5 Signs Your Acne Needs a Dermatologist, Not Just Cream

Acne isn’t just a teenage blip – it’s one of the most common skin conditions in Australia. Estimates suggest acne affects around 3–5 million Australians at any one time, roughly a quarter of the population. And while we often picture high‑schoolers with pimples, up to 10–20% of adults continue to have acne, with about 5% of women and 1% of men still affected at age 40.

Yet many adults are still told, “It’s just a phase,” or “Grab a better face wash and you’ll be fine.”

If you’ve been dutifully buying over‑the‑counter products, changing your pillowcases, drinking more water – and your skin is still angry – you’re not alone, and you’re not imagining it. For a lot of people, especially with adult or hormonal acne, properly clearing breakouts does need expert help from a GP and sometimes a dermatologist (a skin specialist).

In this article, we’ll walk through:

• Why adult acne is different to the “teenage pimples” you may remember
• What dermatologists and skin specialists in Australia can offer that chemist creams can’t
• 5 clear signs your acne needs a dermatologist referral, not just another tube of spot gel
• How to organise a dermatologist referral – including via telehealth with us at NextClinic
• Practical steps you can start this week while you’re waiting for specialist care

If you’re in Australia, juggling work, study, relationships and your skin – and starting to wonder if something more serious is going on – this guide is for you.

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Adult acne: why it’s more than “just pimples”

Adult acne (often called hormonal acne) is acne that continues beyond your late teens, or starts for the first time in your 20s, 30s or later. Healthdirect (the Australian government‑backed health information service) recognises adult acne as a distinct type, often linked to hormones, and notes it can keep going long after the usual teenage years.

Australian dermatologists through the All About Acne program describe that:

• Adult acne is more common in women than men
• It often clusters around the chin, jawline and neck
• Spots may be deeper, more painful, and last longer
• Triggers can include hormones, stress, some medications, and conditions like PCOS (polycystic ovarian syndrome)

So if your skin is flaring along your jaw every month, or you suddenly have deep, painful breakouts in your 30s, you’re not “too old” for acne – but you may need a different approach to treatment.

The invisible impact: confidence, intimacy, and mental health

Acne doesn’t just live on the surface of your skin. Studies consistently show people with acne have higher rates of depression, anxiety, poor self‑esteem and social withdrawal.

When acne leaves scars or dark marks, that psychological impact can be even stronger. One recent study found that around 38% of people with acne scars had clinical depression, and many reported a major impact on their quality of life, body image and sexual confidence.

If you’ve ever:

• Cancelled dates or social events because of a breakout
• Avoided intimacy because you’re embarrassed about your back or chest
• Felt your skin is holding you back at work, in photos, or on dating apps

…that’s valid. Acne is a visible condition, and in our image‑driven world it can hit self‑worth and sexual wellbeing hard.

The key message? You don’t have to be “covered head‑to‑toe” or “in hospital” before your acne matters. If it’s affecting your confidence, relationships or day‑to‑day life, it’s serious enough to deserve proper medical care.

What a dermatologist or skin specialist can do that chemist creams can’t

In Australia, dermatologists are specialist doctors who focus solely on skin, hair and nail conditions. They’re the people GPs turn to for complex cases – severe eczema, skin cancers, psoriasis, and yes, stubborn or scarring acne.

For acne, a dermatologist (or a GP with a special interest in skin) can:

• Confirm your diagnosis (is it definitely acne, or something that looks similar?)
• Classify your acne as mild, moderate or severe, and identify whether it’s nodular, cystic, comedonal, hormonal, etc.
• Look for underlying causes or contributing factors, like medications, hormonal conditions (e.g. PCOS), or steroid use
• Prescribe stronger, prescription‑only treatments, such as:
  • Topical retinoids
  • Combination gels with benzoyl peroxide + antibiotics or retinoids
  • Oral antibiotics when appropriate
  • Hormonal treatments (for suitable women), such as certain oral contraceptive pills or anti‑androgen tablets like spironolactone
  • Oral isotretinoin (formerly known as Roaccutane) for severe or resistant acne
• Help prevent and treat scarring and pigmentation, including procedural options (like peels, laser, microneedling) once active acne is controlled
• Coordinate care if your acne is tied to broader health issues or mental health concerns

Government‑backed resources like healthdirect outline that many effective acne treatments need to be used for weeks to months before you see the full benefit, and that more severe cases may need prescription medicines and/or referral to a skin specialist.

So how do you know when it’s time to move from “chemist aisle” to “dermatologist referral”? Let’s break down the five big signs.

Sign 1: Your acne is deep, painful, or cystic – and it’s leaving marks

If your breakouts aren’t just a few small whiteheads, but:

• Large, sore bumps under the skin
• Deep, tender cysts or nodules
• Clusters of inflamed red spots that take ages to settle
• Pimples that leave pits, raised scars or dark marks (post‑inflammatory hyperpigmentation) even when you don’t pick

…that’s a strong sign you need more than another gentle cleanser.

