What is acne?
Acne develops when hair follicles become blocked with oil and dead skin cells, allowing bacteria to multiply and trigger inflammation — producing blackheads, whiteheads, red papules and, in severe cases, deep painful nodules and cysts. It affects the vast majority of teenagers to some degree, driven by hormonal changes, but adult acne is common too, particularly in women, and can persist or first appear in the twenties, thirties and beyond. Beyond the skin itself, acne's impact on confidence and mental health is well recognised, and severe inflammatory acne can leave permanent scars.
Diagnosis is made on examination — no tests are usually needed — with severity grading guiding treatment, from creams and antibiotics through to isotretinoin, which requires specialist supervision and monitoring.
Common symptoms
- Blackheads and whiteheads
- Red, inflamed spots (papules and pustules)
- Deep, painful nodules or cysts
- Greasy skin
- Spots on the face, chest, shoulders or back
- Scarring or dark marks where spots have healed
How long will you wait?
Most acne is managed by GPs, but referral for severe or scarring acne needing isotretinoin joins routine dermatology queues that commonly run four to seven months in many areas — a long time when scarring is accumulating.
Privately, you can typically see a consultant dermatologist within 3–7 days and, where appropriate, start isotretinoin within 1–2 weeks after baseline blood tests.
NHS England median referral-to-treatment wait: 12.4 weeks, with 2.5 million people waiting over 18 weeks (May 2026). Individual waits vary by trust and urgency.
Treatment options
- Topical treatments. Retinoid and benzoyl peroxide creams or gels unblock pores and calm inflammation in mild to moderate acne.
- Oral antibiotics. Courses of lymecycline or doxycycline, combined with topical treatment, tackle moderate inflammatory acne.
- Hormonal treatment. The combined pill or spironolactone can be effective for women whose acne flares with their cycle.
- Isotretinoin (Roaccutane). A specialist-supervised tablet course that offers the closest thing to a cure for severe or scarring acne.
- Scar treatments. Once acne is controlled, options such as microneedling, laser or chemical peels — usually private — improve established scarring.
What does private treatment cost?
As a guide, a private dermatology consultation costs around £200–£300, and a full supervised course of isotretinoin, including follow-up appointments and blood monitoring, typically £1,000–£2,000 over six to nine months.
Does health insurance cover acne?
Insurance cover for acne is mixed and worth checking carefully. Many policies will fund an initial dermatology consultation for a new or worsening skin problem, but acne is often then classed as a chronic or ongoing condition, so extended treatment courses such as isotretinoin with its monthly monitoring frequently fall outside cover. Treatment for scarring is generally considered cosmetic and excluded, and acne that predates the policy is excluded as pre-existing.
Frequently asked questions
When should acne be seen by a dermatologist rather than a GP?
See a specialist if you have nodules or cysts, any sign of scarring, acne that has not responded to two or three months of GP-prescribed treatment, or acne causing significant distress. Scarring is the crucial one: it is permanent, preventable, and accumulates while you wait. Severe acne responds extremely well to isotretinoin, but only dermatologists can prescribe it, so earlier referral genuinely changes outcomes.
Is isotretinoin (Roaccutane) safe?
For most patients, yes, under proper specialist supervision — it is the most effective acne treatment available and clears even severe acne long-term in the majority. It does demand respect: dry skin and lips are near-universal, blood tests monitor liver and cholesterol, it must never be taken in pregnancy, and mood should be monitored, with any changes reported promptly. Your dermatologist will weigh the risks against the very real harms of scarring acne.
Does diet cause acne?
Diet is a contributor for some people rather than the cause. The best-supported links are with high-glycaemic diets — sugary foods and refined carbohydrates — and, in some individuals, large amounts of dairy, particularly skimmed milk. Chocolate and greasy food have never been convincingly shown to cause acne by themselves. A sensible balanced diet is worth trying, but persistent acne deserves proper medical treatment, not just dietary blame.