Acne vulgaris affects approximately 95% of people aged 11 to 30 at some point, according to the NHS. It is the most common skin condition in the UK and one of the most frequent reasons young people seek advice from a community pharmacist. While severe acne requires GP or dermatologist intervention, mild to moderate acne can often be managed effectively with over-the-counter treatments available from any pharmacy.

Understanding acne severity

Before recommending treatment, pharmacists assess acne severity:

• Mild acne: mostly blackheads (open comedones) and whiteheads (closed comedones), with occasional small inflamed spots. Predominantly on the face.
• Moderate acne: more widespread papules and pustules, potentially affecting the face, chest and back. Some spots leave temporary marks.
• Severe acne: deep, painful nodules and cysts, widespread inflammation, scarring. This requires GP referral — OTC treatment alone is insufficient.

For mild to moderate acne, pharmacy treatment is appropriate as a first step. NICE Clinical Knowledge Summary guidance supports a stepped approach starting with OTC options before escalating to prescription treatments.

First-line OTC treatments

Benzoyl peroxide (2.5%–10%)

Benzoyl peroxide is the single most evidence-based OTC acne treatment. It works through three mechanisms: killing the bacterium Cutibacterium acnes (formerly P. acnes), reducing inflammation, and mildly unblocking pores.

Available as:

• Acnecide 5% gel — the most widely stocked pharmacy brand
• PanOxyl preparations (various strengths)
• Generic benzoyl peroxide wash or gel

Key counselling points:

• Start with the lowest strength (2.5% if available, or 5%) — higher concentrations are not necessarily more effective but cause more irritation
• Apply a thin layer once daily at night, building to twice daily if tolerated
• Expect initial dryness, peeling and mild stinging — this usually settles within two to four weeks
• Bleaches fabric. Warn patients about pillowcases, towels and clothing. Use white bedding during treatment.
• Results take 4–6 weeks to become apparent. Full benefit may take 8–12 weeks.
• Unlike antibiotics, C. acnes does not develop resistance to benzoyl peroxide — it can be used long-term

Salicylic acid (0.5%–2%)

Salicylic acid is a beta-hydroxy acid that exfoliates the skin surface and unblocks pores. It is less potent than benzoyl peroxide against active spots but is useful for comedonal (blackhead-dominant) acne and as a maintenance treatment.

Available in cleansers, toners and spot treatments from multiple brands. Apply once or twice daily. It is less irritating than benzoyl peroxide and does not bleach fabric, making it a good option for patients who cannot tolerate benzoyl peroxide.

Adapalene 0.1% gel (Differin)

Adapalene is a topical retinoid that was reclassified from prescription-only to pharmacy (P) status in the UK in 2023. This was a significant change — adapalene is one of the most effective topical acne treatments available and was previously accessible only via a GP or dermatologist.

It works by normalising skin cell turnover, preventing the formation of comedones (blocked pores) and reducing inflammation. Apply a thin layer once daily at night.

Important counselling:

• Expect a purge. Acne often worsens during the first 2–4 weeks of treatment as blocked pores are brought to the surface. This is normal and does not mean the treatment is failing.
• Use sunscreen daily. Retinoids increase photosensitivity.
• Not for use in pregnancy or when planning pregnancy — retinoids are teratogenic.
• Avoid waxing treated skin.
• Can be combined with benzoyl peroxide (applied at different times of day) for enhanced effect.

Skincare advice alongside treatment

Pharmacists should recommend:

• Gentle, non-comedogenic cleanser — avoid harsh scrubs, which can worsen inflammation
• Oil-free moisturiser — treatment-related dryness is the most common reason patients stop prematurely
• SPF 30+ sunscreen daily — especially with adapalene or benzoyl peroxide
• Avoid picking or squeezing — this increases scarring risk
• Non-comedogenic make-up — reassure patients that wearing make-up is fine, provided it is labelled non-comedogenic and removed thoroughly at night

When to refer to a GP

Pharmacists should refer when:

• Acne is moderate-to-severe with nodules or cysts
• OTC treatment has been used consistently for 8–12 weeks without improvement
• There is significant scarring
• Acne is causing psychological distress, affecting confidence or social functioning
• The patient is female with irregular periods, excess hair growth or weight gain (suggesting polycystic ovary syndrome — PCOS)
• The patient is under 12 years of age with significant acne

GP treatments include topical antibiotics (e.g. clindamycin, usually combined with benzoyl peroxide), oral antibiotics (lymecycline, doxycycline), combined oral contraceptive pill (for females), and isotretinoin for severe or treatment-resistant cases.

The pharmacy's role

Community pharmacies are the natural first point of contact for acne advice. With adapalene now available without prescription, pharmacists have access to a treatment toolkit that covers mild to moderate acne comprehensively. For many patients — particularly teenagers who may feel uncomfortable discussing their skin with a GP — the pharmacy consultation is the difference between effective early treatment and years of unnecessary suffering.

To find a pharmacy near you, use PharmSee's pharmacy finder. For pharmacists looking for clinical roles, explore current vacancies.

Sources: NICE Clinical Knowledge Summary — Acne Vulgaris; British National Formulary; BAD Patient Information — Acne; NHS — Acne Overview; PharmSee pharmacy register data (April 2026).