Severe or nodulo‑cystic acne is particularly likely to cause permanent scarring. In one large Australian school study, about one in four older teens already had acne scars, and that was before many had even reached full adulthood.

Why this is a dermatologist problem

International guidelines (such as the NICE acne guideline) recommend referral to a dermatologist when people have:

• Nodulo‑cystic acne
• Acne that is scarring or causing pigment changes
• Acne that is severe and not responding to standard treatments

These forms of acne usually need prescription‑only medicines, and sometimes oral isotretinoin, which in Australia can only be started by a dermatologist or certain hospital specialists.

What you can do now

• See a GP early – don’t wait for scars to become obvious.
• Ask directly whether your pattern sounds like nodular or cystic acne and whether a dermatologist referral is appropriate.
• While waiting, keep your routine simple:
  • A gentle, non‑foaming cleanser
  • A non‑comedogenic moisturiser
  • Sunscreen every day (scars and dark marks worsen with UV exposure)

At NextClinic, our doctors can assess mild to moderate acne via telehealth, help start prescription treatments where appropriate, and organise a dermatologist referral if your acne looks severe, cystic or scarring.

Sign 2: You’ve tried “proper” treatment for 2–3 months… and nothing’s changing

Most of us have dabbled in skincare: random cleansers, scrubs, charcoal masks, the occasional spot treatment.

But when we talk about a real trial of adult acne treatment, we mean:

• A consistent daily routine with active ingredients like benzoyl peroxide, salicylic acid or azelaic acid, or
• A GP‑prescribed topical retinoid or combination acne gel, or
• A supervised course of oral antibiotics, usually for several months

…and you’ve used them exactly as directed, for at least 8–12 weeks.

Guidelines suggest that acne treatments generally need a minimum of 8 weeks before you can judge their effectiveness properly.

If you’ve diligently done all of this – and your skin is no better, or even worse – that’s another clear sign it may be time for a dermatologist or skin specialist in Australia to take over.

Why “cream after cream” stops making sense

NICE guidance specifically recommends referral when:

• Mild to moderate acne has not responded to two full courses of appropriate treatment, or
• Moderate to severe acne hasn’t improved after treatment containing an oral antibiotic

In other words, once you’ve done the basics properly and long enough, endlessly rotating products isn’t the answer. You likely need:

• A deeper look at underlying causes – hormones, medications, lifestyle, skincare habits
• Consideration of stronger systemic treatments like hormonal therapies or isotretinoin
• A tailored plan that fits your skin type, age, and other health issues

How telehealth can help you fast‑track this stage

If booking in with a local GP is hard (or the clinic is booked out for weeks), telehealth can be a great bridge. At NextClinic, we:

• Offer full telehealth consultations with Australian‑registered doctors
• Can review your acne history, what you’ve already tried, and your general health
• Prescribe many acne medicines via eScript, sent straight to your phone
• Provide an online dermatologist referral letter when specialist review is appropriate, usually after a short phone consultation

That way, you don’t lose months bouncing between chemists – you can move more quickly from “nothing’s working” to “let’s escalate this properly”.

Sign 3: Your acne is seriously affecting your mental health or relationships

This is one sign that is easy to downplay but incredibly important.

If your acne is making you:

• Avoid social events, cameras, or eye contact
• Feel depressed, anxious, or ashamed about your appearance
• Struggle with intimacy because you’re self‑conscious about your face, chest or back
• Spend hours picking, analysing, or obsessing over your skin

…your mental health is sending as loud a signal as your skin.

Multiple studies show people with acne are more likely to experience depression, anxiety, low self‑esteem, and even suicidal thoughts, and that these effects can be stronger in adults than in teenagers. For people with acne scars, one recent study found a large proportion reported significant depression and a “very large” impact on quality of life, including embarrassment, body image concerns and impaired sexual activity.

Why this is a valid reason for specialist care

The NICE guideline specifically says dermatology referral should be considered for anyone whose acne of any severity is causing persistent psychological distress or a mental health disorder.

In other words:

"If acne is making your life miserable – even if a doctor calls it “mild” – you still deserve proper help, and a referral is absolutely reasonable."

