Acne. The word alone conjures images of teenage years, stress, and endless jars of cream that seem to do nothing. But acne is far more complex than most people think - and so is its treatment.
What is acne, really?
Acne occurs when hair follicles become clogged by a combination of sebum (skin oil) and dead skin cells. Four key factors drive this process.
The four pillars of acne
Excess sebum production. Your sebaceous glands produce more oil than needed. This can be hormonal, but stress, diet, and certain medications also play a role.
Abnormal keratinisation. In acne-prone skin, dead cells 'stick' together in the follicle, creating a plug.
Bacteria. Cutibacterium acnes finds ideal conditions in a clogged follicle to multiply, causing inflammation.
Inflammation. Your immune system responds to bacterial growth, transforming a simple blockage into a red, painful spot.
Dermatologist Dr. James Fulton, co-inventor of the acne medication Retin-A, described this as a chain reaction that begins weeks before you see a pimple. By the time that red bump appears, the problem has long been brewing beneath the surface.
Types of acne
Comedones (blackheads and whiteheads)
Open comedones (blackheads) are clogged pores where the plug contacts air and oxidises. Closed comedones (whiteheads) sit beneath a thin layer of skin. Both are non-inflammatory.
Best approach: salicylic acid (BHA) 0.5-2% daily. It's oil-soluble and penetrates into the pore to dissolve the plug.
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Papules and pustules
Papules are small, red, inflamed bumps. Pustules are what most people call 'spots' - red bumps with a white or yellow tip.
Best approach: benzoyl peroxide (2.5-5%) kills acne bacteria and is available without prescription. Studies show 2.5% is equally effective as 10%, with far less irritation.
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Nodular and cystic acne
Deep, painful inflammations that can cause scarring. If you have this type, see a dermatologist. Over-the-counter products are often insufficient.
The pharmacy routine that works
Step 1: Cleanse (but not too much)
This is where most people go wrong. The natural reaction to acne is aggressive cleansing. But over-cleansing damages your skin barrier, causes more irritation, and can actually stimulate sebum production.
Choose a mild, soap-free cleanser with a neutral to slightly acidic pH (around 5.5). Use your hands, not a flannel. Maximum twice daily.
Brands like La Roche-Posay (Effaclar), CeraVe, and Bioderma (Sébium) offer excellent cleansers specifically developed for acne-prone skin.
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Step 2: Treat
After cleansing, apply your active ingredient based on your acne type:
- Mainly blackheads: Salicylic acid 0.5-2% daily
- Inflamed spots: Benzoyl peroxide 2.5-5%, start every other day
- Both: Alternate - salicylic acid mornings, benzoyl peroxide evenings
- Post-acne dark marks: Niacinamide or azelaic acid
Always start with one active ingredient at a time.
Step 3: Moisturise
'But my skin is already oily!' - the most common reason to skip moisturiser. And exactly the wrong one. Oily skin isn't automatically hydrated skin. By skipping hydration, you dry out your skin barrier, resulting in more sebum production as compensation.
Choose a lightweight, oil-free moisturiser. Gel textures work particularly well.
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Step 4: Protect
Sun protection is essential with acne. Many treatments make skin more sun-sensitive. UV radiation can also worsen post-inflammatory hyperpigmentation.
Choose a non-comedogenic sunscreen. Look for 'oil-free' and 'non-comedogenic' on the label.
At Belgian online pharmacies like Viata, Farmaline, and Medi-Market, you'll find a wide range of non-comedogenic SPFs, often for significantly less than in physical pharmacies.
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Common mistakes
Touching and squeezing
Everyone does it. Nobody should. Squeezing pushes infection deeper, spreads bacteria, and increases scarring risk. If you can't resist, use a hydrocolloid patch (pimple patch).
Switching products too quickly
Give any new product at least six to eight weeks. In the first two weeks, your skin may temporarily worsen (the 'purge') - that's often a sign the product is working.
Ignoring dietary factors
Recent research shows dairy products (especially skimmed milk) and high-glycemic foods can worsen acne in some people. Not a universal trigger, but worth monitoring.
Too many products at once
A damaged skin barrier is worse than acne.
When to see a dermatologist
If acne doesn't improve after 8-12 weeks of consistent over-the-counter use, if you're developing scars, or if acne impacts your mental wellbeing.
Smart savings on acne products
A complete acne routine can easily cost €80-100 monthly at physical pharmacies. Online pharmacies often offer the same products at 15-30% less.
On PharmaCompare, compare prices at a glance across all licensed Belgian online pharmacies. A La Roche-Posay cleanser that costs €14.90 at one pharmacy might be €11.50 at another. That €3.40 difference per product adds up significantly.