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

Sorry you’re dealing with this — adult acne can be stubborn. If drugstore stuff hasn’t helped, here’s a sensible plan and specific options you can try next.

1. See a dermatologist (best first step)

• Why: a derm will diagnose the type/causes of your acne, check for scarring or hormonal causes, and prescribe more effective meds that aren’t available OTC.
• How: book an in‑person visit with a board‑certified dermatologist or use a reputable telederm service if access is an issue. Telemedicine options: Curology (custom prescription topicals) and Apostrophe (prescription acne care) — both connect you with licensed providers who can prescribe tretinoin, topical antibiotics, azelaic acid, etc.

1. Prescription treatments commonly used (what your derm may offer)

• Topical retinoids — tretinoin (brand: Retin‑A) or stronger adapalene formulations than OTC; these normalize cell turnover and reduce comedones.
• Combination topical therapy — clindamycin + benzoyl peroxide or adapalene + benzoyl peroxide (Epiduo is a commonly prescribed combo).
• Azelaic acid — Finacea (15% gel, Rx) or prescription 20% formulations; good for both acne and post‑inflammatory hyperpigmentation.
• Oral antibiotics — doxycycline or minocycline for moderate inflammatory acne (short course, paired with topical therapy).
• Hormonal therapy (for people who menstruate) — combined oral contraceptives approved for acne (e.g., Ortho Tri‑Cyclen, Estrostep) or spironolactone (Aldactone) to reduce androgen‑driven oil production.
• Isotretinoin (Accutane/generic isotretinoin) — for severe, nodulocystic, scarring, or treatment‑resistant acne. Highly effective but requires monitoring and pregnancy prevention programs (iPLEDGE in the U.S.).

1. Practical OTC and skincare changes to do now

• Gentle cleanser: CeraVe Foaming or Cetaphil Daily Cleanser.
• Non‑comedogenic moisturizer: CeraVe PM, Vanicream, or Neutrogena Hydro Boost.
• Sunscreen: EltaMD UV Clear (often recommended for acne‑prone skin) or La Roche‑Posay Anthelios (mineral/chemical options).
• Targeted OTC actives: Differin (adapalene 0.1% OTC) if you haven’t tried it yet; Paula’s Choice 2% BHA (salicylic acid) for occasional exfoliation; azelaic/niacinamide serums for discolouration (The Ordinary Niacinamide, The Ordinary Azelaic Acid 10%).
• Avoid harsh scrubs, over‑drying cleansers, and picking/popping lesions.

1. Treatments for scarring or pigmentation

• Chemical peels (salicylic/glycolic), microneedling, fractional lasers (Fraxel, etc.), and topical depigmenting agents (hydroquinone under supervision, azelaic acid, retinoids). These require a dermatologist or aesthetic specialist.

1. Tests to consider

• If adult‑onset acne or signs of hormonally driven acne (irregular periods, excess facial/body hair), ask your derm about labs: total testosterone, free testosterone, DHEA‑S, TSH, possibly fasting insulin.

1. Safety notes

• Tell your derm if you’re pregnant, breastfeeding, or trying to conceive (many acne meds are contraindicated).
• Expect retinoids to take 8–12 weeks to show major improvement; some worsening (“purging”) can occur early.

If you’d like, tell me:

• Your sex, age, whether you’re pregnant or on birth control, what prescription or OTC products you’ve already tried, and how severe the acne is (whiteheads/blackheads vs painful cysts/scarring). I can then suggest a more tailored next step.