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

Sorry you’re dealing with persistent acne — that’s frustrating and common in adults. Since drugstore products haven’t worked, the next best steps are medical evaluation and prescription/office treatments. Here’s a clear plan and some specific brands/services to consider.

1. See a dermatologist (best first step)

• Why: a dermatologist will determine your acne type (inflammatory, hormonal, nodulocystic), rule out other causes, and prescribe the right medication and monitoring.
• How: find one via your insurance network, Zocdoc, or local dermatology clinics. If you prefer virtual care, services such as Curology, Apostrophe, and Forefront Dermatology provide telederm visits and prescriptions.

1. Prescription topical options your derm may try

• Topical retinoids (most effective for comedones and preventing new lesions): tretinoin (Retin‑A), tazarotene (Tazorac), or prescription-strength adapalene (stronger than OTC Differin 0.1%).
• Topical antibiotics/combos: clindamycin + benzoyl peroxide (Duac, Benzaclin) for inflammatory acne.
• Azelaic acid (Finacea 15% gel is prescription; The Ordinary Azelaic Acid 10% is OTC) — good for inflammatory and post-inflammatory hyperpigmentation.
• Dapsone gel (Aczone) for inflammatory acne, especially in women.

1. Oral medications (for moderate-to-severe or widespread inflammatory acne)

• Oral antibiotics for short courses: doxycycline (Vibramycin), minocycline (Minocin).
• Hormonal treatments for women with menstrual/hormonal flares: combined oral contraceptives approved for acne (Ortho Tri‑Cyclen, Estrostep, Yaz) or spironolactone (generic spironolactone/Aldactone) — often very effective for adult female acne.
• Isotretinoin (Accutane and other generics like Amnesteem, Claravis, Absorbica) for severe or treatment‑resistant nodulocystic acne — highly effective but requires specialist monitoring and pregnancy prevention.

1. In‑office procedures

• Cortisone injection (triamcinolone) for painful cysts — very fast relief.
• Chemical peels (salicylic/glycolic), light/laser treatments, extractions, or microneedling for scarring and persistent lesions — discuss pros/cons and cost with your derm.

1. Practical daily skincare (gentle, non‑irritating)

• Cleanser: CeraVe Foaming Cleanser or La Roche‑Posay Effaclar (salicylic) — one gentle wash twice daily.
• Use a non‑comedogenic moisturizer: CeraVe PM, Vanicream, or La Roche‑Posay Toleriane.
• Sun protection: EltaMD UV Clear SPF 46 (formulated for acne-prone, often recommended with retinoids).
• Stop using multiple active OTC products at once (can worsen inflammation). Avoid harsh scrubs and picking/popping.

1. Tests to consider (if your derm suspects hormonal causes)

• For women with adult-onset or severe hormonal signs: testosterone, free androgen index, DHEA‑S, prolactin, TSH. Your dermatologist or primary care can order or refer to endocrinology/gynecology.

1. Timeline and expectations

• Many topical and oral treatments take 8–12 weeks to show meaningful improvement. Spironolactone and OCPs may take 3 months. Isotretinoin is usually a 4–6 month course with gradual clearing.
• Be patient and follow-up with your provider to adjust therapy.

1. Safety notes

• No isotretinoin or topical/systemic retinoids during pregnancy or if trying to become pregnant. Spironolactone is teratogenic risk in pregnancy if pregnancy occurs due to antiandrogen effects — use contraception if sexually active and on these meds.
• Some oral antibiotics require sun protection and can have side effects; monitor with your doctor.

Concrete next step I recommend

• Book a dermatology appointment (in-person if you have cysts/scarring). If you want telemedicine first, try Curology or Apostrophe to get a clinician review and a prescription starter plan. Tell the provider you’ve tried OTC products without success and describe what you’ve used and for how long.

If you want, tell me:

• your sex, age, how long you’ve had acne, what OTC products you tried, whether your acne is mostly blackheads/whiteheads or red cysts, and whether acne flares with your cycle — I can suggest more tailored next steps.