Most acne that walks through our door has already been treated as one single thing. It is not. Comedonal, inflammatory and nodular acne need different work, hormonal adult acne needs a different conversation again, and a fair number of “acne” breakouts turn out not to be acne at all. We grade it, name it, and only then agree a plan.
“Mild” and “severe” get used loosely, usually by whoever is selling the treatment. UK clinical guidance is countable, so we count. It decides whether your acne belongs in a treatment room, with a prescriber, or with a dermatologist — and it stops you paying for the wrong thing.
| Grade | What that means, counted | Where it should be treated |
|---|---|---|
| Mild to moderate | Any number of blackheads and whiteheads, plus up to 34 inflamed spots, and no more than two nodules. | Treatable here, alongside a proper homecare routine. |
| Moderate to severe | 35 or more inflamed spots, or three or more nodules. | Needs a prescriber. We assess, explain, and tell you what to ask for. |
| Nodulocystic | Deep, tender lumps and cysts, often on the jaw, neck, chest or back. | Dermatology territory. High scarring risk, and the priority is stopping the scarring, not polishing the surface. |
| Scarring already present | Pitted, raised or discoloured marks that persist after spots clear. | Treatable here, but only once the acne itself has been settled for a while. |
| Sudden, severe, with feeling unwell | Rapid onset of painful ulcerating lesions, sometimes with fever or joint pain. | Same-day medical attention. Not a cosmetic appointment. |
Grading takes five minutes and it is the difference between a plan and a guess. Photographs are taken at the same visit so change is measured rather than remembered.
Acne is one name for several different processes. Treating a blocked pore the way you would treat an inflamed one wastes months.
| What you see | What is actually happening | What tends to help |
|---|---|---|
| Blackheads and whiteheads Comedonal. Forehead, nose, chin, often no redness. | The lining of the pore is shedding too fast and plugging the opening. Bacteria are barely involved. | Keratolytic and retinoid-type routines, professional extraction, salicylic-based peels. Antibacterial products alone do very little. |
| Red spots and pus-heads Inflammatory papules and pustules. | A blocked pore has become inflamed, with Cutibacterium acnes — a bacterium that lives on everyone’s skin — driving the immune response. | Benzoyl peroxide, anti-inflammatory peels, LED, and a routine that does not strip the skin. Scrubbing harder makes this worse. |
| Deep tender lumps Nodules and cysts, slow to come and slow to go. | Inflammation deep in the dermis, which is where scarring is made. | Prescription treatment, promptly. Everything cosmetic can wait; preventing the scar cannot. |
| Brown marks after spots clear Post-inflammatory hyperpigmentation. | Pigment left behind by the inflammation. More common and longer-lasting in deeper skin tones. | Pigment-directed work, and daily broad-spectrum SPF 50. See pigmentation treatment. |
| Red or purple marks after spots clear Post-inflammatory erythema. | Dilated vessels, not pigment. Frequently mistaken for scarring. | Vascular-directed treatment and time. Pigment treatments do nothing for it, which is why the distinction matters. |
| Pits and dents that stay Ice pick, boxcar and rolling scars. | Collagen lost during deep inflammation. Permanent change to the skin’s structure. | Needling and resurfacing work, once the acne has been quiet for months. Improvement, not erasure. |
This is the most common reason a course of treatment fails. If the diagnosis is wrong, the plan cannot be right — and two of these three get worse with standard acne treatment.
Central facial redness with flushing, visible small vessels, and papules that come and go — but no blackheads or whiteheads. That absence is the giveaway. Rosacea flares when it is treated with strong acne actives or aggressive exfoliation, which is why separating the two at the assessment matters. We do treat rosacea — on its own pathway, with calming rather than clearing protocols and redness-directed work; see rosacea treatment. What we will not do is run an acne course on it.
Small clustered bumps around the mouth, nose or eyes, typically leaving a clear rim right at the lip border. Very often triggered by a topical steroid cream, or an inhaled steroid for asthma. The treatment is usually to stop the trigger under medical guidance, not to add a retinoid or a peel, both of which make it angrier.
Uniform, itchy, same-sized bumps, usually on the chest, back, shoulders or hairline, with no comedones. Caused by yeast in the follicle rather than bacteria, so it needs antifungal treatment — and it characteristically gets worse on antibiotics. Plenty of people spend months on peels and LED courses for this.
Others worth naming, because they are regularly mistaken for acne: keratosis pilaris on the upper arms and cheeks, hidradenitis suppurativa in the armpits and groin, acne caused by friction from helmets, straps or phones, and breakouts caused by medication. If your breakout matches one of these, we will say so at the assessment rather than start a course.
Adult acne is not teenage acne that stayed too long. It behaves differently and it responds to different things.