A dermatologist isn’t a psychologist, but they can:

• Treat the physical driver – your acne – more effectively
• Work alongside your GP, and, if needed, mental health professionals
• Help reduce the visible reminders (like scars or dark marks) that keep distress going

What you can do this week

1. Tell your doctor honestly how bad it feels. It can help to say something specific like:
   • “I avoid dating and social events because of my skin.”
   • “I’m feeling low and thinking about my acne multiple times a day.”
2. Ask whether, given the emotional impact, a dermatologist referral is appropriate.
3. If your mood is very low, you’re losing interest in things you used to enjoy, or you’re having any thoughts of self‑harm or suicide, please seek help urgently:
   • Call 000 if you’re in immediate danger
   • Contact Lifeline on 13 11 14 or Beyond Blue on 1300 22 4636

If you prefer not to sit in a waiting room, we can organise a telehealth consultation so you can talk through both the skin and emotional side in a more relaxed setting, and arrange the right next steps.

Sign 4: Your breakouts look and behave like hormonal acne

Many adults, especially women and people assigned female at birth, describe a very recognisable pattern:

• Breakouts concentrated around the chin, jawline and lower cheeks
• Spots that flare up before your period, during major stress, or with changes to contraception
• Deep, tender lumps that hang around for weeks
• Other possible symptoms like irregular periods, excess facial/body hair, thinning scalp hair or weight changes (which can suggest PCOS or hormonal imbalance)

This is classic hormonal acne, also known as adult female acne. Healthdirect and All About Acne both acknowledge that adult acne often has a hormonal component and can persist well into your 20s, 30s and beyond.

Why hormonal acne often needs more than skin‑deep treatment

For hormonal acne, simply slapping on stronger creams may not be enough. You may need systemic treatments that influence hormone levels, such as:

• Specific combined oral contraceptive pills with anti‑androgenic properties
• Anti‑androgen medications such as spironolactone (for suitable women)
• Occasionally, oral isotretinoin for severe or resistant cases

These medicines have important pros and cons:

• They aren’t appropriate for everyone (for example, certain pills are unsuitable if you smoke or have clotting risks).
• Some can harm a developing baby, so reliable contraception and pregnancy planning are crucial.
• They work best when the right diagnosis (e.g. PCOS, other endocrine conditions) has been considered.

That’s where a GP and sometimes an endocrinologist or dermatologist come in.

When to involve a skin specialist in Australia

You should definitely talk to a doctor – and often consider a dermatology or gynaecology/endocrinology referral – if:

• You have hormonal‑pattern acne plus other hormonal symptoms, like irregular or absent periods, unexpected hair growth, or fertility issues.
• Your acne worsens after starting steroids, testosterone, bodybuilding supplements or other hormone‑related medication.
• You’ve tried standard topical and/or oral antibiotic treatments without improvement.

At NextClinic, we frequently help patients with hormonal acne by:

• Reviewing their contraceptive options and current medications via telehealth
• Providing eScripts for suitable treatments when clinically appropriate
• Arranging online specialist referrals (for dermatologists or gynaecologists/endocrinologists) so you can get onto the right waitlists sooner

If hormonal acne is affecting your sexual confidence or you’re worried it’s a sign of a deeper hormonal issue, that’s a completely legitimate reason to seek proper medical review.

Sign 5: Your acne is sudden, severe, or looks “not quite typical”

Most acne develops gradually and follows a familiar pattern. But there are some situations where new or changing acne deserves prompt medical attention and often a specialist opinion:

• Sudden, explosive acne appearing over weeks, especially if you also feel unwell (fever, joint pain). This can (rarely) be a severe form called acne fulminans, which needs urgent specialist care.
• Acne that starts for the first time well into adulthood (40s or beyond), especially with other symptoms like weight loss or unusual hair growth.
• Acne that appears after starting a new medication, such as certain steroids, testosterone, lithium, some anti‑epileptics or B‑vitamin supplements.
• A rash that looks “acne‑ish” but:
  • is mainly around the mouth or eyes,
  • is intensely itchy or burning, or
  • doesn’t form typical whiteheads/blackheads

In these cases, it might be rosacea, folliculitis, perioral dermatitis or another skin condition, not classic acne at all. A dermatologist or experienced skin GP can tell the difference and prevent months of using the wrong treatments.

Guidelines recommend referral when there’s diagnostic uncertainty – in other words, when your doctor isn’t 100% sure it’s “just acne”.

What to watch for and mention to your doctor

• Timing: “My acne appeared out of nowhere 3 months ago.”
• Triggers: “This started after I began [medication/supplement].”
• Systemic symptoms: fevers, joint pains, weight changes, night sweats.
• Distribution: Is it just the face? Also the back and chest? Mainly around the mouth or eyes?
• Appearance: Deep lumps, tiny uniform bumps, pustules around hair follicles, or anything that seems different from the teenage pimples you remember.

If anything feels severe or you’re systemically unwell, don’t wait for a blog or a telehealth consult – go to an emergency department or call 000.

How to actually get a dermatologist referral in Australia (without going in circles)

In Australia, to claim Medicare rebates for most specialist appointments (including dermatologists), you’ll need a valid referral from a GP or another specialist.

