I have adult acne that drugstore products cannot fix. What should I do?

Sorry you’re dealing with persistent acne — that’s frustrating. If drugstore products haven’t worked, here’s a clear plan with specific brands and services to consider and why.

1. See a dermatologist (in-person or telederm)

• Why: They can examine your skin, identify the type (hormonal, inflammatory, cystic, scarring) and prescribe treatments that aren’t available OTC.
• Telederm options: Curology or Apostrophe — they provide board-certified dermatologists who can prescribe customized topical prescriptions (retinoids, azelaic acid, topical antibiotics) and are convenient if you can’t get an in‑person visit.

1. Prescription medical treatments they may offer

• Topical retinoids (stronger than OTC): tretinoin (Retin‑A, Altreno) — very effective for prevention of new acne and for unclogging pores.
• Azelaic acid (Finacea, Azelaic acid gels) — good for inflammatory lesions and post‑inflammatory pigmentation, well tolerated.
• Topical combos: clindamycin + benzoyl peroxide (often prescribed together) — reduces bacteria and inflammation.
• Oral hormonal options (for people with hormone‑related adult acne): spironolactone (Aldactone) — often highly effective for women with jawline/cyclic acne; combined oral contraceptives that are FDA‑approved for acne (Yaz, Ortho Tri‑Cyclen, Estrostep).
• Oral antibiotics (short term): doxycycline or minocycline (Solodyn) — used for moderate inflammatory acne while other treatments take effect (avoid long courses to limit resistance).
• Oral isotretinoin (for severe/refractory nodulocystic acne): Absorica, Amnesteem, Claravis — can be curative but requires close monitoring and strict pregnancy prevention.

1. In‑office procedures (for inflammatory lesions or scarring)

• Cortisone injections for painful nodules (fast relief).
• Chemical peels (salicylic/glycolic) and light/laser treatments for persistent inflammation or acne scarring—ask your derm about options they offer.

1. Practical home routine (supportive; non‑prescription)

• Cleanser: CeraVe Foaming Facial Cleanser or La Roche‑Posay Effaclar Medicated Cleanser (salicylic acid) — gentle, non‑stripping.
• Leave‑on exfoliant: Paula’s Choice 2% BHA Liquid (salicylic acid) — unclogs pores.
• Moisturizer: CeraVe PM or La Roche‑Posay Toleriane — replenishes barrier and reduces irritation.
• Spot benzoyl peroxide: Neutrogena On‑the‑Spot (2.5–5%) — antibacterial; use with a moisturizer to limit dryness.
• Sunscreen: EltaMD UV Clear — formulated for acne‑prone skin and contains niacinamide.

Note: Differin (adapalene 0.1% OTC) can help many people, but if you’ve tried OTC retinoids without benefit, tretinoin or a compounded prescription plan from a derm is often more effective.

1. Timing and safety

• Prescription topicals: expect 8–12 weeks to judge improvement.
• Spironolactone: often takes 2–3 months to see benefit.
• Isotretinoin: typical course 4–6 months; requires pregnancy testing and monitoring (iPLEDGE in the US).
• Avoid long antibiotic monotherapy; combine with benzoyl peroxide and transition to other treatments.

1. When to see a specialist or get labs

• If you have deep cysts/nodules, scarring, or acne that flares with your cycle (possible hormonal), ask your derm about hormone testing (testosterone, DHEA‑S).
• If you’re female and suspect hormonal acne, discuss spironolactone or an appropriate birth control pill with your derm or gynecologist.

If you want, tell me:

• Are you male or female? (important for hormonal options)
• What treatments have you already tried (names, how long)?
• Any medications, pregnancy/breastfeeding plans, or health issues?

I can help you draft questions for a dermatologist or suggest which telederm service might fit you best.