Treatment is chosen against the grade and type above, not picked from a menu. Once the assessment has identified what is actually driving your breakouts, a treating protocol is selected from the professional ranges we work with — mesoestetic, Medik8 and iS Clinical — and paired with homecare from the same system so the two are not working against each other. Your exact plan, and its full cost, is written down before anything is booked.
Professional-strength protocols from mesoestetic, Medik8 and iS Clinical are matched to your grade and type, with the in-clinic step and the homecare designed as one course rather than bought separately. Which range suits you depends on whether the problem is congestion, inflammation, pigment left behind, or a combination.
Professional deep cleansing and careful extraction of comedones, done properly rather than squeezed. This is what shifts congestion that no home routine reaches, and it is the fastest visible change for comedonal acne.
Anti-inflammatory in-clinic work paired with a home routine that stops stripping the skin. Most inflamed acne arriving here is being over-treated, not under-treated, and part of the job is undoing that.
Controlled resurfacing for texture, congestion and the marks left behind, spaced to your skin’s tolerance and stepped down for deeper skin tones because of the pigmentation risk.
Brown marks and redness are treated after the acne settles, not alongside it — see pigmentation treatment for how that side is assessed. Established scarring is treated later still — see acne scar treatment.
Written down, in order, with what to use when and what to stop. Daily broad-spectrum SPF 50 is not the optional part: without it, the marks will not fade whatever else we do.
A clinic that will treat anything is a clinic that is not assessing anything. Here is the line, drawn plainly.
Acne affects how people feel, not just how they look, and UK guidance is explicit that this should be asked about rather than ignored. If it is affecting your mood, your sleep or whether you leave the house, say so at your appointment — it changes how urgently we push for prescription input, and your GP needs to know too.
Your plan and its total cost are agreed and written down at your assessment, before any treatment is booked. That includes what you will spend in clinic, what the homecare adds, and over how many weeks — so there is no figure that appears later.
It starts on the skin analysis machine, which shows congestion, oil distribution, redness and pigment that are not yet visible on the surface. Your acne is then graded and typed, your Fitzpatrick skin type recorded, and your history taken — including every product you are currently using and any medication. Images are stored so change is measured rather than remembered. The assessment fee comes off your treatment if you go ahead.
What we will do in clinic, what you will do at home, how long before you should expect a change, and what it costs in total. If part of the answer is a prescriber, that is written down too.
Booked as its own short appointment. Required, not optional.
In-clinic treatments spaced to your skin’s tolerance, not to a sales calendar. Expect things to look slightly worse before better — that is normal, and you will be warned about it rather than surprised by it.
Compared against your first images. If it has not moved enough, the plan changes or we escalate. Twelve weeks is also roughly when prescription treatment should be reviewed, which is why we use the same clock.
Pigment, redness and scarring are treated once the acne is quiet. Treating marks while spots are still forming is spending money on a moving target.
Professional ranges are not the versions sold in shops. They are supplied only to trained clinics, used at strengths that need supervision, and built so the in-clinic protocol and the homecare belong to one system rather than working against each other. We stock three, and which one you go on depends on what your skin is doing.
All three are professional cosmetic ranges. None contains a prescription-only medicine, and where your skin genuinely needs one we will say so rather than reach for the nearest alternative on the shelf.
Dermacy opened in July 2020 and has treated skin in the same place ever since — acne, rosacea, melasma, pigmentation and sensitive, reactive skin, in every skin tone. The clinic was built on fifteen years of hospital work beforehand, across anaesthesia, pain, oncology, plastic surgery and dermatology, and it shows in how we work: assess first, grade it, write it down, and refer when referring is the right answer.
Your grading, skin analysis, treatment plan and progress reviews are carried out within each practitioner’s current professional scope.
Carries out the graded acne assessment, skin typing and clinical history review, sets the treatment plan and the twelve-week review, and decides when a case should go to a prescriber or GP rather than be treated in clinic.
Your total is set at the assessment and written down before anything is booked — in-clinic work, homecare and the number of weeks, together. We do that rather than quote a single headline figure, because the right plan for comedonal congestion and the right plan for inflamed acne are not the same price. Call 07899 703678 and the current cost of each step is confirmed before you commit.
Yes, always. It runs 45 minutes and starts on the skin analysis machine, so the grading is based on what your skin is actually doing rather than on what is visible in a mirror. Nothing is booked before that, because the grade decides whether treatment here is even the right answer — and the assessment fee comes off your treatment if you go ahead.
Not while you are on it, and not immediately after. Isotretinoin changes how your skin heals, so peels, microneedling and energy-based treatments are postponed until you have been off it for a period agreed with your prescriber. Bring your dates to the assessment and we will plan around them. It is worth asking any clinic this question before you book.
The quickest test is blackheads. Acne produces blackheads and whiteheads; rosacea does not. Rosacea tends to sit centrally with flushing and visible small vessels, and it flares when treated with strong acne actives. If your skin reacts badly to every acne product you try, that is worth taking seriously rather than pushing through. We treat both conditions, so the assessment is about getting you onto the right pathway rather than about turning anyone away.
