Acne That Won't Clear: Private Dermatology Assessment in Surbiton

Acne vulgaris affects up to 95% of teenagers and around 12% of adult women. For many people, it resolves through their 20s. For others, it persists — and in some cases, it begins or worsens in adulthood, particularly along the jawline and chin, where hormonal acne is common.

Despite being extremely prevalent, acne is widely undertreated. Research suggests that a significant proportion of people with moderate or severe acne never receive prescription treatment. This matters because inadequately treated acne leaves lasting physical and psychological scars — often preventable with appropriate early intervention.

Understanding Acne

Acne develops through four main mechanisms, all of which interact:

• Excess sebum production: Androgens stimulate the sebaceous glands to produce more oil
• Follicular hyperkeratinisation: Abnormal shedding of skin cells blocks pores, forming comedones (blackheads and whiteheads)
• Cutibacterium acnes (C. acnes): This bacterium colonises blocked follicles and triggers an inflammatory cascade
• Inflammation: The immune response to C. acnes produces the red, painful papules and pustules characteristic of inflammatory acne

Effective treatment targets one or more of these mechanisms. The choice depends on acne type (comedonal, inflammatory, mixed, cystic), severity, and your individual circumstances.

The Acne Treatment Ladder

Key Prescription Treatments Explained

Topical Retinoids

Retinoids (adapalene, tretinoin) are the most evidence-based topical treatments for acne. They work by normalising follicular keratinisation — clearing blocked pores and preventing new ones forming. They are prescription-strength at concentrations above adapalene 0.1%, and are photosensitising, so must be applied at night with daily SPF during the day. Many people experience a "purge" in the first 4–6 weeks (temporary worsening) before significant improvement. Retinoids also reduce post-inflammatory hyperpigmentation over time.

Topical Antibiotics

Clindamycin reduces C. acnes colonisation and directly reduces inflammation. It should always be prescribed with benzoyl peroxide to minimise antibiotic resistance. Used alone without benzoyl peroxide, topical antibiotics risk selecting resistant C. acnes strains.

Oral Antibiotics

Doxycycline and lymecycline are the main oral options. They are effective for moderate inflammatory acne but current UK guidelines recommend limiting courses to 3 months — and always combining with benzoyl peroxide — to minimise antibiotic resistance. They are not suitable for use in pregnancy.

Hormonal Treatments for Women

The combined oral contraceptive pill (particularly co-cyprindiol or Yasmin) reduces androgen-driven sebum production. It is especially effective for women with a hormonal pattern — worse in the week before a period, predominantly affecting the jaw and chin. For women who cannot or do not want to take the pill, spironolactone at low doses can be highly effective for hormonal acne.

What Happens at a Private Acne Assessment?

At Lambert Medical Practice, Dr Nancy Abdelrahman conducts a thorough assessment including:

• Grading acne severity and type (comedonal, inflammatory, cystic, scarring)
• Identifying hormonal or dietary patterns that may be contributing
• Reviewing your current skincare routine (many people are unknowingly using comedogenic products)
• Discussing the full treatment ladder and helping you choose what is appropriate for your circumstances
• Prescribing prescription treatments on the day, where clinically appropriate
• Advising on acne scarring management if relevant

Frequently Asked Questions