It is widely suspected that the anaerobic bacterial species Propionibacterium acnes (P. acnes) contributes to the development of acne, but its exact role is not well understood.[2] There are specific sub-strains of P. acnes associated with normal skin, and moderate or severe inflammatory acne.[49] It is unclear whether these undesirable strains evolve on-site or are acquired, or possibly both depending on the person. These strains have the capability of changing, perpetuating, or adapting to the abnormal cycle of inflammation, oil production, and inadequate sloughing of dead skin cells from acne pores. Infection with the parasitic mite Demodex is associated with the development of acne.[29][50] It is unclear whether eradication of the mite improves acne.[50]
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Acne is caused when the sebaceous glands in your skin get infected or inflamed. Blemishes and pimples are most commonly found on your face, chest and back. You have a system of oil glands under your skin, and this is where sebum is produced. Sebum is supposed to keep your skin healthily moisturized, but too much production of this oil can cause blackheads and whiteheads. When the oil is pushed out through your hair follicles, it can clog your pores if it attaches to bacteria or dead skin cells. If this happens, sebum will build up behind the plug and form a pimple. And we all know what that is.

That’s why, no matter how uncomfortable your skin may feel while plagued with acne, you must resist the urge to touch your skin. If the irritating sensations become unbearable, there are other methods of treating your skin, such as cooling it with ice packs or aloe vera gel. You can even use medicated creams designed to soothe irritated skin – given that your dermatologist says it’s okay.
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If a pore is open, it’s called a blackhead or “open comedo”. Because of the opening, contact with the air oxidizes the dead skin cells inside the pore. The air contact turns the melanin inside them darker in color, similar to the way a peeled banana left exposed to the air will darken. This is how the blackhead forms. The color of a blackhead is not because of dirt. It’s a mixture of air and the skin pigment called melanin.

Feverfew – Commonly known as wild chamomile, feverfew is a plant that has been used for generations. It was once called “parthenium” by the ancient Greeks and is used to treat various ailments and disease. When it comes to your skin, feverfew is anti-inflammatory7, reducing and preventing redness and swelling. It’s also high in anti-oxidants and can be consumed orally in the form of tea for added benefits, like healing your skin from the inside out.
The relationship between diet and acne is unclear, as there is no high-quality evidence that establishes any definitive link between them.[51] High-glycemic-load diets have been found to have different degrees of effect on acne severity.[7][52][53] Multiple randomized controlled trials and nonrandomized studies have found a lower-glycemic-load diet to be effective in reducing acne.[52] There is weak observational evidence suggesting that dairy milk consumption is positively associated with a higher frequency and severity of acne.[50][51][52][54][55] Milk contains whey protein and hormones such as bovine IGF-1 and precursors of dihydrotestosterone.[52] These components are hypothesized to promote the effects of insulin and IGF-1 and thereby increase the production of androgen hormones, sebum, and promote the formation of comedones.[52][56] Available evidence does not support a link between eating chocolate or salt and acne severity.[51][54] Chocolate does contain varying amounts of sugar, which can lead to a high glycemic load, and it can be made with or without milk. Few studies have examined the relationship between obesity and acne.[2] Vitamin B12 may trigger skin outbreaks similar to acne (acneiform eruptions), or worsen existing acne, when taken in doses exceeding the recommended daily intake.[57] Eating greasy foods does not increase acne nor make it worse.[58][59] One review linked a Western pattern diet, high in simple carbohydrates, milk and dairy products, and trans fats and saturated fats, along with a low omega-3 fatty acids, with acne.[56]
The recognition and characterization of acne progressed in 1776 when Josef Plenck (an Austrian physician) published a book that proposed the novel concept of classifying skin diseases by their elementary (initial) lesions.[163] In 1808 the English dermatologist Robert Willan refined Plenck's work by providing the first detailed descriptions of several skin disorders using a morphologic terminology that remains in use today.[163] Thomas Bateman continued and expanded on Robert Willan's work as his student and provided the first descriptions and illustrations of acne accepted as accurate by modern dermatologists.[163] Erasmus Wilson, in 1842, was the first to make the distinction between acne vulgaris and rosacea.[164] The first professional medical monograph dedicated entirely to acne was written by Lucius Duncan Bulkley and published in New York in 1885.[165][166]
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If your acne is severe, painful, or refusing to get lost, you may just be beyond what an over-the-counter treatment can do. Not only can a professional set you up with the really powerful stuff, but also Fitz Patrick explains that “working closely with an aesthetician or dermatologist means you can keep tweaking a routine to make it work best for you.”

