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

Sorry it’s not getting better — that’s very common with adult acne, and there are effective next steps beyond drugstore products. Short version: see a dermatologist (in person or via telemedicine) so you can get prescription treatment tailored to your acne type and medical history. Below is a practical plan, what your dermatologist may offer, and some specific brands/services to consider.

1. See a dermatologist (or telederm)

• Why: they can grade severity, check for scarring/hyperpigmentation, order labs if needed, and prescribe treatments (sometimes combinations) that OTC products can’t provide.
• Telederm options that prescribe and ship meds: Curology and Apostrophe — both offer personalized prescription formulas (retinoids, azelaic acid, topical antibiotics) and are convenient if you can’t get to a clinic. For more complex or scarring acne, an in‑person board‑certified dermatologist is best.

1. Prescription treatments your dermatologist may recommend (with why/how they’re used)

• Prescription topical retinoids: tretinoin (Retin‑A), tazarotene (Tazorac), or prescription adapalene — stronger and often more effective than OTC Differin for many people. They normalize cell turnover and reduce comedones and scarring risk.
• Topical combination therapies: tretinoin/adapalene plus benzoyl peroxide or clindamycin (antibiotic) to treat both inflammation and bacteria while preventing resistance.
• Azelaic acid (Finacea/Azelex) — helps inflammatory acne and post‑inflammatory hyperpigmentation, often well tolerated.
• Topical dapsone (Aczone) — useful for inflammatory lesions, especially in women.
• Oral antibiotics (short term): doxycycline or minocycline for moderate inflammatory acne. Usually used for limited time to reduce inflammation.
• Hormonal therapies (for adult women): combined oral contraceptives approved for acne (e.g., Ortho Tri‑Cyclen, Yaz, Estrostep) or spironolactone (Aldactone) — very effective for hormonal adult acne (jawline/cheek distribution). Your derm or gyn can advise and monitor.
• Isotretinoin (Accutane / Amnesteem / Claravis, etc.): the most effective for severe, nodulocystic, or scarring acne. Requires monitoring and pregnancy prevention (iPLEDGE in the U.S.) and has notable side effects, so it’s prescribed by dermatologists only.

1. Skincare routine adjustments that help (keep it simple and non‑irritating)

• Cleanser: gentle, non‑foaming or gentle foaming — CeraVe Foaming Cleanser or Cetaphil Daily Facial Cleanser.
• Exfoliant for blackheads: salicylic acid products (Paula’s Choice 2% BHA) can help.
• Moisturizer: non‑comedogenic, ceramide-containing — CeraVe PM or La Roche‑Posay Toleriane Sensitive. Moisturizers reduce irritation from prescription meds.
• Sunscreen: daily mineral/chemical sunscreen safe for acne-prone skin — EltaMD UV Clear is a favorite for acne-prone skin and those using retinoids.
• Avoid overwashing, harsh scrubs, and picking/popping lesions (risk of scarring).

1. Tests and causes to consider

• For adult women with new or worsening acne, your derm may check for hormonal contributors (irregular periods, hair growth) and order labs (free testosterone, DHEA‑S, LH/FSH, TSH) if indicated.
• If you have painful nodules, rapid spread, or scarring, see a dermatologist promptly.

1. What to expect timewise and safety notes

• Topical Rx retinoids and azelaic acid: improvement in 6–12 weeks; fuller benefit by 3–6 months.
• Hormonal meds: 3 months to see improvement; maximal by 6 months.
• Isotretinoin course is usually 4–6 months for long‑term remission. Requires contraception and monitoring.
• Discuss side effects with your derm (e.g., dryness from retinoids, antibiotic risks, spironolactone pregnancy precautions, isotretinoin teratogenicity).

1. Quick recommendations by name (based on common effectiveness)

• In‑person dermatologist (best for scarring or severe acne).
• Telederm: Curology or Apostrophe for personalized Rx topical combos.
• Prescription options to ask about: Retin‑A (tretinoin), Tazorac (tazarotene), Finacea (azelaic acid), Aczone (dapsone), oral spironolactone (women), oral doxycycline/minocycline, isotretinoin (Accutane/generics) for severe cases.
• Gentle skincare: CeraVe, La Roche‑Posay, Cetaphil; sunscreen: EltaMD UV Clear; salicylic acid: Paula’s Choice 2% BHA.

If you want, tell me: how long you’ve had acne, whether you’re male or female, if you’re pregnant or trying to conceive, what prescription/OTC products you’ve already tried, and whether you have scarring — I can suggest the most likely next‑step options for your situation.