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

Sorry you’re dealing with stubborn adult acne — that’s frustrating. If drugstore products haven’t helped, here’s a clear, practical plan and options to discuss with a clinician.

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

• Why: a dermatologist can diagnose type/cause of acne, check for scarring, rule out rosacea or fungal acne, and prescribe more effective treatments.
• How: find a board-certified derm through the American Academy of Dermatology finder, or use telemedicine services like Curology or Apostrophe (they offer custom prescription topical mixes and are convenient if you can’t get to an office).

1. Prescription topical treatments they may try

• Adapalene + benzoyl peroxide (Epiduo / Epiduo Forte): a convenient, clinically proven combo that reduces inflammation and unclogs pores.
• Tretinoin (Retin‑A, Altreno, generic tretinoin): a stronger retinoid for comedonal and inflammatory acne; works by normalizing skin turnover.
• Clindamycin + benzoyl peroxide (Duac, Benzaclin): antibiotic + benzoyl peroxide to reduce bacteria and resistance.
  Expect 8–12 weeks to see meaningful improvement.

1. Oral options for moderate–severe or inflammatory acne

• Oral antibiotics (doxycycline, minocycline): usually used short-term (6–12 weeks) to reduce inflammation and bacteria.
• Hormonal therapy (for people who menstruate): combined oral contraceptives that are FDA‑approved for acne (Ortho Tri‑Cyclen, Estrostep, Yaz) or anti‑androgen spironolactone (Aldactone, off‑label for acne). These can be very effective for hormonal adult acne — discuss pregnancy risk and monitoring with your clinician.
• Isotretinoin (brand names: Accutane, Absorica, Amnesteem, Zenatane): for severe, nodulocystic, or treatment‑resistant acne. Very effective but requires strict monitoring (pregnancy prevention program iPLEDGE, blood tests for lipids/liver).

1. In‑office procedures (if appropriate)

• Intralesional steroid injections for painful nodules, chemical peels, light/laser therapy, microneedling, or extrac­tions. These are done by dermatologists and can speed resolution or reduce scarring.

1. Gentle supportive skincare (helps prescription treatments work better)

• Cleanser: a gentle, nonstripping cleanser (CeraVe Hydrating or Foaming Cleanser; La Roche‑Posay Effaclar).
• Exfoliant: leave-on salicylic acid products (Paula’s Choice 2% BHA) can help, but don’t overdo exfoliation.
• Moisturizer: non‑comedogenic options (CeraVe PM, Vanicream).
• Sunscreen: EltaMD UV Clear SPF 46 (formulated for acne/rosacea-prone skin). Avoid harsh scrubs, picking, and layering multiple actives without guidance.

1. Tests and monitoring to consider

• Pregnancy test before starting isotretinoin or hormonal therapy; use contraception as advised.
• If hormonal signs (irregular periods, hirsutism), your derm/PCP may check testosterone, DHEA‑S, or screen for PCOS.
• For isotretinoin: baseline and periodic blood tests (lipids, liver enzymes) and enrollment in iPLEDGE.

1. Timeline and expectations

• Topicals: expect 8–12 weeks for improvement; initial flares can occur with retinoids.
• Oral antibiotics: improvement often in 6–12 weeks; used short‑term.
• Isotretinoin: typical course 4–6 months with long‑term remission possible.

1. When to seek urgent care

• If you have large painful cysts, rapidly worsening acne, scarring, or severe emotional distress from acne, book a dermatology appointment promptly.

If you want, tell me:

• Your age and sex,
• What prescription or OTC products you’ve already tried,
• Any menstrual irregularities or hormonal symptoms, and I can suggest more targeted next steps to discuss with a provider.