No single product can contain all of the necessary acne-fighting ingredients, despite what some may claim. Some chemicals shouldn’t be used together, while others work together to totally eradicate acne and all the blemishes that come with it. The best acne treatment systems can do that for you, but because everyone’s skin is unique, what works for one person may not work for another. The key lies in finding the right system, a combination of products, that work best for your unique skin.


Our favorite for banishing blemishes on the fly, Glossier's zit stick is not only effective, but it's portable. Just stash it in your purse for any unexpected breakouts! Packed with acne-fighting benzoyl peroxide, this convenient roll-on works extremely quickly. In a clinical trial, 83% of test subjects said that it lessened the appearance of pimples in just 3 hours. We've tried it ourselves and can confirm the 3-hour claim is true.

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Acne vulgaris is the catch-all term for everything from angry red lesions to tiny white bumps, which are the results of hair follicles and their sebaceous glands becoming blocked and inflamed So our first plan was to look at it all — spot treatments, washes, scrubs and creams — until we learned that when it comes to over-the-counter treatments, there is no single cure.
One of the most gentle face cleansers we selected is this one from Paula’s Choice. It won’t dehydrate sensitive skin because it has just 0.5% salicylic acid. But it still contains enough to unclog pores and exfoliate dead skin. You’ll hardly know that it’s working because it’s so pleasant to use. The silky texture glides on and lathers away oil and grime. Furthermore, there are no parabens or artificial fragrances in the formula.
Acne vulgaris is the catch-all term for everything from angry red lesions to tiny white bumps, which are the results of hair follicles and their sebaceous glands becoming blocked and inflamed So our first plan was to look at it all — spot treatments, washes, scrubs and creams — until we learned that when it comes to over-the-counter treatments, there is no single cure.
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We suggest avoiding spot treatments. “Benzoyl peroxide, when placed on red spots, can actually cause more irritation and inflammation to the area. It’s best used to prevent red bumps and pustules, and applied all over the area you want to treat,” said Townsend, who was also quick to naysay a spot-treat-only approach: “Acne affects all of the pores. If someone is going to spot treat against my advice, I still suggest they spot treat one day and treat the whole face the next.”
P. acnes also provokes skin inflammation by altering the fatty composition of oily sebum.[44] Oxidation of the lipid squalene by P. acnes is of particular importance. Squalene oxidation activates NF-κB (a protein complex) and consequently increases IL-1α levels.[44] Additionally, squalene oxidation leads to increased activity of the 5-lipoxygenase enzyme responsible for conversion of arachidonic acid to leukotriene B4 (LTB4).[44] LTB4 promotes skin inflammation by acting on the peroxisome proliferator-activated receptor alpha (PPARα) protein.[44] PPARα increases activity of activator protein 1 (AP-1) and NF-κB, thereby leading to the recruitment of inflammatory T cells.[44] The inflammatory properties of P. acnes can be further explained by the bacterium's ability to convert sebum triglycerides to pro-inflammatory free fatty acids via secretion of the enzyme lipase.[44] These free fatty acids spur production of cathelicidin, HBD1, and HBD2, thus leading to further inflammation.[44]

A major mechanism of acne-related skin inflammation is mediated by P. acnes's ability to bind and activate a class of immune system receptors known as toll-like receptors (TLRs), especially TLR2 and TLR4.[44][64][65] Activation of TLR2 and TLR4 by P. acnes leads to increased secretion of IL-1α, IL-8, and TNF-α.[44] Release of these inflammatory signals attracts various immune cells to the hair follicle including neutrophils, macrophages, and Th1 cells.[44] IL-1α stimulates increased skin cell activity and reproduction, which in turn fuels comedo development.[44] Furthermore, sebaceous gland cells produce more antimicrobial peptides, such as HBD1 and HBD2, in response to binding of TLR2 and TLR4.[44]
In most cases, acne products need to be used for at least 30 days before you can begin to ascertain its efficacy. Some skin and acne types may see noticeable results in a few days and end up totally clear in just a few weeks. Others may take several weeks to see the slightest change, or need to have their regimen adjusted as their skin adapts. Treating acne can often be a months-long process.

