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Acne is an extremely common inflammatory skin condition and affects most people at some point during their lives most commonly during adolescence, though it can persist or even emerge in adulthood.
Acne usually starts when hair follicles become clogged with oil and dead skin cells, and then lead to the production of whiteheads, blackheads, pimples, and sometimes deeper more painful cysts or nodules.
Excessive sebum production, which is often triggered by hormonal fluctuations, creates an environment where bacteria can thrive. Some bacteria which are naturally present on the skin then proliferate in these conditions, causing inflammation and leading to acne. Abnormal cell turnover can lead to follicular hyperkeratinisation. This is where the dead skin cells stick together and block the pores. Genetics also increases the risk of acne susceptibility and severity. Other risk factors include certain medicines, stress and a bad diet which may exacerbate the condition.
Acne can cause physical discomfort and pain and as it is a visible medical condition, especially facial acne, it can lead to low self-esteem & confidence, social anxiety and even depression leading to a reduced quality of life. Studies have shown that acne sufferers often experience stigmatisation, difficulties in relationships, and limited employment opportunities. The psychological impact can be long term especially if there is scarring.
Multiple pharmaceutical options target the various pathophysiological mechanisms of acne:
Topical retinoids (tretinoin, adapalene) normalise follicular cell turnover, preventing pore blockage and reducing inflammation by binding to nuclear receptors that regulate gene expression.
Benzoyl peroxide works as an antimicrobial agent, releasing oxygen free radicals that destroy P. acnes bacteria, which cannot survive in oxygen-rich environments.
Topical and oral antibiotics (clindamycin, doxycycline) reduce P. acnes populations and provide anti-inflammatory effects by inhibiting bacterial protein synthesis.
Hormonal therapies such as combined oral contraceptives (available from Dr Weightman’s contraceptive service) reduce the production of sebum.
Treatment regimens can often combine multiple products to address the different aspects of acne pathophysiology simultaneously. This is tailored to the patient’s specific acne type, skin type, severity, and medical history.
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