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

I’m sorry you’re dealing with persistent acne — that’s frustrating. If drugstore products haven’t helped, the next step is to escalate care because adult acne often needs prescription treatment, a hormonal check, or in‑office procedures. Here’s a practical plan and specific options to discuss with a clinician.

1. See a dermatologist (in person or by telemedicine)

• Why: a dermatologist can examine your acne type (inflammatory, cystic, hormonal), check for scarring, prescribe stronger meds, and monitor side effects.
• How: look for a board‑certified dermatologist via the American Academy of Dermatology website, or use telederm services like Curology or Apostrophe (they offer personalized prescription formulas and can be faster/cheaper than an office visit).

1. Prescription treatments they may recommend (and why)

• Topical retinoids (tretinoin/Retin‑A, tazarotene, or prescription adapalene 0.3%): normalize follicle turnover and are foundational for adult acne and preventing scarring.
• Topical combinations: tretinoin or adapalene + benzoyl peroxide or an antibiotic can reduce bacteria and inflammation.
• Azelaic acid (Finacea 15% gel prescription, or The Ordinary Azelaic Acid 10% OTC): good for inflammatory and post‑inflammatory redness/hyperpigmentation.
• Oral options for more severe or hormonal acne:
  • Spironolactone (generic spironolactone; often used off‑label for women with hormonal acne) — reduces androgen effects on the skin.
  • Combined oral contraceptives approved for acne (e.g., Ortho Tri‑Cyclen, Yaz, Estrostep) — if you’re a woman and contraception is desired.
  • Oral antibiotics (doxycycline, minocycline) for short courses to control inflammation.
  • Isotretinoin (Accutane/Amnesteem/generic): for severe nodulocystic or scarring acne — highly effective but requires monitoring and pregnancy prevention.
• Important: these require dermatologist supervision because of side effects and monitoring.

1. In‑office procedures that help faster or for scarring

• Intralesional steroid injections for large cysts (quick relief).
• Chemical peels (salicylic or glycolic), light/laser therapies (blue/red light, photodynamic therapy), and laser resurfacing or microneedling for scarring.
• Ask your dermatologist which are suitable for your acne type and skin tone.

1. Practical, evidence‑based skincare you can use now

• Gentle cleanser: CeraVe Hydrating Cleanser or La Roche‑Posay Effaclar Purifying Gel (non‑stripping).
• Non‑comedogenic moisturizer: CeraVe PM, Vanicream, or La Roche‑Posay Toleriane.
• Sunscreen: EltaMD UV Clear (favored for acne‑prone/rosacea skin) or La Roche‑Posay Anthelios (broad‑spectrum).
• Avoid harsh scrubs, over‑drying alcohol toners, and picking/popping lesions (increases scarring).
• Active OTC helps but may not be enough: look for benzoyl peroxide (2.5–5%) or salicylic acid products (Paula’s Choice 2% BHA). If you’ve already tried these without improvement, a prescription retinoid or stronger therapy is the next step.

1. When to seek urgent/priority care

• Large painful nodules, rapidly spreading acne, new scarring, significant emotional distress, or any severe side effects from medications — see a dermatologist promptly.

If you want, tell me:

• your age and sex,
• how long you’ve had this acne,
• whether you’ve scarring or tried prescription retinoids or hormonal treatments, and I can suggest the most likely next option (e.g., make a case for spironolactone vs isotretinoin) or help find a telederm service near you.