First, it’s a cleansing oil, not the typical gel wash or liquid. Next, it has a potent blend of salicylic, glycolic, and lactic acid for superior exfoliation. Third, it contains natural ingredients that repair damage to the skin and get rid of acne. For example, soapwort extract dissolves oil without the need for drying sulfates. Then, vitamin B and lavender combine to reduce oil secretion and inflammation. Finally, watercress is full of antioxidant vitamins that heal damage caused by the sun.
Although the late stages of pregnancy are associated with an increase in sebaceous gland activity in the skin, pregnancy has not been reliably associated with worsened acne severity.[137] In general, topically applied medications are considered the first-line approach to acne treatment during pregnancy, as they have little systemic absorption and are therefore unlikely to harm a developing fetus.[137] Highly recommended therapies include topically applied benzoyl peroxide (category C) and azelaic acid (category B).[137] Salicylic acid carries a category C safety rating due to higher systemic absorption (9–25%), and an association between the use of anti-inflammatory medications in the third trimester and adverse effects to the developing fetus including too little amniotic fluid in the uterus and early closure of the babies' ductus arteriosus blood vessel.[46][137] Prolonged use of salicylic acid over significant areas of the skin or under occlusive dressings is not recommended as these methods increase systemic absorption and the potential for fetal harm.[137] Tretinoin (category C) and adapalene (category C) are very poorly absorbed, but certain studies have suggested teratogenic effects in the first trimester.[137] Due to persistent safety concerns, topical retinoids are not recommended for use during pregnancy.[138] In studies examining the effects of topical retinoids during pregnancy, fetal harm has not been seen in the second and third trimesters.[137] Retinoids contraindicated for use during pregnancy include the topical retinoid tazarotene, and oral retinoids isotretinoin and acitretin (all category X).[137] Spironolactone is relatively contraindicated for use during pregnancy due to its antiandrogen effects.[1] Finasteride is not recommended as it is highly teratogenic.[1]
The side effects depend on the type of treatment you use. Generally, for topical, over-the-counter creams, you can watch out for stinging, redness, irritation and peeling — these side effects usually don’t go any deeper than the skin. Others, like oral antibiotics or hormonal medications, could come with new sets of complications, so we suggest talking to your doctor before pursuing the treatment.

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Thanks to its special MicroClear technology, Neutrogena Oil-Free Acne and Redness Facial Cleanser helps boost the delivery of active ingredient salicylic acid, in order to help reduce the appearance of acne. The inclusion of aloe and chamomile help to calm irritation while visibly reducing facial redness, a source of emotional stress for many acne sufferers.

Retinoids and retinoid-like drugs. These come as creams, gels and lotions. Retinoid drugs are derived from vitamin A and include tretinoin (Avita, Retin-A, others), adapalene (Differin) and tazarotene (Tazorac, Avage). You apply this medication in the evening, beginning with three times a week, then daily as your skin becomes used to it. It works by preventing plugging of the hair follicles.

The costs and social impact of acne are substantial. In the United States, acne vulgaris is responsible for more than 5 million doctor visits and costs over US$2.5 billion each year in direct costs.[13] Similarly, acne vulgaris is responsible for 3.5 million doctor visits each year in the United Kingdom.[19] Sales for the top ten leading acne treatment brands in the US in 2015, have been reported as amounting to $352 million.[175]

ungrouped: Paronychia Acute Chronic Chevron nail Congenital onychodysplasia of the index fingers Green nails Half and half nails Hangnail Hapalonychia Hook nail Ingrown nail Lichen planus of the nails Longitudinal erythronychia Malalignment of the nail plate Median nail dystrophy Mees' lines Melanonychia Muehrcke's lines Nail–patella syndrome Onychoatrophy Onycholysis Onychomadesis Onychomatricoma Onychomycosis Onychophosis Onychoptosis defluvium Onychorrhexis Onychoschizia Platonychia Pincer nails Plummer's nail Psoriatic nails Pterygium inversum unguis Pterygium unguis Purpura of the nail bed Racquet nail Red lunulae Shell nail syndrome Splinter hemorrhage Spotted lunulae Staining of the nail plate Stippled nails Subungual hematoma Terry's nails Twenty-nail dystrophy
Considerations: Ask your doctor before using any other products on your skin while using erythromycin, as it may be too irritating. This includes other prescriptions, over-the-counter medicines (including those listed on this site), and harsh or abrasive cleansers, perfumes, or make-up.2 People report burning as the most frequent side effect, and also peeling, dryness, itching, redness, and oiliness, among others.2

