I am going to a big family wedding in 10 days and a big cyst has come up on my face. I just know it will still be there on the day. Can I do anything to get rid of it?

Some doctors are experienced at injecting cysts like this with a steroid. It must be done by a doctor with this experience, as it can cause permanent damage to the skin if the correct technique and strength of steroid are not used. If your own doctor has no such experience with these types of acne treatments, ask whether anyone else in the practice could do it.

If not, or if your doctor works single-handed, you would have to see a dermatologist, but even going privately you might have trouble getting an appointment in time. It is likely, though, that the cyst will have calmed down in time for the wedding. The moral here is that, if you are prone to acne, make sure that it is under control in advance of any special occasion.

My acne is much better than it used to be but I still have some hard lumps on my cheeks. Can I have them cut out?

You could, but it would not be a good idea because you would end up with ugly scars to replace what are probably old cysts. These can be treated with liquid nitrogen, which is very cold. It is most often used to treat warts or verrucas and many doctors have access to it in their surgeries; if your doctor is not happy to freeze your cysts, you should ask for referral to a dermatologist.

I have heard about some lamps that treat acne. Do they work?

A mixture of red-blue light used in a controlled way has had some effect on inflammation and in reducing the number of acne spots. One trial of the technique involved treating the skin for 15 minutes three times a day for 12 weeks. It produced reasonable results in making inflammatory spots 75 per cent better but had no proven effect on comedones. It probably works by a combination of antibacterial and anti-inflammatory action. If you worked this hard at any of the more standard treatments, you would probably get as good if not better results. It also seems that the acne comes back once you stop the light treatment.

I don't want to take isotretinoin because I'm too scared of the side-effects. Is there anything else the dermatologist can offer me?

The dermatologist can try some of the standard treatments in different doses or combinations. The most common trick is to use higher doses of antibiotics. Both minocycline and trimethoprim can work well in higher doses than doctors are used to using. There shouldn't be any problems with the trimethoprim but the minocycline may cause some side-effects. In the higher doses of 200mg a day rather than 100mg it can cause unsightly blue-black pigment to be laid down in the skin. It is also associated with some serious conditions that can lead to liver damage or arthritis. As long as you are properly supervised and have regular blood tests, these side-effects can be prevented by stopping the drug if the dermatologist tells you to.

My acne seems to be made worse by my monthly periods so I wanted to try the hormone treatment. My doctor says it wouldn't be very safe because of problems with blood clotting. Is there nothing I can try?

It is the estrogen part of the usual hormonal treatment that would cause you problems. There is a slightly increased risk of blood clots in some people taking hormones, and it can rise if there is a personal or close family history of clots. The anti-androgen part of the treatment is not suitable to take on its own but some dermatologists prescribe another drug that can have the same effect. Called spironolactone, it blocks the action of testosterone. It is worth trying but needs to be started at a low dose and increased slowly in case it produces side-effects such as menstrual irregularities, breast tenderness or fatigue. It also needs some blood tests to check on possible changes in some of the salts (sodium and potassium) in the blood but these rarely cause any problems.