It is worth considering if the bumps are all the same size, itchy, mainly on the chest, back, shoulders or hairline, with no blackheads — and particularly if they got worse on antibiotics. Fungal folliculitis needs antifungal treatment and does not respond to acne protocols. We check for this pattern at assessment.
The pattern is fairly recognisable: jawline, chin and neck, deeper and more tender, cyclical, in an adult rather than a teenager. If it comes alongside irregular periods, unusual hair growth or thinning hair, that combination deserves a proper GP conversation rather than surface treatment alone. We can treat the skin either way, but we will tell you when the driver sits somewhere we cannot reach.
If you have deep cysts or nodules; if your acne is already scarring or leaving lasting marks; if a proper routine has not moved it in about twelve weeks; if it is on your chest and back with lumps; or if it is affecting your mood or whether you go out. A GP can prescribe what we cannot, and can refer you on. Coming here first is not a wasted visit — a graded assessment and images make that GP appointment considerably more productive.
Often, yes, for the first two to six weeks. Starting anything that speeds up pore turnover brings what was already forming to the surface sooner. It is expected, it is not a reaction, and stopping at week three is the commonest reason people conclude that nothing works. You will be told what is normal and what is not before you start.
It depends on grade and type, and you get the number at your assessment rather than being sold a course first. As a guide, in-clinic work is usually spaced two to four weeks apart and judged at twelve weeks. Comedonal congestion tends to respond faster than inflammatory acne; scarring takes longest by far.
Yes, with the plan changed accordingly. Fitzpatrick types IV to VI carry a real risk of the treatment itself leaving a darker mark, so heat-based options are used far more cautiously or avoided, settings are conservative, and the sequence is slower. Post-inflammatory pigmentation is also more persistent in deeper tones, which is precisely why the acne itself is treated first and the marks second.
Some of it, with the plan stripped back. Several standard acne actives, retinoids in particular, are not used in pregnancy. Pregnancy also changes the skin, and breakouts that appear then often settle afterwards. We will agree a short, safe routine and coordinate with your midwife or GP rather than working around them.
Yes, with a parent or guardian present, and with a deliberately gentle approach. Teenage acne that is moderate or severe is also the clearest case for prescription treatment, so a GP conversation is often part of what we recommend rather than something we replace.
Yes, and it is worth doing, because truncal acne scars readily and gets neglected. Skin there is thicker, it responds more slowly than the face, and it is assessed and priced as its own area. Truncal acne with nodules is also the pattern most likely to need a prescriber.
Usually not, and this is where money gets wasted. While spots are still forming, new marks keep arriving, so the pigment and redness work is chasing a moving target. We settle the acne, then treat what it left. The exception is sun protection, which starts on day one because without it the marks will not fade whatever else we do.
They help specific things well: congestion, blackheads, surface texture, and the marks left afterwards. They are supportive rather than curative, and they are not a substitute for prescription treatment in moderate to severe acne. We use them where they earn their place and say so where they do not.
Honestly: not on their own, and UK clinical guidance does not recommend them as the primary treatment for active acne. They are useful adjuncts — LED for calming inflammation, and vascular or pigment-directed devices for the redness and brown marks left behind. Any clinic presenting a device as the cure for acne is selling the device, not treating the condition.
It can, particularly hormonal acne and particularly if homecare stops. Acne is a condition you manage rather than one you finish. What a good plan buys you is control, far fewer flares, much less scarring — and a routine you can maintain without living in the bathroom.
True scars — the pits and dents — are permanent changes to the skin’s structure, and treatment improves them rather than erasing them. A meaningful improvement is realistic; a flawless result is not, and anyone promising one is not being straight with you. Brown marks and redness are different: those genuinely do fade, given time and protection.
Professional protocols from mesoestetic, Medik8 and iS Clinical. Which one you are put on depends on what the assessment finds — congestion, inflammation, pigment left behind, or a combination — rather than on which range we happen to stock most of. All three are professional cosmetic systems: none contains a prescription-only medicine, and if your skin genuinely needs one of those, we will tell you rather than sell you the nearest alternative.
You need a routine, and what you use at home matters more than what happens in the room. The in-clinic protocol and its homecare are designed as one course, so they work best together. That said, if what you already own does the job, we will say so — the plan is written as what the routine needs to do, not as a shopping list.
Armthorpe, Doncaster, with free customer parking directly outside. We are open Monday to Saturday, 10:00 to 18:00, and we see clients from across South Yorkshire — Doncaster, Bawtry, Bessacarr, Rossington, Thorne and Conisbrough among them.
A graded assessment tells you which acne you have, whether it belongs here or with a prescriber, and what a realistic result looks like. That is worth knowing either way.
