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 helped, here’s a practical, safe plan and what to expect from a doctor.

1. Start (or optimize) a simple evidence-based routine now

• Cleanser: gentle twice daily — CeraVe Foaming Cleanser or La Roche‑Posay Toleriane Purifying.
• Active treatments:
  • Differin Gel (adapalene 0.1% OTC) at night — a topical retinoid helps clogged pores and long‑term improvement.
  • Benzoyl peroxide (2.5–5%) in the morning for breakouts — brands: PanOxyl, Clean & Clear Persa-Gel. Use only once daily at first to reduce irritation.
  • Moisturizer: non‑comedogenic (CeraVe PM, Vanicream) to manage dryness.
  • Sunscreen daily: EltaMD UV Clear is popular for acne‑prone skin.
• Use for 8–12 weeks before judging effectiveness. Expect some initial irritation or “purging” with retinoids; taper frequency if too irritated.

1. See a dermatologist if there’s no meaningful improvement, acne is moderate/severe, or you have scarring What a derm can offer:

• Prescription topicals: tretinoin (Retin‑A), higher‑strength adapalene, topical azelaic acid (Finacea or Azelex), or combinations (retinoid + benzoyl peroxide + antibiotic).
• Oral meds: doxycycline/minocycline for inflammatory acne; spironolactone (for many adult women with hormonal acne); combined oral contraceptives known to help acne (e.g., Ortho Tri‑Cyclen, Yaz); and isotretinoin (Accutane) for severe/refractory cases.
• Procedures: cortisone injections for cysts, chemical peels, light/laser treatments, extractions.
  A dermatologist will also check for underlying causes (PCOS, medication‑related acne).

1. Hormones and tests (if you’re a woman with adult acne)

• If you have adult acne that flares cyclically, new facial hair, irregular periods, or sudden worsening, ask about hormone evaluation (tests for testosterone/DHEA) and treatments like spironolactone or certain birth control pills.

1. Safety notes

• Do not use isotretinoin if pregnant or trying to become pregnant; many acne meds interact with pregnancy/breastfeeding — tell your provider if you’re pregnant or planning pregnancy.
• Avoid picking/popping (scarring, infection). Keep hair and cosmetics non‑comedogenic.

1. Telemedicine options (if you don’t want to wait)

• Curology, Apostrophe and Hers offer remote dermatology care and can prescribe tretinoin, topical antibiotics/azelaic acid, or spironolactone depending on evaluation.

If you’d like, tell me:

• your age and sex, current/past treatments you’ve tried, whether you’re on hormonal birth control, and whether you have irregular periods — I can suggest a next-step plan you can take to a dermatologist or help pick a telederm service.