scrubs, toners, acids and retinol while you adjust. Use sunscreen every day.
For a routine that fits around treatment, see our acne skincare routine.
When to stop and get help
Stop and call 999 if your face, lips, tongue or throat swell, or you have difficulty breathing. Stop and get urgent medical advice if you have severe, persistent or bloody diarrhoea (with clindamycin), a severe headache with blurred vision (with antibiotic tablets), yellow skin or eyes, a blistering rash, or blistering or burns where a cream was applied. With Dianette, get urgent help for leg pain or swelling, chest pain, sudden breathlessness or a sudden severe headache.
Speak to your prescriber, rather than stopping on your own, if irritation is severe or doesn't settle, if your mood drops, or if your acne is no better after 12 weeks.
Pregnancy
Retinoids (adapalene, tretinoin), tetracycline antibiotics and co-cyprindiol must not be used in pregnancy. If you find you're pregnant while using any acne treatment, stop and contact your GP. We don't supply acne treatment online during pregnancy or breastfeeding.
Reporting side effects
If you think you have had a side effect from any medicine, you can report it through the MHRA Yellow Card scheme at yellowcard.mhra.gov.uk. You can also tell us, and our prescribers can review your treatment.
Frequently asked questions
Is it normal for acne to get worse before it gets better?
It can be. Some treatments, especially retinoids, can cause a short-lived increase in spots in the first few weeks, often called purging. It usually happens where you normally get spots and settles within a few weeks. If spots appear in new areas, or it is still getting worse after 6 to 8 weeks, speak to your prescriber.
How long do acne cream side effects last?
Dryness, redness, peeling and stinging are usually worst in the first two to four weeks and then settle as your skin adjusts. Using the treatment every other night for a while, applying a plain moisturiser and protecting your skin from the sun all help.
What should I do if my acne cream burns?
Mild stinging or burning when you apply it is common at first. Make sure your skin is completely dry before applying, use a thin layer, and use it less often for a week or two. Stop and get advice if the skin blisters, swells or burns badly, or the burning doesn't settle.
Why do acne treatments bleach towels?
Benzoyl peroxide, found in Acnecide, Epiduo and Duac, is a bleaching agent. It can bleach towels, bedding, clothes and hair. Let it dry fully before your skin touches fabric, wash your hands after applying, and use white or old towels and pillowcases.
Do acne antibiotics have side effects?
Most people take them without problems. The commonest side effects are nausea, stomach ache, diarrhoea, headache and thrush, and they can make your skin burn more easily in the sun. Rarely, they cause raised pressure in the head, so stop and get advice if you get a severe headache with blurred vision.
When should I stop acne treatment because of side effects?
Stop and get urgent help if your face or throat swells or you have difficulty breathing, if you get severe or bloody diarrhoea, a severe headache with vision changes, yellow skin or eyes, or a blistering rash. For irritation that is bothersome but not severe, speak to your prescriber before stopping, as there are usually ways to manage it.
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
- Summaries of product characteristics for each medicine named, electronic medicines compendium. medicines.org.uk/emc
- MHRA. Yellow Card scheme. yellowcard.mhra.gov.uk
- 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.