Medical Aesthetics for Active Acne: Do Peels, Light Therapy and Facials Help While You Have Spots?

What is active acne, and why a physician first?

Acne (spots) is a chronic disease of the hair follicle and the oil gland attached to it. It presents with blackheads and whiteheads (comedones), red bumps, pus-filled spots and, deeper down, painful nodules or cysts. 'Active acne' means the period in which new lesions continue to appear. Acne is not a lack of cleanliness, and it should be approached not as a beauty problem but as a skin disease for which there is treatment.

This distinction matters, because almost all the options with strong evidence in acne treatment are medicines, and planning medical treatment is the physician's job. The guideline of the American Academy of Dermatology, updated in 2024, published 18 recommendations after systematically assessing the evidence. The options given a strong recommendation in this guideline are these:

• Topical medicines: benzoyl peroxide, retinoids (vitamin A derivatives) and antibiotics; using products with different mechanisms of action together is recommended.
• Oral antibiotics: for a limited period and together with topical medicines; it is stressed that the duration of use should be kept short in order to reduce antibiotic resistance.
• Oral isotretinoin: for acne that is severe, leaves scars, markedly affects the person psychologically or does not respond to other treatments.

In the same guideline, topical products containing salicylic acid and azelaic acid, and hormonal treatments in suitable female patients, received a conditional recommendation. Your physician decides which medicine is used, in which combination and for how long. The United Kingdom guideline (NICE) also recommends that first-line treatments be given as twelve-week courses; in other words, assessing the response takes months, not weeks. How topical retinoids are used is explained in the article “Retinoid Guide”.

Creams containing retinoids and oral isotretinoin are not used in pregnancy. If you are pregnant, planning a pregnancy or breastfeeding, be sure to plan your acne treatment with a physician; the details are in the article “Medical Aesthetics in Pregnancy and Breastfeeding”.

Where do medical aesthetic procedures stand in acne treatment?

Procedures are considered as an adjunct alongside medical treatment, or as an option in people who cannot use the medicines. The working group that prepared the American guideline concluded that there is not enough evidence to make a recommendation for procedures such as chemical peels, laser and light-based devices and microneedling. This does not mean 'it does not work'; it means 'there are not enough good studies to say with confidence that it works'.

Do chemical peels help spots?

The peels used in acne are superficial; salicylic acid and glycolic acid are used most often. Because salicylic acid is soluble in oil, it can reach inside the pores; this is why it is preferred for comedones. A systematic review assessing twelve randomised studies of chemical peels in acne (387 participants in total) reported that commonly used peels appeared similarly effective in mild and moderate acne and were well tolerated. The same review also emphasised that the methodological quality of the studies ranged from very low to moderate, that the results could not be pooled because the studies differed so much from one another, and that no firm conclusion could be reached.

• A peel is not an acne treatment in its own right but a treatment that can be added to medical therapy.
• The effect appears slowly, over several sessions; it may not last once the sessions stop.
• In skin being treated with a topical retinoid or benzoyl peroxide, a peel may penetrate more deeply; tell the person carrying out the treatment about all the products you use.
• In olive and darker skin the risk of pigmentation after the procedure is higher.
• Medium and deep peels are not a treatment for active acne.

The procedure itself and the recovery process are explained in the article “Chemical Peels”, and the precautions to take according to skin colour in the article “Laser, IPL and Chemical Peels on Olive and Darker Skin”. Using high-concentration acids bought online at home carries a risk of burns and scarring.

How effective are blue light, photodynamic therapy and laser in acne?

The idea behind light therapies is that particular wavelengths may reduce the bacteria and the inflammation that play a part in acne. In photodynamic therapy a medicine that makes the skin sensitive to light is applied first, and light is then delivered; the aim is to affect the oil glands as well.

The Cochrane review of light therapies in acne assessed 71 studies (4,211 participants). Most of the studies are small, their methods differ greatly from one another, and two thirds were supported by manufacturers. The review's conclusion is clear: there is no high-quality evidence on the use of light therapies in acne. The certainty about the benefit of photodynamic therapy as a standard treatment in moderate to severe acne was found to be low; and because side effects such as burns, blisters and scarring were not adequately reported in the studies, no clear conclusion could be reached on safety either.