Although the late stages of pregnancy are associated with an increase in sebaceous gland activity in the skin, pregnancy has not been reliably associated with worsened acne severity.[137] In general, topically applied medications are considered the first-line approach to acne treatment during pregnancy, as they have little systemic absorption and are therefore unlikely to harm a developing fetus.[137] Highly recommended therapies include topically applied benzoyl peroxide (category C) and azelaic acid (category B).[137] Salicylic acid carries a category C safety rating due to higher systemic absorption (9–25%), and an association between the use of anti-inflammatory medications in the third trimester and adverse effects to the developing fetus including too little amniotic fluid in the uterus and early closure of the babies' ductus arteriosus blood vessel.[46][137] Prolonged use of salicylic acid over significant areas of the skin or under occlusive dressings is not recommended as these methods increase systemic absorption and the potential for fetal harm.[137] Tretinoin (category C) and adapalene (category C) are very poorly absorbed, but certain studies have suggested teratogenic effects in the first trimester.[137] Due to persistent safety concerns, topical retinoids are not recommended for use during pregnancy.[138] In studies examining the effects of topical retinoids during pregnancy, fetal harm has not been seen in the second and third trimesters.[137] Retinoids contraindicated for use during pregnancy include the topical retinoid tazarotene, and oral retinoids isotretinoin and acitretin (all category X).[137] Spironolactone is relatively contraindicated for use during pregnancy due to its antiandrogen effects.[1] Finasteride is not recommended as it is highly teratogenic.[1]
Dermatologists aren’t sure why azelaic acid is so effective at clearing up inflammation, but it’s often used as an option for sensitive skin or pregnant patients. Linkner says the ingredient is good at treating malasma, acne, and rosacea. Your dermatologist can prescribe a foam product with azelaic acid, and you can also find beauty products with very small amounts of this active ingredient.
Genetics play a big part in who gets acne and how severely, but each blemish can be blamed on some combination of sebum production, a bacteria called Propionibacterium acnes (P. acnes), plugged follicles, and inflammation. Finding a good treatment is really about finding the right combination of ingredients to troubleshoot each of those issues. Some factors that might worsen acne include hormones, certain medications, diet and stress.
Dapsone is not a first-line topical antibiotic due to higher cost and lack of clear superiority over other antibiotics.[1] Topical dapsone is not recommended for use with benzoyl peroxide due to yellow-orange skin discoloration with this combination.[10] While minocycline is shown to be an effective acne treatment, it is no longer recommended as a first-line antibiotic due to a lack of evidence that it is better than other treatments, and concerns of safety compared to other tetracyclines.[88]

The best acne treatment will also include gentle cleanser. Regular bars of soap have harsher cleansers in them that can create problems of their own and encourage bacteria to spread. It is also a good idea to use makeup wipes to clean off any makeup (if you wear it) before you wash your face. Only washing your face without the wipe or wiping your face without the wash is not a good combination. You will either end up missing some of the makeup or you will end up leaving preservatives and other residues on your face.
Oh, hello old friend. Salicylic acid is the go-to fix for pimply preteens. And cruising through the aisles at the drugstore, you’ll find it as the active ingredient on the majority of products labeled “acne wash” or “spot treatment.” Salicylic acid is a beta-hydroxy acid that works by dissolving excess oil and gently exfoliating away dead skin cells. Salicylic also has anti-inflammatory properties to help with inflamed cystic breakouts that can occur when blockages deep in the hair follicles rupture beneath the skin. It’s best to apply this ingredient as a toner, moisturizer, or leave-on spot treatment instead of a face wash to give it time to do its work. And keep in mind, salicylic acid can dry out the skin if over-applied, so maybe choose only one product with the ingredient to use every day.
The costs and social impact of acne are substantial. In the United States, acne vulgaris is responsible for more than 5 million doctor visits and costs over US$2.5 billion each year in direct costs.[13] Similarly, acne vulgaris is responsible for 3.5 million doctor visits each year in the United Kingdom.[19] Sales for the top ten leading acne treatment brands in the US in 2015, have been reported as amounting to $352 million.[175]

