9 Reasons Your Acne Won't Go Away, According to Derms

You Have Hormonal Acne

Acne tends to occur around puberty when the sebaceous glands, which produce sebum, start functioning. It can often continue into young adulthood. "In your 20s and 30s, acne is often caused by excess sebum (oil), bacteria and debris clogging pores, as well as changing hormone levels," says board-certified cosmetic dermatologist Dr. Dendy Engelman.

While teen boys seem to suffer more than teen girls, the problem performs a gender reversal as time goes on, and adult women tend to suffer from more acne flare-ups than adult men. Why? Blame hormones. This is why birth control pills, which can normalize hormones, often help cut down on acne.

"While many people think they’ve left acne behind in their teenage years, our bodies continue to undergo hormonal fluctuations for various reasons in adulthood, which can trigger breakouts," says Engelman. "It can pop up at any point, even if you’ve gone your whole life without serious acne. Women who are starting to go through menopause commonly experience acne during this time, as levels of the hormone progesterone may become higher than that of estrogen (which helps prevent acne), causing breakouts." 

You're Using the Wrong Products

The best over-the-counter products to combat acne are salicylic acid and benzoyl peroxide. "It is always best to start with benzoyl peroxide as it is more tolerable," says Zuriarrain. "Benzoyl peroxide is responsible for killing the bacteria that causes acne and helps to remove excess oil from the skin. It can also remove dead skin cells which can clog pores."

"Salicylic acid helps prevent pores from becoming plugged. The over-the-counter products include strengths from 0.5 to 5%," he explains. "They can cause side effects that include mild stinging and skin irritation."

"Retinoids can work well by speeding up skin cell turnover, but can cause significant dryness and redness to the skin. It is always best to start with a lower strength acne product before increasing its concentration," he continues.

You're Treating the Wrong Type of Acne

You've cultivated the holy-grail bathroom cabinet of top acne fighters, and you're still not seeing results. While you may have done all the research and chosen all the right products, you could be stocking up on all the wrong products for your particular type of acne. Hormonal and bacterial acne are the most common, especially amongst teens, so most literature focuses on ways to treat those specific types of acne. Fungal acne, however, is caused by yeast rather than bacteria or buildup, so it's pretty resilient to most acne medications. What it's not resilient to? Anti-fungal medications. A simple swap to an anti-fungal shampoo containing ketoconazole may prove to be drastically more effective.

You Might Be Overusing Products

When it comes to treating inflammation of the skin, you may think more is better. Perhaps you are applying treatment pads a few times a day or you are mixing your salicylic acid cleanser with facial scrubs and a host of products that have been recommended to you. Too much use can actually worsen your skin. You should not be using more than one salicylic or benzoyl peroxide product on your face at a time and certainly not in tandem with Retin-A or prescribed products. Do not cleanse with a salicylic acid product, then follow up with a salicylic acid pad, and then complete your regimen with an application of the gel. It's simply too much. Your skin will be aggravated, including mild stinging and dryness.

Also, acne products tend to be formulated for teen skin because a high percentage of teens suffer from acne. If you're an adult, you may be using too harsh a product to treat your acne.

You Don't Practice Good Skin Hygiene

“Not taking care of your skin and going to bed without washing your face can cause or worsen acne,” says Engelman. In addition, you should wash your pillowcase frequently and keep your makeup brushes clean. Also, don’t share your makeup brushes with friends as this can transfer dirt and oil onto your skin.

Your makeup could also be clogging your pores and contributing to your acne. Look for makeup and skincare products that won’t clog pores or have labels like non-comedogenic, non-acnegenic, and oil-free.

You Ignore Diet

Greasy foods, chocolate, and dairy don't cause acne, but certain foods can exacerbate it. "Diet can affect hormones that, in turn, can make acne worse,”  says Zuriarrain.  “Foods that are high in sugar can cause a spike in insulin levels which can alter your hormones and affect your skin.”

So if you're on a strict skincare regimen but your skin isn't clearing up, you should take a look at your diet. Dairy, in particular, is known to cause problems with current acne-sufferers. Greasy foods are also bad for the skin. Zuriarrain says a higher intake of fruits and vegetables can be beneficial to preventing acne. A healthy diet, in addition to the right acne-fighting products, can help you have healthy and clear skin.

You Keep Picking

If there's one piece of advice we'll never stop giving, it's this: Don’t touch, pick, or pop pimples no matter how enticing it may feel. In fact, avoid touching your face altogether. Taking matters into your own hands (pun intended) can cause scarring and even make acne worse. Each time you pop a pimple, you risk pushing bacteria, buildup, or whatever is irritating the pore further into the skin. If these were acneic roots, you're deepening them. So that angry pimple will only take longer to go away and, if you're breaking the skin, even longer to heal. If you have a large pimple or acne cyst, talk to your dermatologist and they can determine if an acne extraction is needed.

You're Not Addressing Underlying Medical Conditions

There can also be some underlying medical conditions that can contribute to acne that won't go away. "Endocrine disorders commonly cause acne because they affect the endocrine system, which is responsible for producing hormones," says Engelman. She explains Polycystic ovary syndrome (PCOS), "a condition affecting women in which the body produces too much of the male sex hormone androgen, causing cysts to develop on the ovaries" can also be a cause of acne.

Engleman explains there are other endocrine conditions that could cause stubborn acne, including acromegaly (a disorder in which the body produces too much growth hormone) and Cushing syndrome (a disorder in which the body produces too much cortisol, or "stress hormone"). She explains there are also non-endocrine conditions that can cause stubborn acne, however they are more rare. They include PAPA syndrome, SAPHO syndrome, and Apert syndrome. Your dermatologist can address these issues to determine your best course of treatment.

You Need to See a Dermatologist

Some types of acne can't be treated with over-the-counter products. "If you have been taking care of your skin and treating your acne with over-the-counter products for two weeks or more without seeing any change, it may be time to visit your dermatologist," says Engelman.

"The gold standard for treating acne is a prescription retinoid along with a topical benzoyl peroxide. I like prescription Epiduo Forte Gel, which contains the highest-available concentration of adapalene (a retinoid) as well as benzoyl peroxide-so it not only reduces acne-induced redness and inflammation, it also unclogs pores and kills acne-causing bacteria under the skin," she says.

"For patients with serious and cystic acne, I recommend a combination of prescription retinoid and topical benzoyl peroxide," she says. "Talk to your dermatologist to find treatment options that are best for you."

Other treatment options include oral medications. "Antibiotics can work by killing excess skin bacteria and reducing redness and inflammation," says Zuriarrain, who adds that there are non-antibiotic options available as well, such as isotretinoin.