That doesn’t always mean hours in a waiting room, though.

Your main options

1. Your regular GP (in‑person)
   • Ideal if you have an ongoing relationship and they know your wider health picture.
   • Ask them to document:
     • How long you’ve had acne
     • Treatments you’ve already tried
     • Any scarring or pigment changes
     • Any psychological impact or other symptoms
2. Telehealth GP services (like ours at NextClinic)
   • Great if you’re time‑poor, in a remote area, or your local clinics are booked out.
   • At NextClinic we can:
     • Take a detailed history via an online form and phone consultation
     • Ask you to securely share photos if needed
     • Issue online specialist referrals (including dermatologist referrals) usually within about an hour when appropriate
     • Combine this with eScripts for interim treatment so you’re not doing nothing while you wait for your specialist appointment
3. Public vs private specialists
   • Public dermatology clinics (usually hospital‑based) are cheaper but often have longer waitlists and stricter triage; they’re more likely to prioritise severe, scarring or complex acne.
   • Private dermatologists can often see you sooner, but there’ll be out‑of‑pocket costs after your Medicare rebate.

Our blog post on how to fast‑track your specialist referral dives deeper into how referrals work, how long they last, and practical ways to reduce delays – especially in high‑demand areas like dermatology.

Where telehealth fits into your acne journey

Telehealth isn’t just for sore throats and COVID. Used well, it can be a powerful tool in your adult acne treatment plan.

At NextClinic, we use telehealth to help Australians with acne to:

• Get quick, safe access to prescriptions for many standard acne medicines (where clinically appropriate)
• Arrange dermatologist referrals online, including renewals if you’re already under specialist care
• Support other aspects of your health that intersect with acne – like contraception, sexual health, or mental wellbeing
• Provide medical certificates online if your skin flare‑ups or treatment side effects mean you genuinely need time off work or study to cope or recover

We’re big believers that telehealth doesn’t replace in‑person care – especially for emergencies or very complex cases – but it can remove a lot of friction:

• Less time off work for appointments
• No commute or waiting room
• Easier to seek help when you’re feeling self‑conscious about your appearance

For many people with acne, that lower barrier makes it more likely they’ll actually start – and stick with – a proper treatment plan.

Bringing it all together – and your next step this week

Let’s recap the 5 key signs your acne needs more than just another cream:

1. Deep, painful or cystic acne that’s scarring or leaving dark marks – especially on your face, back or chest.
2. No real improvement after 8–12 weeks of proper, consistent treatment with recommended products or prescriptions.
3. Significant emotional or mental health impact – low mood, anxiety, social withdrawal, or hits to your confidence and sexual wellbeing.
4. Clear hormonal pattern (jawline flares, cycle‑linked breakouts, PCOS‑type symptoms) that likely needs systemic treatment, not just topical products.
5. Sudden, severe, unusual or medication‑linked acne, or anything that doesn’t quite fit the typical “pimple” picture.

If any of those sound like you, your acne has officially graduated from “just a cosmetic issue” to something that deserves proper medical attention and, often, a dermatologist referral.

Your challenge for this week

Rather than trying five new products at once, choose one concrete step from this list to take in the next 7 days:

• Book an appointment with your usual GP and bring a written timeline of your acne and everything you’ve tried.
• Arrange a telehealth consultation (with us or another reputable provider) to discuss acne treatment and a potential skin specialist referral in Australia.
• Start a simple, evidence‑based routine (gentle cleanser + non‑comedogenic moisturiser + sunscreen + your prescribed treatment) and commit to it daily for at least 8 weeks.
• If your acne is affecting your mood, tell a doctor or trusted person explicitly and ask about both skin and mental health support.

Then, we’d love to hear from you:

Which strategy are you going to try this week – and why? Share your choice or your results in the comments, or let us know what’s been the hardest part of navigating adult acne so far. Your story might be exactly what someone else needs to feel less alone – and to finally ask for the help they deserve.

References

• Acne
• Acne | Healthengine Blog
• Acne | healthdirect
• Adult Acne - Adult Hormonal Acne - All About Acne
• Acne can affect more than your skin
• Depression, body image and quality of life in acne scars - PMC
• Acne - treatments, causes and prevention | healthdirect
• Acne treatments | healthdirect
• prevalence of common skin conditions in Australian school students: 3. Acne vulgaris | British Journal of Dermatology | Oxford Academic
• Acne vulgaris: management - NCBI Bookshelf
• NextClinic: Online Medical Certificates, Instant Scripts and Telehealth Consults
• Acne Vulgaris: Diagnosis and Treatment | AAFP
• Hormonal Acne Explained In 3 Minutes By Dermatologist
• How to Fast-Track Your Specialist Referral | NextClinic
• Online Medical Certificate | NextClinic

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