Medically reviewed by Kristin Hall, FNP
Written by Our Editorial Team
Last updated 3/30/2021
Ask a group of people to describe their acne breakouts and you’ll usually get two main types of response.
Some people will quickly mention getting a pimple every now and then, or occasionally spotting a blackhead or other mild acne lesion every other week.
Others will be able to describe persistent, stubborn acne breakouts that never seem to go away and have a tendency to pop up at the worst possible moments.
If you’re one of the millions of people who fit into the second category, you’ll know that treating acne isn’t always as easy as it’s made out to be. You’ll also know that the typical treatments for acne can fall short when your breakouts are particularly severe or resistant to treatment.
Although stubborn acne can be seriously annoying, it is treatable with the right combination of science-based medications and skin-friendly habits.
Below, we’ve explained how stubborn acne can develop, as well as the treatments that you can use to get it under control for good. We’ve also shared some simple habits and lifestyle changes that you can implement to prevent acne breakouts and keep your skin looking its best.
Acne can vary hugely in severity, meaning that over-the-counter products and “get rid of acne” guides may not be the best option if your acne is particularly stubborn or severe.
A variety of factors can cause and contribute to acne, including sebum, dead skin cells, bacteria and inflammation. To successfully treat your acne breakouts, you may need to use more than one product to target the causes of acne from multiple angles.
Instead of relying on over-the-counter acne products, talk to a healthcare provider about using prescription medication. Prescription acne creams are stronger and more capable of producing results than products available over the counter.
As well as using medication, making changes to your habits and lifestyle can help to get rid of acne breakouts and keep your skin free of blemishes.
It’s important to be patient when you’re treating acne. Keep using each treatment for at least four weeks before you decide if it’s a success or a failure. No treatment, no matter how effective, will produce overnight results.
Acne develops when a combination of sebum and dead skin cells create a blockage in your hair follicles, or pores.
To understand the process behind acne breakouts, it’s important to cover the basics of how your skin maintains and cares for itself.
Your skin is constantly exposed to damage from the outside world. As part of your body’s line of defense against toxins, bacteria and other germs, your skin needs to maintain and repair itself in order to stay healthy.
Your sebaceous glands, small glands that open into your hair follicles, play a part in this process by producing an oily substance called sebum.
Sebum plays an integral role in protecting and repairing your skin. It’s essential for keeping your skin moisturized, lubricated and healthy, as well as providing a physical barrier that keeps toxins and other harmful microbes out of your body.
When your sebaceous glands produce too much sebum, the excess sebum can get stuck inside your follicles, causing a blockage to develop.
Your skin also repairs and rejuvenates itself by constantly creating new skin cells to replace old, dead ones. This process is referred to as epidermal turnover and occurs roughly every 40 to 56 days.
As part of the epidermal turnover process, dead, leftover skin cells can gradually build up on the surface layers of your skin. When these mix with sebum, they can contribute to the blocked hair follicles that cause acne breakouts.
Acne that’s caused by sebum and dead skin cells alone tends to be mild and is often referred to as comedonal acne. These are the classic whiteheads and blackheads that can develop if your skin is overly oily.
Although comedonal acne is usually mild, acne can become more severe when bacteria enters into the equation.
Certain types of bacteria, including the P. acnes bacteria that resides on your skin, can become trapped inside blocked hair follicles. When these bacteria multiple, they can cause your acne to become red, inflamed and painful.
Inflamed acne is often stubborn and difficult to treat. This type of acne includes larger pustules, papules and nodules, as well as more severe cysts that can form deep in your skin and lead to acne scarring.
No matter how severe or stubborn your acne seems to be, it’s almost always possible to treat it with the right combination of products, medications and habits.
We’ve listed the treatment options for stubborn acne below, along with more information on how each treatment works to control breakouts and prevent acne.
Although products available over the counter often aren’t strong enough to get rid of very severe or persistent acne, some can offer real benefits for your skin.
One of the most important products to have in your toolkit for treating stubborn acne is a gentle, non-abrasive facial cleanser.
A good quality quality cleanser, such as our Deep Sea Cleanser, will help to lift dirt and oil from your skin, reducing your risk of developing blocked pores. Make sure to look for a mild cleanser that’s labeled non-comedogenic -- this means that it’s less likely to contribute to blockages.
It’s important to use your cleanser properly. Instead of scrubbing your skin clean, be gentle and apply cleanser lightly using your fingertips in a circular motion. Once you’re finished, wash away the cleanser using warm water and carefully pat your skin until it’s dry.
If you have inflamed or infected acne, you may want to look for a cleanser that contains benzoyl peroxide. This ingredient is a topical medication that prevents the bacteria that cause acne from multiplying on your skin.
You can find benzoyl peroxide in many over-the-counter acne cleansers, facial scrubs and other products.
Other active ingredients to look for include alpha and beta-hydroxy acids, such as glycolic acid, salicylic acid and others. Although these ingredients don’t target bacteria, they can help to peel away the dead skin cells that can accumulate on your skin and contribute to breakouts.
We’ve talked more about these ingredients and their effects in our guide to chemical peeling for treating acne.
While over-the-counter products can certainly make a difference, treating stubborn acne usually requires the use of prescription medications.
