Acne

Acne is one of the most common skin conditions and mainly affects adolescents and young adults between 16 and 30 years of age. It develops when sebaceous glands become blocked and inflamed, usually on the face as well as the back and chest. Following a medical assessment via photo or video consultation, a topical prescription therapy can be initiated and monitored over the long term.

Medically reviewed by Adi Zoabi, Approbation als Arzt.
Last reviewed on August 31, 2026. Updated as clinical guidelines change.

Overview

Acne (acne vulgaris) is a chronic inflammatory condition of the sebaceous follicles and is one of the most common skin diseases overall. Adolescents and young adults between 16 and 30 are particularly affected, although the condition can occur at any age. Typical features are comedones as well as inflamed papules and pustules, mainly on the face but also on the back, shoulders and chest. Severity ranges from a few comedones to deep, painful nodules with a risk of scarring. Acne responds well to medical treatment. Because the diagnosis is primarily a visual one, it is particularly well suited to telemedicine: using photos and a video call, the doctor can assess the skin. Following medical assessment, a topical prescription therapy can be initiated and monitored over the long term through regular follow-up appointments. The aim of treatment is to reduce inflammation, prevent new lesions and avoid permanent scarring as far as possible.

Common causes

Acne results from an interplay of several factors. At its core are increased sebum production, a keratinisation disorder of the follicle openings and colonisation with the skin bacterium Cutibacterium acnes, which together promote inflammation. Hormonal influences play a major role: rising androgen levels during puberty explain why acne is most common in adolescence and young adulthood; the menstrual cycle, hormonal changes or stopping hormonal contraceptives can also affect the skin. A family predisposition further increases the risk. In addition, comedogenic cosmetics, mechanical irritation from tight clothing or helmets, heavy sweating and certain medications can worsen acne. The role of diet is still under scientific discussion; in some people, dairy products or foods high in sugar appear to trigger flare-ups. Contrary to a widespread assumption, acne is not the result of poor hygiene.

When to see a doctor

A medical assessment is advisable if over-the-counter skincare products bring no improvement after six to eight weeks, if inflamed pustules are spreading, or if the first scars or dark spots are appearing. You should also seek medical advice if your skin is causing significant emotional distress — the earlier an effective therapy begins, the lower the risk of scarring. Warning signs that should be evaluated promptly include: deep, painful nodules or abscesses, extensively inflamed and hardened areas, sudden worsening despite ongoing therapy, and acne that first appears in adulthood together with menstrual irregularities or increased body hair. If a high fever and pronounced malaise occur together with painful, rapidly progressing skin changes, or if a new preparation is followed by shortness of breath or swelling of the face or throat, call the emergency number 112.

Symptoms & Indications

Blackheads and whiteheads (open and closed comedones) Inflamed papules and pus-filled pustules Oily, shiny skin (seborrhoea) Painful nodules beneath the skin Redness and tenderness of affected areas Skin changes on the face, back, shoulders and chest Healing lesions leaving dark spots or scars Emotional distress caused by the skin's appearance

Treatment Options

Topical benzoyl peroxide — by private prescription following medical assessment
Topical retinoids to normalise keratinisation
Azelaic acid for inflammatory acne and pigmentation
Topical antibiotics, usually in fixed combinations
Non-comedogenic skincare and gentle cleansing
Adjusting skincare routine, sun protection and possible triggers
Long-term follow-up with photo documentation

Important Notes

Photo and video assessment has its limits: severe or scarring forms of acne (e.g. acne conglobata) should additionally be examined in a dermatology practice.
Systemic therapy with isotretinoin requires regular blood tests and, for women, reliable contraception; it cannot be managed by telemedicine alone.
A prescription is only issued if the medical assessment provides a medical justification for treatment — there is no entitlement to one.
If you develop a high fever with painful, rapidly progressing skin changes, or signs of a severe allergic reaction (shortness of breath, swelling of the face or throat), call the emergency number 112.

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Medical notice: Not a substitute for an in-person medical examination. The information on this page is intended for general guidance only. In an emergency, please call 112.

Frequently Asked Questions

Can acne be assessed via photo or video consultation?

Yes, acne is well suited to visual diagnosis. Using meaningful photos and a video call, the doctor can assess the severity and distribution of the skin changes. Following medical assessment, a topical therapy can be initiated and monitored over the long term through follow-up appointments. For unclear or severe findings, an in-person visit to a practice is recommended.

What does the video consultation cost and who covers the costs?

Billing is carried out as a private service according to the German medical fee schedule (GOÄ). Privately insured patients can usually submit the invoice to their private health insurer; reimbursement depends on the individual plan. Self-payers receive a transparent GOÄ invoice, and the costs are displayed before booking.

Will I receive a prescription in every case?

No. Whether a private prescription is issued is decided by the doctor after the visual diagnosis. Following medical assessment, a prescription may for example be issued for topical retinoids, benzoyl peroxide or azelaic acid. If telemedicine treatment is not suitable, you will receive a recommendation on how to proceed.

How quickly does acne improve with treatment?

Topical therapies require patience: visible improvement often only appears after several weeks of consistent use. At the beginning, the skin may temporarily become irritated or the complexion may initially worsen. Follow-up checks are therefore useful to adjust the therapy if needed.

What else can I do myself?

Use mild, non-comedogenic cleansing and skincare products and avoid squeezing pimples, as this can promote inflammation and scarring. Sun protection is important, especially during treatment with topical retinoids. Note possible triggers such as certain cosmetics and discuss them during your appointment.