Fraxel

Sorry you’re dealing with this — adult acne can be stubborn. If drugstore stuff hasn’t helped, here’s a sensible plan and specific options you can try next. 1) See a dermatologist (best first step) Why: a derm will diagnose the type/causes of your acne, check for scarring or hormonal causes, and prescribe more effective meds that aren’t available OTC. How: book an in‑person visit with a board‑certified dermatologist or use a reputable telederm service if access is an issue. Telemedicine options: Curology (custom prescription topicals) and Apostrophe (prescription acne care) — both connect you with licensed providers who can prescribe tretinoin, topical antibiotics, azelaic acid, etc. 2) Prescription treatments commonly used (what your derm may offer) Topical retinoids — tretinoin (brand: Retin‑A) or stronger adapalene formulations than OTC; these normalize cell turnover and reduce comedones. Combination topical therapy — clindamycin + benzoyl peroxide or adapalene + benzoyl peroxide (Epiduo is a commonly prescribed combo). Azelaic acid — Finacea (15% gel, Rx) or prescription 20% formulations; good for both acne and post‑inflammatory hyperpigmentation. Oral antibiotics — doxycycline or minocycline for moderate inflammatory acne (short course, paired with topical therapy). Hormonal therapy (for people who menstruate) — combined oral contraceptives approved for acne (e.g., Ortho Tri‑Cyclen, Estrostep) or spironolactone (Aldactone) to reduce androgen‑driven oil production. Isotretinoin (Accutane/generic isotretinoin) — for severe, nodulocystic, scarring, or treatment‑resistant acne. Highly effective but requires monitoring and pregnancy prevention programs (iPLEDGE in the U.S.). 3) Practical OTC and skincare changes to do now Gentle cleanser: CeraVe Foaming or Cetaphil Daily Cleanser. Non‑comedogenic moisturizer: CeraVe PM, Vanicream, or Neutrogena Hydro Boost. Sunscreen: EltaMD UV Clear (often recommended for acne‑prone skin) or La Roche‑Posay Anthelios (mineral/chemical options). Targeted OTC actives: Differin (adapalene 0.1% OTC) if you haven’t tried it yet; Paula’s Choice 2% BHA (salicylic acid) for occasional exfoliation; azelaic/niacinamide serums for discolouration (The Ordinary Niacinamide, The Ordinary Azelaic Acid 10%). Avoid harsh scrubs, over‑drying cleansers, and picking/popping lesions. 4) Treatments for scarring or pigmentation Chemical peels (salicylic/glycolic), microneedling, fractional lasers (Fraxel, etc.), and topical depigmenting agents (hydroquinone under supervision, azelaic acid, retinoids). These require a dermatologist or aesthetic specialist. 5) Tests to consider If adult‑onset acne or signs of hormonally driven acne (irregular periods, excess facial/body hair), ask your derm about labs: total testosterone, free testosterone, DHEA‑S, TSH, possibly fasting insulin. 6) Safety notes Tell your derm if you’re pregnant, breastfeeding, or trying to conceive (many acne meds are contraindicated). Expect retinoids to take 8–12 weeks to show major improvement; some worsening (“purging”) can occur early. If you’d like, tell me: Your sex, age, whether you’re pregnant or on birth control, what prescription or OTC products you’ve already tried, and how severe the acne is (whiteheads/blackheads vs painful cysts/scarring). I can then suggest a more tailored next step.

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If drugstore products haven’t helped, see a clinician — adult acne often needs prescription medicines or in‑office treatments. Steps and options to discuss with a board‑certified dermatologist (or a reputable telederm): See a dermatologist (or telederm) Why: they can identify acne type and underlying causes (hormonal, inflammatory, medication‑related), look for scarring, and prescribe appropriate treatments. Use the American Academy of Dermatology website to find local board‑certified dermatologists, or telederm services like Curology or Apostrophe for prescription plans if you prefer remote care. Prescription topical options Retinoids (strengthen skin cell turnover): tretinoin (brand: Retin‑A), tazarotene (Tazorac), or adapalene (Differin — OTC 0.1% or prescription 0.3%). Prescription retinoids are often more effective than OTC. Combination topicals: Epiduo (adapalene + benzoyl peroxide) or Duac (clindamycin + benzoyl peroxide) to reduce both comedones and bacteria. Oral medicines (for more persistent or inflammatory acne) Oral antibiotics for short courses (doxycycline, minocycline/Minocin) — used briefly to calm inflammation. Hormonal options for adult women: combined oral contraceptives approved for acne (Ortho Tri‑Cyclen, Yaz, Estrostep) or spironolactone (Aldactone) which blocks androgen effects — very effective for hormonal acne but used under physician supervision. Isotretinoin for severe or treatment‑resistant nodulocystic acne (brand names: Accutane, Absorica, Amnesteem). Highly effective but requires strict monitoring and pregnancy prevention (iPLEDGE in the U.S.) because of teratogenicity. In‑office procedures (speed results or treat scarring) Chemical peels (salicylic or glycolic acids), Blue/Red light or photodynamic therapy, laser resurfacing (Fraxel for scarring), or microneedling (SkinPen). These are done by dermatologists or licensed medical aesthetic clinics. Basic daily skincare to support treatment Gentle cleanser (CeraVe Foaming or Cetaphil), non‑comedogenic moisturizer (CeraVe PM), sunscreen (EltaMD UV Clear is popular for acne‑prone skin). Avoid harsh scrubs, picking, and pore‑clogging oils/comedogenic makeup (look for “non‑comedogenic” or “oil free” — brands: La Roche‑Posay Effaclar line, Neutrogena). When to check for underlying causes If you have irregular periods, new facial/body hair, sudden severe acne, or adult onset acne after age 25–30, ask your doctor about hormonal testing (PCOS workup). How to choose a provider Prefer a board‑certified dermatologist for medical acne care. If you want telemedicine, Curology and Apostrophe provide personalized prescriptions and follow‑up. For complex cases or isotretinoin, see an in‑person dermatologist. If you’d like, tell me: your age, sex, how long you’ve had acne, type (whiteheads, blackheads, red bumps, deep nodules), and any treatments you already tried — I can suggest specific next steps to discuss with a doctor.

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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) 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. 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. 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. 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.

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