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

Sorry you’re dealing with persistent adult acne — that’s frustrating but common, and there are effective next steps beyond drugstore products.

Quick questions before specific advice

• How old are you, do you have scarring or painful cysts, and are you pregnant or trying to become pregnant?
• What prescription or OTC products have you already tried (names and for how long)?

What to do now (practical steps)

1. Book a dermatology evaluation

   • Why: a dermatologist will identify the acne type (hormonal, inflammatory, cystic, comedonal), check for scarring, rule out medical causes, and prescribe treatments not available OTC.
   • How: look for a board‑certified dermatologist. If you prefer telemedicine, consider Curology or Apostrophe (U.S.) — both offer virtual consults and prescription topical formulas. For in‑person care use the American Academy of Dermatology “Find a Dermatologist” tool or Zocdoc to find nearby providers.

2. Expect prescription options (what derms commonly use)

   • Topical prescription retinoids: tretinoin (Retin-A), tazarotene (Tazorac) or adapalene prescription strength — better than most OTCs for clogged pores and aging skin.
   • Combination topicals: Epiduo (adapalene + benzoyl peroxide) or Duac/Onexton (clindamycin + benzoyl peroxide) for inflammatory acne.
   • Azelaic acid: Finacea (20% gel) — good for inflammatory lesions and post‑inflammatory pigmentation.
   • Topical dapsone: Aczone 7.5% gel — for inflammatory or hormonal acne.
   • Oral antibiotics (short term): doxycycline or minocycline for moderate inflammatory acne (usually limited duration to avoid resistance).
   • Hormonal therapy for adult women: oral contraceptives (several brands are FDA‑approved for acne) or spironolactone — often very effective for hormonally driven acne.
   • Isotretinoin (Accutane and other brands) for severe, nodular, or scarring acne — highly effective but requires enrollment in iPLEDGE and close monitoring for pregnancy risk and side effects.

3. Procedures your dermatologist may offer (for persistent acne or scarring)

   • Cortisone injection for large nodules/cysts (fast relief).
   • Chemical peels (salicylic/mandelic), microneedling (SkinPen), subcision, or lasers (Fraxel for scarring, Vbeam for redness). These are provided by dermatologists or cosmetic specialists.

4. Skin care you can keep doing (nonprescription but evidence‑based)

   • Gentle cleanser (CeraVe Foaming or Hydrating Cleanser) twice daily.
   • Non‑comedogenic moisturizer: CeraVe PM, La Roche‑Posay Toleriane. Don’t skip moisturizer if you’re using retinoids or drying treatments.
   • Sunscreen: EltaMD UV Clear is widely recommended for acne‑prone, sensitive skin.
   • Avoid over‑scrubbing, harsh exfoliants, and picking lesions.

Safety notes

• If pregnant or planning pregnancy, many acne meds (isotretinoin, some retinoids) are contraindicated — tell any provider right away.
• Antibiotics should not be used alone long‑term; combination therapy reduces resistance risk.
• Spironolactone: effective for many adult women but discuss pregnancy prevention and monitoring with your clinician.
• Isotretinoin requires labs and strict pregnancy prevention measures.

If you’d like, I can:

• Help you find a board‑certified dermatologist or telederm service in your area.
• Review what you’ve already tried and suggest which prescription options are most likely to help based on your acne type.

Tell me your age, sex, whether you’re pregnant/planning pregnancy, and what you’ve tried so far and I’ll give more tailored guidance.