Medically reviewed by Vicky Davis, FNP
Written by Our Editorial Team
Last updated 3/17/2021
When was the last time you remember having clear skin? Has it been a while?
If your acne breakouts are so frequent or persistent that you can’t remember the last time your face felt free of blemishes, then you may have a more serious case of acne than your current skincare routine is capable of managing.
We say “may” here because the reasons your acne won’t go away are many. You could be treating the wrong problem, you could be misusing the product or you could have had the wrong diagnosis and the wrong course of treatment prescribed to you.
Whether you’ve been going it alone and your frustration is at a boiling point, or you’re seeking answers because your dermatologist hasn’t given you any, there are some important things to consider to determine what’s making your acne bloom out of control.
When your skin’s normal process for getting rid of dead cells in your pores breaks down, acne happens. Acne is the result of a bacterial infection from imbalances that create excess cells, oil, bacteria or inflammation in the pore, and it results in a variety of acne type — from blackheads to cystic acne.
Acne can happen on your face, back, chest, and any other area where you produce a lot of oil ( also called sebum), which can build up and create the ideal conditions for a bacteria called Propionibacterium acnes, or P. acnes, to flourish.
But the mechanism of acne and the cause of it are not the same things. Anything can throw your follicle activity out of alignment, from diet and dehydration to stress, or even the climate you live in.
But what is really behind acne (particularly for teenagers) is a hormonal imbalance, particularly with sexual hormones like androgens.
Androgens can really ratchet up your sebum production. Oil is a normal part of your follicle’s process for ditching dead cells; the follicle literally produces sebum through the sebaceous gland to lubricate the follicle so that the dead cells slide out more easily.
Things are fine unless the cells get stuck or the sebaceous gland is stuck in the “on” position, causing the oil to accumulate. Things can also go wrong if the cells are particularly dehydrated, which can cause them to stick. When your pore fills with oil and skin cells, it makes for a great habitat and food source for bacteria, and that’s where acne starts.
The severity of your acne is determined by how bad the situation is in your pores, and the type of acne is determined by what happens.
Blemishes can be open or closed, can contain material with pus or solid material and can even be caused by fungus instead of bacteria. This is how you get whiteheads, blackhead, papules, nodes, nodules, cystic acne and other types.
The severity of your acne is determined by what kinds of blemishes you have: mostly whiteheads and blackheads is typically considered mild, whereas inflamed nodes and nodules are typically seen in severe cases.
It’s important to understand what kind of acne you have because, depending on the type, you’ll end up benefiting from different treatments for your breakouts. But the type of acne breakout can only tell you so much about treatment. In order to treat the source of your acne, you need to know why it’s happening.
The unfortunately simple reason your acne isn’t going away is that you’re using the wrong treatment. Acne has several causes, but the mechanisms behind those causes can vary widely, from hormonal and dietary influences, to how much time you spend in the sun and whether you’re on birth control.
Whether you have stubborn blemishes or a face full of painful pimples, there are some likely reasons you can’t get them to go away.
Unless your skincare products and acne fighting tools were doctor recommended, there’s a high probability the tools your friends and family recommended for your acne battle aren’t the right ones for you.
You and your best friend may have acne, be the same age and have similar lifestyles, but that doesn’t mean you have the same acne. That means the same over-the-counter acne treatment won’t necessarily work.
While your friend may need to treat the bacteria itself with something like benzoyl peroxide, your root cause may be clogged pores and dead skin, which can be addressed by a retinoid product.
And your routine likely needs to be different from your friend’s. Just because she can get away with washing just with water, or only using a moisturizer, doesn’t mean your problems are the same. Skin drying products are only good if you’re producing excessive oil. Used in excess, drying products are only going to increase the dryness of dead skin cells.
But there’s also consideration to be made for whether or not you’re using the right products the wrong way. When we say you could be using the right products the wrong way, a number of things could be causing your treatment not to work the way it should.
It’s sometimes as simple as following directions: if your medication says apply twice daily, don’t skip applications. If your medication says once daily, doubling up could cause more problems than it creates.
It's also crucial to complete the full round of prescriptions. Got 10 doses of an antibiotic? Take the full round. And washing your face is important, but washing it too aggressively can actually make acne worse by causing more irritation and inflammation.
You’ve probably seen the same countless stories we have about women who couldn’t get rid of their acne until one good doctor finally spotted the real problem. The fact is, because acne has so many causes, it can often take doctors a few tries to even realize that you’re the unlucky owner of a more serious case of acne.
It’s well understood that there’s no one-size-fits-all solution for acne, because no two patients are exactly alike. A 2018 review in the International Journal of Women’s Dermatology (linked above) called the causes of acne complex, and explained that treatments, “vary widely and treatment should be tailored specifically for each individual woman.”
Whether because of a deeper underlying cause or just a different set of issues, some acne treatments just won’t work for some people. If your current treatment isn’t working for you, consulting a healthcare professional is the best step to take.
If you’re struggling with persistent acne, here’s a quick set of next steps for you to consider in your fight for clear skin:
Make sure you’re using any prescribed products the right way, which includes frequency and manner of use.
Consult a healthcare professional or dermatologist to learn more about your particular case of acne and see if they have different recommendations for treatment.
Take a look at lifestyle factors like diet and water intake to see if your general health might be contributing to ongoing skin issues.
Whether you’re just in need of some bigger guns, or are seeing acne as the result of a more serious issue, speaking with a healthcare professional is a wise next step. Because your biggest problem shouldn’t be worrying about fine lines from smiling when you look in the mirror.