• Visible light (blue, red) is tried only for inflamed spots; it is not effective for blackheads and whiteheads, nodules or cysts.
• Who will respond cannot be known in advance. A series of sessions is generally needed, and it is usually used together with a medical treatment.
• Light devices used at home are weaker than clinical devices.
• The United Kingdom guideline mentions photodynamic therapy only as an option that 'may be considered' in people aged 18 and over with moderate to severe acne in whom other treatments have not worked or cannot be used; it found the evidence on physical treatments in mild to moderate acne to be very limited.
• The American guideline includes a conditional recommendation against adding intense pulsed light to topical retinoid treatment.
• After photodynamic therapy the skin remains over-sensitive to light for a while; protection from the sun and bright light is needed for the period specified by the physician.

In summary, light and laser treatments can reduce acne, but they rarely clear it on their own and the evidence for them is limited. It is wise to be cautious about packages of sessions offered with the promise of 'acne treatment without medicines'.

What do comedone extraction and 'acne facials' do, and what are their limits?

Comedone extraction is the opening of blackheads and whiteheads with sterile instruments and the removal of their contents. Dermatology organisations state that this is generally considered for comedones that do not respond to other treatments, that it takes time and that medical treatment needs to continue in order to prevent new lesions from appearing. Deep, painful nodules and cysts are not emptied by squeezing; if the physician considers it necessary, medication can be injected into the lesion or the lesion can be opened and drained in sterile conditions.

Squeezing spots at home or in unsuitable conditions, however, is a different matter: the contents are usually pushed deeper into the skin, the inflammation increases, and the risk of infection and scarring rises. Guidelines recommend that patients be informed that persistently squeezing and picking at lesions increases the risk of scarring.

The sessions offered in beauty salons under the name 'acne facial' or 'deep cleansing' generally consist of steam, mechanical cleansing, a mask and massage. These can make the skin look temporarily cleaner and smoother; however, there is no reliable evidence that they change the course of acne. The points to watch are these:

• Squeezing inflamed spots, harsh scrubbing, grainy scrubs and brushes can increase irritation and inflammation.
• Massage and masks using oily, pore-clogging products can lead to new comedones.
• Instruments that are not sterile are an infection risk.
• Facial sessions do not replace medical treatment; the real loss is that they delay seeing a physician.
• If you are using a prescription acne medicine your skin is more sensitive; consult your physician before waxing, harsh peels and scrubbing.

For daily care the guidelines' advice is simple: washing twice a day with a cleanser that does not irritate the skin; avoiding oil-based and pore-clogging products in moisturisers, sunscreen and make-up; and removing make-up at the end of the day. It is also stated that there is not enough evidence to show that any particular diet treats acne.

Which procedures should not be done, or should be postponed, while acne is active?

Some procedures are carried out not to treat acne but to improve acne scars or another aesthetic problem. In skin with inflamed spots, these procedures can spread the problem, and the new spots that appear can spoil the result achieved.

This list is not a list of prohibitions but a warning about timing; the physician who examines the skin decides which procedure can be done and when. Who microneedling is suitable for is explained in the article “Microneedling”.

Can aesthetic procedures be done while taking isotretinoin?

For many years it was taught that in people taking oral isotretinoin, and those who had recently stopped it, procedures needed to be postponed for months. More recent consensus reports have reassessed this rule by type of procedure; they have reported that for some superficial procedures there is not enough evidence to justify waiting, while caution continues for deep and intensive procedures. The details are in the article “Medical Aesthetics for People on Medication or with Chronic Conditions”.

In practice the decision is one to be made jointly by the physician who prescribes the medicine and the physician who will carry out the procedure. Be sure to say, before any procedure including laser hair removal and waxing, that you are taking isotretinoin or have recently stopped it; do not stop the medicine on your own in order to be able to have a procedure.

When should you see a physician to avoid scarring?

Acne scars are difficult to improve afterwards and often cannot be erased completely; this is why the real aim is to prevent scars from forming. The known way to do this is to treat inflamed acne early and adequately. In the following situations you are advised to consult a physician rather than wait:

If scars have been left, the options are explained in the article “Acne Scars”; they are not dealt with separately here. For the distinction between medical need and cosmetic wish in adolescent acne, see the article “Medical Aesthetics for Young People”.

Realistic expectations

• Acne treatment takes patience: the effect of medicines begins within weeks, and a few months are generally needed to assess the response.
• Acne is a chronic disease; most people need maintenance treatment even after it has improved.
• Peels, light and facial sessions can help; they do not replace medical treatment, and the evidence for them is limited.
• Be cautious about treatments claimed to end acne in a single session or in a short time.
• The right time for scar treatment is after new spots have stopped appearing.