If you suffer from acne, either as an adult or a teen, you may have tried all sorts of products to clear up your skin. And if you're on here, chances are, those products aren't working. One of the biggest issues with people who suffer from acne is they don't understand their acne—what causes it, why it flares up for some and calms down easily for others, what makes it worse or better.
From hormones to diet and even possible underlying medical causes, treating stubborn acne isn’t always as easy as applying a cream to your face. However, sometimes it is that easy—and knowing which type of product to use can make a huge difference in getting clear skin. “Each formulation works differently to treat the skin,” says Dr. Alexander Zuriarrain, who breaks down which type of products are best to use to treat acne.
We spoke to the experts to help pinpoint exactly why acne wants to stick around—and how to get rid of it.
Meet the Expert
- Dr. Dendy Engelman, MD, FACMS, FAAD is a board certified cosmetic dermatologist and Mohs surgeon at the Shafer Clinic in New York City.
- Dr. Alexander Zuriarrain is a quadruple board-certified plastic surgeon with Zuri Plastic Surgery in Miami. He is highly qualified and experienced in the field of plastic surgery and aesthetic care.
Ready for clear skin? Keep scrolling to see the top 7 reasons why your breakouts aren't clearing up.
You Have Hormonal Acne
Acne tends to occur around puberty when the sebaceous glands, which produce sebum, start functioning. It can often continue into young adulthood. "In your 20s and 30s, acne is often caused by excess sebum (oil), bacteria and debris clogging pores, as well as changing hormone levels," says board certified cosmetic dermatologist Dr. Dendy Engelman.
While teen boys seem to suffer more than teen girls, the problem performs a gender reversal as time goes on, and adult women tend to suffer from more acne flare-ups than adult men. Why? Blame hormones. This is why birth control pills, which can normalize hormones, often help cut down on acne.
"While many people think they’ve left acne behind in their teenage years, our bodies continue to undergo hormonal fluctuations for various reasons in adulthood, which can trigger breakouts," says Engelman. "It can pop up at any point, even if you’ve gone your whole life without serious acne. Women who are starting to go through menopause commonly experience acne during this time, as levels of the hormone progesterone may become higher than that of estrogen (which helps prevent acne), causing breakouts."
The right treatment, however, can often take care of hormonal acne—which leads us to the next possible reason for stubborn acne.
You Aren't Using the Right Products
The best over-the-counter products to combat acne are salicylic acid and benzoyl peroxide. "It is always best to start with benzoyl peroxide as it is more tolerable," says Zuriarrain. "Benzoyl peroxide is responsible for killing the bacteria that causes acne and helps to remove excess oil from the skin. It can also remove dead skin cells which can clog pores."
"Salicylic acid helps prevent pores from becoming plugged. The over-the-counter products include strengths from 0.5 to 5%," he explains. "They can cause side effects that include mild stinging and skin irritation."
"Retinoids can work well by speeding up skin cell turnover, but can cause significant dryness and redness to the skin. It is always best to start with a lower strength acne product before increasing its concentration," he says.
Engelman says one of her favorite retinoids is available without a prescription. "I like Differin Gel, which can now be purchased over the counter and contains 0.1 % adapalene to clear blemishes and prevent future breakouts," she says.
Make sure you apply treatment to the entire affected area. If you spot treat, the bacteria could grow elsewhere.
When it comes to treating inflammation of the skin, you may think more is better. Perhaps you are applying treatment pads a few times a day or you are mixing your salicylic acid cleanser with facial scrubs and a host of products that have been recommended to you.
Too much use can actually worsen your skin. You should not be using more than one salicylic or benzoyl peroxide product on your face at a time and certainly not in tandem with Retin-A or prescribed products. Do not cleanse with a salicylic acid product, then follow up with a salicylic acid pad and then complete your regimen with an application of the gel. It's simply too much. Your skin will be aggravated, including mild stinging and dryness.
Also, acne products tend to be formulated for teen skin because a high percentage of teens suffer from acne. If you're an adult, you may be using too harsh a product to treat your acne.
Zuriarrain says to start with lower concentrations of the products to see how your skin responds. Also, make sure you aren't being too rough and scrubbing your face, as this can also cause irritation and aggravate your acne.
Practice Good Skin Hygiene
“Not taking care of your skin and going to bed without washing your face can cause or worsen acne,” says Engelman. In addition, you should wash your pillowcase frequently and keep your makeup brushes clean. Also, don’t share your makeup brushes with friends as this can transfer their dirt and oil onto your skin.
Your makeup could also be clogging your pores and contributing to your acne. Look for makeup and skincare products that won’t clog pores or have labels like non-comedogenic, non-acnegenic and oil-free.
Avoid touching your face. Don’t touch, pick or pop pimples as it can make acne worse and cause scarring. If you have a large pimple or acne cyst, talk to your dermatologist and they can determine if an acne extraction is needed.
Don't Ignore Your Diet
Greasy foods, chocolate, and dairy don't cause acne, but certain foods can exacerbate it. "Diet can affect hormones that, in turn, can make acne worse,” says Zuriarrain. “Foods that are high in sugar can cause a spike in insulin levels which can alter your hormones and affect your skin.”
So if you're on a strict skincare regimen but your skin isn't clearing up, you should take a look at your diet. Dairy, in particular, is known to cause problems with current acne-sufferers. Greasy foods are also bad for the skin. Zuriarrain says a higher intake of fruits and vegetables can be beneficial to preventing acne.
A healthy diet, in addition to the right acne-fighting products, can help you have healthy and clear skin.
You Need to See a Dermatologist
Some types of acne can't be treated with over-the-counter products most effectively. "If you have been taking care of your skin and treating your acne with over-the-counter products for two weeks or more without seeing any change, it may be time to visit your dermatologist," says Engelman.
"The gold standard for treating acne is a prescription retinoid along with a topical benzoyl peroxide. I like prescription Epiduo Forte Gel, which contains the highest-available concentration of adapalene (a retinoid) as well as benzoyl peroxide-so it not only reduces acne-induced redness and inflammation, it also unclogs pores and kills acne-causing bacteria under the skin," she says.
"For patients with serious and cystic acne, I recommend a combination of prescription retinoid and topical benzoyl peroxide," she says. "Talk to your dermatologist to find treatment options that are best for you."
Other treatment options include oral medications. "Antibiotics can work by killing excess skin bacteria and reducing redness and inflammation," says Zuriarrain. "There are even stronger prescription treatments available that include Accutane."
Address Underlying Causes
There can also be some underlying medical conditions that can contribute to acne that won't go away.
"Endocrine disorders commonly cause acne because they affect the endocrine system, which is responsible for producing hormones," says Engelman. She explains Polycystic ovary syndrome (PCOS), "a condition affecting women in which the body produces too much of the male sex hormone androgen, causing cysts to develop on the ovaries" can also be a cause of acne.
Engleman explains there are other endocrine conditions that could cause stubborn acne, including acromegaly (a disorder in which the body produces too much growth hormone) and Cushing syndrome (a disorder in which the body produces too much cortisol, or "stress hormone").
She explains there are also non-endocrine conditions that can cause stubborn acne, however they are more rare. They include PAPA syndrome, SAPHO syndrome and Apert syndrome.
Your dermatologist can address these issues to determine your best course of treatment.
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Pimple popping: Why only a dermatologist should do it. (n.d.). Retrieved January 26, 2022, from https://www.aad.org/public/diseases/acne/skin-care/popping
American Academy or Dermatology Association. Can the right diet get rid of acne?