Do you need a dermatologist for acne?

Can a GP treat acne?

Yes. A GP or other medical doctor can assess acne and start the treatments that guidelines recommend first. A dermatologist is a doctor who has gone on to specialise in skin disease, and usually comes in when acne is severe or first treatments haven't worked.

The acne guideline from the UK's National Institute for Health and Care Excellence, known as NICE, covers both general practice and specialist care. It keeps referral to a dermatology team for specific situations, such as nodules and cysts, scarring, doubt about the diagnosis, or acne that hasn't responded to treatment.

How is acne severity graded?

Doctors look at the type of spots as well as the number. Blackheads and whiteheads, called comedones, are blocked pores without redness. Papules and pustules are red bumps and spots with a white or yellow centre, which doctors call inflammatory spots. Nodules and cysts are larger, deeper, painful lumps under the skin, and they carry the highest risk of scarring.

Scarring, dark marks that linger and how much the acne affects you also count. NICE reminds doctors that acne of any severity can cause psychological distress, and that the risk of scarring rises with how severe the acne is and how long it lasts.

NICE uses spot counts to sort acne into two broad groups.

• Mild to moderate acne means any number of blackheads and whiteheads, up to 34 inflammatory spots, or up to 2 nodules.
• Moderate to severe acne means 35 or more inflammatory spots, 3 or more nodules, or both.

What can a GP prescribe for acne?

Treatment usually starts with something you apply to the skin. NICE and a 2024 guideline from the American Academy of Dermatology both favour combining treatments that work in different ways. A doctor may suggest a gel or cream that pairs a retinoid, such as adapalene or tretinoin, with benzoyl peroxide or the antibiotic clindamycin. Azelaic acid is another option. Tretinoin in South Africa looks at one of these in more detail.

For moderate to severe acne, a doctor may add an antibiotic tablet such as doxycycline. NICE advises against using any antibiotic on its own, or pairing an antibiotic tablet with an antibiotic applied to the skin. It also says antibiotic treatment should run past 6 months only in exceptional circumstances. A 2016 systematic review of antibiotic resistance in acne advised keeping antibiotic tablets to 3 months or less where possible, because resistance in acne bacteria is rising.

For women, hormonal treatment is another route. The American guideline gives conditional support to combined oral contraceptive pills and to spironolactone. In a 2023 UK trial of 410 women with acne lasting at least 6 months, spironolactone improved acne compared with a dummy pill. Hormonal acne covers these options.

How long does acne treatment take to work?

Acne treatment is slow. NICE notes that improvement can take 6 to 8 weeks to show, and advises reviewing a first course at 12 weeks to check progress and side effects. Stopping early, or switching products every few weeks, makes it hard to tell whether anything is working.

Antibiotic tablets are reviewed at the same point. If your skin has improved but not cleared by 12 weeks, NICE suggests continuing the tablet for up to 12 more weeks alongside the skin treatment. Hormonal treatment can take longer to show its full effect. In the spironolactone trial, the difference from the dummy pill was larger at 24 weeks than at 12.

When should you see a dermatologist for acne?

NICE advises referral to a dermatology team, or suggests considering it, in these situations.

• Deep, painful nodules or cysts, including acne conglobata, a severe form in which lumps join up through channels under the skin
• Acne that is leaving scars, or patches of darker skin that don't fade
• Mild to moderate acne that hasn't improved after two different 12-week courses, or moderate to severe acne that hasn't responded to treatment that included an antibiotic tablet
• Doubt about the diagnosis, for example when it could be rosacea or folliculitis, which can look like acne but need different treatment
• Acne or acne scarring that is causing ongoing distress or affecting your mental health

Can acne be treated online?

Often, yes. A doctor can take your history, review clear photos or see your skin on a video call, and prescribe and adjust standard treatments. In a 2010 randomised trial of 151 people with mild to moderate acne, follow-up visits done online, with photos sent every 6 weeks, gave similar results to office visits. A 2024 review of 21 studies also found similar results and satisfaction with online and in-person care.

Online care has limits. A doctor can't feel how deep a lump is through a screen, and in that review some patients felt texture and scars were easier to judge in person. Photos of the back and chest can be hard to take well, and people seen online were less likely to come back for follow-up. The review's authors suggest an in-person first visit with online follow-up as one way round this.

South Africa's Health Professions Council, the HPCSA, says telehealth should replicate an in-person consultation as far as possible without replacing it. The doctor decides whether your condition suits a remote consultation. Its guidelines require a recorded medical evaluation before any prescription, and state that prescribing based only on an online questionnaire is not an acceptable standard of care. If photos and a video call aren't enough, the next step is an in-person examination.

How easy is it to see a dermatologist in South Africa?

Dermatologists are scarce. A 2022 analysis of HPCSA registrations found 264 dermatologists registered in South Africa in December 2019, about 4 per million people. Around 78% worked in private practice, mostly in cities, and the public sector had just over 1 dermatologist per million people, against about 20 per million in the private sector.

Waiting times depend on where you live. A 2026 study that phoned private dermatology practices in August 2023 found a national median wait of 15 days for a routine skin check. Depending on the province, waits ranged from the same day to more than a year. For costs, see acne treatment costs in South Africa.

For most people, a sensible order is to start with a doctor you can see soon, give treatment a fair trial, and ask for a referral if one of the reasons above applies.

The Skin Crowd's doctor, Dr Christine van Looy, is a registered medical practitioner, HPCSA registration MP0879240. She is not a dermatologist, and she refers patients to one, or for an in-person examination, when that's needed. If you'd like a doctor to look at your skin, you can start an online assessment or read how it works first.

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