Acne treatments, matched to your acne

Best for: Mild-to-moderate acne, especially comedonal — the original prescription retinoid

The original topical retinoid, prescription-strength. Like all retinoids it unclogs pores and works over weeks to months; it commonly causes irritation and sun sensitivity early on, and is generally avoided in pregnancy as a matter of practice — though of the topical retinoids only tazarotene is formally contraindicated on its label.

Best for: Mild-to-moderate acne — the accessible foundation treatment (blackheads, whiteheads and inflamed spots)

A topical retinoid that unclogs pores and calms inflammation, and the one that is now available over the counter (Differin 0.1%). Expect some dryness, redness and an early 'purge' before it helps; use sunscreen. Topical retinoids are generally avoided in pregnancy, though only tazarotene carries a formal label contraindication.

Best for: Moderate acne — a stronger topical retinoid

A potent topical retinoid, often more effective but also more irritating than adapalene or tretinoin. Retinoids are contraindicated in pregnancy — tazarotene especially carries that warning.

Best for: Mild-to-moderate acne — a once-daily two-in-one

Pairs a retinoid with benzoyl peroxide, which kills acne bacteria and helps stop antibiotic resistance. Benzoyl peroxide on its own is a cheap, effective over-the-counter option; it bleaches fabric, so mind towels and clothes. Because Epiduo contains adapalene it carries the same retinoid caveats: irritation and sun sensitivity early on, and it is generally avoided in pregnancy.

Best for: Moderate acne — a newer topical option that works for both men and women

A newer topical that blocks androgen receptors in the skin, targeting the hormonal driver of acne — and unlike spironolactone it is used by both men and women because it acts on the skin, not the whole body. It is not established under age 12, and in trials about 9% of adolescents showed temporary suppression of the adrenal (HPA) axis that resolved after stopping. There is no human pregnancy data and animal studies showed fetal harm, so raise it with a prescriber if you are or may become pregnant.

Best for: Inflammatory acne (red, pus-filled spots) — usually alongside benzoyl peroxide

A topical antibiotic for inflamed acne. It should be paired with benzoyl peroxide and not used alone long-term, because acne bacteria build resistance to antibiotics used by themselves. It is CONTRAINDICATED if you have a history of Crohn's disease, ulcerative colitis, or antibiotic-associated colitis: enough is absorbed through the skin that severe and occasionally fatal colitis has been reported even with the topical form. Persistent or bloody diarrhoea — which can start weeks after stopping — needs medical attention.

Best for: Moderate-to-severe inflammatory acne — a short oral course, with a topical

An oral tetracycline antibiotic for more widespread inflammatory acne, used for the shortest effective course to limit resistance and always with a topical (usually a retinoid + benzoyl peroxide). It causes sun sensitivity, and is avoided in pregnancy and in children under 8. Persistent or bloody diarrhoea during a course or up to two months after it needs medical attention — antibiotics including doxycycline can trigger C. difficile colitis.

Best for: Hormonal acne in adult women (jawline/chin, premenstrual flares) — off-label

Used off-label for hormonal acne in women — it blocks androgens, the hormones that drive oil production. It is not used for acne in men (it can feminise), and it must not be used in pregnancy. It is CONTRAINDICATED if you already have high potassium, Addison's disease, or take eplerenone — and potassium supplements, salt substitutes, ACE inhibitors, ARBs, NSAIDs and trimethoprim all push potassium higher, so it is checked by blood test. In the US it is FDA-approved as a diuretic, not for acne.

Best for: Severe, nodular or scarring acne, or acne that hasn't responded to everything else

The most powerful acne treatment and the only one that can produce lasting remission after a course. It is also the most tightly controlled: a severe cause of birth defects, so in the US it requires the iPLEDGE program with monthly pregnancy tests and two forms of contraception. Do NOT take it together with a tetracycline antibiotic such as doxycycline or minocycline — the isotretinoin label says the combination should be avoided because it has been associated with pseudotumor cerebri (raised pressure around the brain); avoid vitamin A supplements for the same reason. This birth-defect risk is an FDA BOXED WARNING, the highest tier FDA issues. Expect dryness, and blood-test monitoring; discuss mood changes with your prescriber.