Several prescription medications are available for acne, including topical medications you apply to your skin and oral medications you take in tablet form. Common prescription medications for treating stubborn acne breakouts include:
The birth control pill. Believe it or not, the combination birth control pill is quite effective at getting rid of acne, including stubborn hormonal acne breakouts that can develop near your period.
The pill treats acne by reducing your production of sex hormones that control your skin’s sebum production.
Currently, the FDA has approved Ya®z, Estrostep FE®, and Ortho Tri-Cyclen® to treat acne. We offer generic forms of these birth control pills online. You can learn more about how the birth control pill treats acne in our guide to birth control as an acne treatment.
Tretinoin. Tretinoin is a topical medication for acne. It belongs to a class of medications called retinoids and works by speeding up your epidermal turnover process and stopping dead skin cells from clogging your hair follicles.
Tretinoin is one of the most effective topical medications for acne, with numerous studies showing that it can get rid of acne lesions and prevent breakouts.
You can purchase tretinoin as a cream or gel. It’s one of several active ingredients in our Customizable Acne Cream, which is specially tailored to target stubborn acne breakouts that don’t respond to other treatments.
Clindamycin. Clindamycin is a topical antibiotic that works by slowing down or stopping the growth of acne-causing bacteria. It’s available as a gel, foam or liquid and needs to be applied directly to areas of your skin affected by acne.
Your healthcare provider may recommend using clindamycin if you’re prone to inflamed, infected acne caused by bacteria.
Isotretinoin. Isotretinoin is a powerful medication that’s used to treat severe nodular or cystic acne. It comes in tablet form and usually needs to be taken daily for four to five months in order to successfully treat your acne breakouts.
If you have very stubborn acne that doesn’t seem to respond to other treatments, your healthcare provider may recommend using isotretinoin.
Isotretinoin is effective. In some cases, it can even permanently stop acne from coming back. However, it’s more likely to cause side effects than other acne medications and isn’t safe for use if you’re pregnant or planning to become pregnant.
Because of this, your healthcare provider may require that you check in with them on a regular basis and use multiple forms of birth control while you take this medication.
If you have stubborn acne and would like to use prescription medication to treat it, you can talk to a healthcare provider online to learn more about your options.
Because no two cases of acne are precisely the same, there’s no one-size-fits-all medication for treating stubborn acne. Depending on your needs and the severity of your acne, your healthcare provider may prescribe one or several medications to get your breakouts under control.
The right combination of over-the-counter products and prescription medications can usually get rid of even the most stubborn, persistent acne.
However, even if you’re prescribed medication to treat acne, it’s important to maintain good skin care habits. Taking good care of your skin will help to prevent your acne breakouts from coming back. Use the following tips to prevent stubborn acne from returning:
Be patient with your treatment. Acne treatments can take anywhere from a few weeks to several months to begin working. If you’re prescribed medication to treat acne, give it at least four weeks to start working before you assess your results.
Keep using your medication, even if your acne clears up. If you use medication to treat acne, make sure to keep using it even if your skin completely clears up before the end of your course of treatment.
If you no longer want to use your medication, talk to your healthcare provider before you make any changes.
Wash your face two times per day. Try to wash your face two times every day -- once when you wake up, and once when you’re ready to go to bed. Washing more frequently may irritate your skin and make your acne breakouts more severe.
In addition to washing your face every morning and night, make sure to wash your face after you exercise or do anything else that causes you to sweat.
Be gentle when you wash your skin or apply products. Avoid scrubbing your skin, as this can cause irritation and can make your acne worse. Instead, clean your skin gently with your fingertips in a circular motion and carefully pat it dry using a clean towel.
Never squeeze or pop your pimples. Not only is squeezing acne ineffective -- it’s also an easy way to spread sebum, skin cells and bacteria deeper into your hair follicles and make your acne breakouts worse.
If you have severe acne that you feel tempted to pop, visit your local dermatologist and have it extracted professionally.
Wash anything that touches your face regularly. Make sure to wash pillowcases and other fabric items that touch your face. Over time, oil, bacteria and other substances can stick to fabrics and spread to your skin through direct contact.
Avoid comedogenic makeup and skin care products. Instead, look for products that are labeled “non-comedogenic” or “oil free.” Although these can still cause acne, they’re less likely to do so than conventional makeup and skin care products.
When acne is extremely persistent and doesn’t seem to respond to any medication, it may not be acne at all.
Several skin conditions can cause acne-like breakouts that won’t respond to the products and skin care medications typically used to treat acne. These include perioral dermatitis, keratosis pilaris and hidradenitis suppurativa (HS).
Many of these conditions are treatable, but require different medications than the ones used to treat and prevent acne breakouts.
If you think you may have a non-acne skin condition that resembles acne, it’s best to schedule an appointment with a dermatologist. They’ll be able to check your skin and let you know what you’re dealing with and your best options for treating it.
Dealing with stubborn, persistent acne can be a frustrating process, especially when products designed specifically to treat acne do little to reduce the severity of your breakouts.
If you have persistent acne, your best move is to talk to a licensed healthcare provider to learn more about your options and, if appropriate, receive science-based medication to prevent acne breakouts and keep your skin clear.
You can also find out more about treating acne in our detailed guide to acne treatment options backed by science.