Aside from the obvious fact that a good face wash can help heal acne and pimple-prone skin, your choice of facial cleanser really matters when you’re trying to get rid of acne. For starters, the wrong face washes can cause acne, or at least, make yours a lot worse. Throughout the day, your skin does come into contact with a lot of dirt and grime, and it also secretes sebum – an oily, waxy, fatty substance that keeps your skin waterproof and lubricated. Oily skin is the result of an excessive amount of sebum secretion, and most soaps are designed to remove that oil from your skin. However, your skin actually needs some of that sebum to function normally. Without it, you end up with dry skin that tightens to create clogged pores and, ultimately, acne.
The recognition and characterization of acne progressed in 1776 when Josef Plenck (an Austrian physician) published a book that proposed the novel concept of classifying skin diseases by their elementary (initial) lesions.[163] In 1808 the English dermatologist Robert Willan refined Plenck's work by providing the first detailed descriptions of several skin disorders using a morphologic terminology that remains in use today.[163] Thomas Bateman continued and expanded on Robert Willan's work as his student and provided the first descriptions and illustrations of acne accepted as accurate by modern dermatologists.[163] Erasmus Wilson, in 1842, was the first to make the distinction between acne vulgaris and rosacea.[164] The first professional medical monograph dedicated entirely to acne was written by Lucius Duncan Bulkley and published in New York in 1885.[165][166]
Benzoyl peroxide is an antibacterial ingredient, and it’s very effective at killing the P. acnes bacteria that causes breakouts. But benzoyl isn’t without its downsides. The leave-on creams and cleansing treatments can dry out sensitive skin types and bleach clothing if you aren’t careful. Board-certified dermatologist Eric Meinhardt, M.D., previously told SELF that it's best to stick to formulations that have no more than 2 percent of benzoyl peroxide listed on the active ingredients chart; stronger concentrations are harder on your skin without being any tougher on bacteria.
Most studies of acne drugs have involved people 12 years of age or older. Increasingly, younger children are getting acne as well. In one study of 365 girls ages 9 to 10, 78 percent of them had acne lesions. If your child has acne, consider consulting a pediatric dermatologist. Ask about drugs to avoid in children, appropriate doses, drug interactions, side effects, and how treatment may affect a child's growth and development.
Sulfur – Not to be confused with irritating sulfates that can be found in some cleansers and treatments, sulfur is an element that can be quite good for your skin. It removes the dead skin cells and excess oils that clog your pores. But just like any chemical ingredient, too much of it can dry your skin out. You’ll likely find it coupled with other ingredients in your cleanser, like benzoyl peroxide, salicylic acid, and resorcinol.
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Acne is caused by what you eat. SOMEWHAT FALSE. This isn’t a complete lie, but studies are still being done. To date, there have only been small studies done on a few people that have shown a possible connection between acne and high carbohydrate foods like bread, pastries and sodas. There are also studies involving more people, but they relied on adults remembering their acne and eating habits when they were in high school. There just isn’t enough evidence to link any food with breakouts. Some people swear that certain foods make their acne worse. The best way to determine if a food is causing your pimples to appear is by keeping a food/skin diary. Keep track of everything you eat and assess your skin condition in the morning and evening of each day. If you find a pattern, it can’t hurt to avoid the foods that lead to more blackheads and whiteheads. Keep in mind that eating a balanced diet is always a good idea.

The Pore Normalizing Cleanser is designed just to cleanse, not treat, which is a good thing: The Nurse Practitioner study emphasizes the importance of washing with mild cleansers in conjunction with topical acne medications to combat or avoid excessive skin irritation. This one is water-based and fragrance-free, and uses sodium laureth sulfate (as opposed to its harsh cousin sodium lauryl sulfate) to eliminate any chance for irritation.

A complete skin care regimen to control acne usually starts with washing. The ideal face wash creates a soft creamy lather in warm water. It rinses off dirt, excess oil, and makeup, leaving the face ready for the next step in daily skin care, whether that is toner, moisturizer, exfoliant, sunblock, or more makeup. It is fragrance-free, and it does not create a foam, film, or tingly sensation on the face. Any product that foams and suds vigorously, like a detergent, is a strict no-no for acne treatment, especially on dry skin.
Acne isn’t just a problem for teens. According to studies, those pesky zits and pimples can pop up at any age. Whether it’s your diet, environment or stress that’s to blame, you don’t have to suffer helplessly. To get the skinny on acne, we talked to board-certified dermatologist Cynthia Bailey, M.D., president and CEO of Advanced Skin Care and Dermatology Physicians, Inc. and founder of DrBaileySkinCare.com. Here, she shares her best tips on how to choose the right acne cleanser for you, as well as how to use it to get the best results.
But the side effects of targeted breakout cream treatments aren’t always worth it. “So many products instruct consumers to use benzoyl peroxide spot treat red bumps and pustules. I don’t recommend it,” says Dr. Lawrence Green, board-certified dermatologist and assistant clinical professor of dermatology at George Washington University. Such high concentrations of benzoyl peroxide cause added irritation and inflammation to already sensitive skin, so with this in mind, we cut kits that included spot treatments.
Even though scientists know how pimples and blackheads are formed, they are still not sure what causes you to have a body full of blemishes and the guy sitting next to you not to have a single spot on his face? It’s probably related to hereditary factors. If your parents dealt with acne when they were younger, you’re more likely to struggle with acne, too.

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