Acne and rosacea: prescription creams and gels after an online assessment

What a cream or gel can treat

Acne ranges from blackheads and whiteheads with a few red spots to deep, painful lumps. The HSE describes mild and moderate acne as mostly blackheads, whiteheads, papules and pustules, and that is the range where treatments applied to the skin do the work. Rosacea is a different condition: redness and flushing across the cheeks, nose and forehead, sometimes with small red bumps, most often in people over 30.

If you have not tried anything yet, a pharmacist can supply benzoyl peroxide without a prescription, and used consistently it is a reasonable first step for mild acne. A prescription treatment makes sense when that has not been enough, or when a combination product is more suitable.

How the assessment works

You describe the problem in the questionnaire: where the spots are, how long you have had them, what you have used and how your skin reacted. The doctor may ask for photographs, taken in daylight without filters or make-up, and may write back with questions. If the picture suggests a different condition, or acne too severe for treatment on the skin alone, he declines and tells you where to go instead. There is no video consultation, no phone appointment and no live chat.

When treatment is appropriate, the prescription arrives as a PDF by email, and you take it to a pharmacy with photo identification.

What the questionnaire asks

The topic questions are short. You are asked whether you are pregnant, planning a pregnancy or breastfeeding, because retinoids applied to the skin are not used then; and whether the spots are painful or lumpy, leave scars or are getting worse quickly, which would point to acne that needs a dermatologist. Two more questions ask whether the problem has lasted longer than three months and whether you have used a prescription treatment for it before. List the skin products and medicines you use as well, including contraception.

Treatments the doctor may consider

Adapalene is a topical retinoid: it unblocks pores and reduces the build-up of dead skin cells, and is usually applied once a day in the evening, sometimes in a fixed combination with benzoyl peroxide. Dryness, redness and peeling are common at first, so NICE advises starting on alternate days or washing it off after a short time and building up. It also makes the skin more sensitive to sunlight.

Clindamycin is an antibiotic applied as a lotion or gel. NICE advises against using a topical antibiotic on its own, because that encourages resistant bacteria, so it is combined with benzoyl peroxide or a retinoid for a limited course. Azelaic acid is often chosen when other products irritate too much, works for acne and for rosacea, and may sting or itch at first. For the bumps of rosacea, ivermectin cream is another prescription option.

All of these take time: the HSE notes that acne treatment can take up to three months to work, so judge it only after a fair trial.

Pregnancy and retinoids

Retinoids applied to the skin must not be used in pregnancy or by women planning a pregnancy. The European Medicines Agency confirmed this as a precaution in 2018: very little of the medicine is absorbed through the skin, but it is still not used. If you could become pregnant, the doctor will ask about contraception and may choose a different treatment. Mention breastfeeding too, since some combination products are avoided then.

When you need a dermatologist

A cream will not fix every kind of acne. Painful nodules, deep cysts, scarring, or many spots on the chest and back as well as the face need a dermatologist, and NICE recommends considering referral when acne has not improved after two completed courses of treatment or is leading to scars. Isotretinoin, the treatment for severe acne, is prescribed under specialist supervision with strict pregnancy prevention, and we do not issue it.

With rosacea, eye symptoms change the priority. A painful or red eye, blurred vision or sensitivity to light need an urgent GP appointment, because they can signal inflammation at the front of the eye. Any new or changing mole or skin growth needs to be examined in person.

Using the prescription in Ireland

The document is a PDF prepared to the Annex of Commission Implementing Directive 2012/52/EU, naming the active substance, form, strength, quantity and directions. It is signed by lek. Damian Wojno, who is registered with the Polish Medical Chamber (licence no. 3211301) and is not on the Irish Medical Council register.

Print it and take it to the pharmacy with photo identification. The pharmacist decides whether to dispense, and the PSI guidance on prescriptions from other EEA countries does not change that. Creams and gels are paid for at the pharmacy, separately from the assessment.