If you’re reading this, I bet you’ve already been to a dermatologist (or ten), and you’ve already tried over-the-counter products and prescription medications to treat your acne, to no avail. You’re probably wondering why your acne products aren’t working. Here I explain why your acne products may not be working for you, and what to try instead.
Table Of Contents
- Why Acne Products Aren’t Working
- Types of Acne Products
- How To Reverse Acne Naturally
Why Acne Products Aren’t Working For You
Skin is an organ, and like any other organ, it needs certain nutrients and conditions within the body to look and perform its best. Aside from occasional breakouts induced by harsh skincare, cosmetics, or pollution, chronic acne is more commonly a sign of internal imbalance and inflammation.
Focusing solely on the outside without addressing what’s going on the inside is a losing battle. Sure a zit cream can dry up a pimple fast, but only addresses the symptom, not the root cause. That means, you’ll likely be using zit cream for years, or even decades.
According to WebMD, teens with acne commonly suffer from it for 5-10 years, while adults can battle it for decades (1). A survey cited in a Rutgers Medical School Study, including over 1,000 women, found that 50% of 20-somethings, 30% of 30-somethings, and 25% of 40-something will struggle with acne (2). Despite the plethora of acne products, acne is the most common inflammatory skin condition, affecting 50 million Americans, or 15% of the population.
The conventional way of treating acne subdues it but doesn’t eradicate it (or else we wouldn’t have these statistics). So, if acne products are not working for you, you’re not alone. (If any of these products DO work for you, then great! Remember, everyone is different and has a different response to treatments). Read on to see why common acne products aren’t working or effective at fully eradicating acne, and what actually does.
Types Of Acne Treatments
The most common types of acne products include:
- Over-the-counter topical creams, cleansers, and treatments with one of the below active ingredients:
- Benzoyl Peroxide
- Salicylic Acid
- Prescription topicals, such as:
- Prescription oral medications, such as
- Birth Control
- Isotretinoin (Accutane)
There are additional options in each of these categories, but in this article, we’ll address the above, as they are some of the most common. While these treatments may offer some relief, none are considered a curative acne treatment. Some even come with serious side effects that may outweigh any benefits.
Why aren’t Benzoyl Peroxide Products Working?
For some, benzoyl peroxide may improve mild to moderate forms of acne. It has an antibacterial effect against C. acnes, the bacteria associated with acne, and dries out the skin which causes flaking. But according to a large review in the Journal of Drugs, it doesn’t have an effect on oil production or cell production and turnover. This suggests it may offer temporary relief, as opposed to eradicating the issue altogether (3).
What’s more, it can deplete Vitamin E from the skin, leaving it more vulnerable to inflammation, and can even kill the good (and much needed!) bacteria on your skin (4). Benzoyl peroxide may be helpful short-term if you can stand the flaking and raw skin, but you may find it doesn’t give you full, long-term clearance.
Why Aren’t Salicylic Acid Products Working?
Salicylic acid helps exfoliate excess cell buildup in the follicles, thereby preventing pimples. It’s also an anti-inflammatory which helps reduce redness.
Though salicylic acid is tolerated by many, there are not many clinical trials that demonstrate its efficacy (5). It can be helpful in the short term while in use, but probably won’t give you complete freedom from acne, as it doesn’t address the underlying reason your pores are getting clogged in the first place.
Why Aren’t Topical Retinoids Working For Acne?
When I suffered from acne, retinoids could only be obtained with a prescription. Now, you can find them over the counter at drugstores and Sephora, albeit in lower concentrations. Retinoids, such as Retin A, Differin, Retinova, and Isotrex are synthetic derivatives of Vitamin A and have been the cornerstone of conventional acne therapy since the 1960s. They work by preventing the overgrowth of cells that line the hair follicle, thereby preventing the clogged pores that cause acne.
Although they’re prescribed regularly, research supporting retinoids suggests they should be expected to offer an improvement of 26-35% in acne patients (6). Because they don’t offer full improvement on their own, they are often paired with antibiotics which improves the efficacy, but comes with its own set of concerns which we’ll discuss below.
What’s more, retinoids make the skin raw, red, and flakey, and may even make it break out more for about 2-4 weeks as the skin undergoes “retinization.” They can also make the skin more sensitive and impair skin barrier function. So, while they may reveal clearer skin after the “it has to get worse before it gets better” period, it may come at the cost of more sensitive, less healthy skin (7).
Why Aren’t Topical Antibiotics Working for Acne?
Topical antibiotics kill the bacteria, C. acnes, associated with acne which may result in fewer pimples. They may also have an anti-inflammatory effect, which can help explain their efficacy, particularly for inflammatory lesions. They have not, however, been found to make much of a difference for non-inflammatory lesions (8).
While they may work short-term, topical antibiotics are not a long-term solution, as the bacteria eventually develops resistance to the antibiotic (9). They should be stopped after 6-8 weeks, or as soon as marked improvement occurs, whichever comes first (10).
Beyond the threat of antibiotic-resistant bacteria, another concern is that antibiotics are typically indiscriminate. They don’t distinguish “good” bacteria from “bad” bacteria, and so they can wipe out the good along with C.acnes. Just as your gut needs a variety of bacteria strains living in harmony to be healthy, so does your skin.
Additionally, antibiotics can find their way into widespread circulation throughout your body. This is because your skin is an organ and absorbs much of what you put on it. This disrupts the balance of other natural and healthy bacteria or microbiomes, particularly in your digestive tract. Although rare, cases of colitis resulting from topical antibiotics, have been reported.
More and more research is starting to look at the microbiome of the skin as a whole. The acne treatments of the future will be more about fortifying the body and supporting “good” bacteria. This will naturally keep the “bad” bacteria in check.
Why Aren’t Oral Antibiotics For Acne Working?
Taking oral antibiotics to treat acne by killing excess C. acnes bacteria has been a treatment method prescribed by dermatologists for decades. But along with killing the bad bacteria, antibiotics can also kill the good bacteria in other parts of your body. (Hence why yeast infections are common in women who take antibiotics. Your vajay has a microbiome, too!)
While they may offer relief in the short-term, antibiotics may impair digestion, cause gut dysbiosis and increase intestinal permeability. Prolonged antibiotic use disrupts the gut-brain-skin axis which contributes to acne. It’s not uncommon for acne to come back in the months after oral antibiotic treatment.
Even a short dose of antibiotics affects our gut microbiome for months, and even years after they’re taken. Researchers from the University of Copenhagen found it took 6 months for a healthy person’s gut bacteria to rebound after a 4-day dose of antibiotics. Nine beneficial strains of bacteria were completely wiped out and did not return, while some new non-desirable bacteria had colonized the gut (11). Moreover, prolonged or multiple courses of antibiotics has been associated with an increased risk of gut disorders, including Crohn’s disease (12).
Why Isn’t Birth Control Working For Acne?
Birth control alters the hormones. Specifically, it reduces the levels of androgens (male hormones) in the body. Elevated levels of androgens, like testosterone, stimulate sebum or oil production which can clog pores. That’s why birth control is often prescribed as an acne treatment for women.
It’s common to have an initial acne flare after starting birth control, but many women find their body adjusts and it subsides after 2-3 months. While some women report clearer skin on birth control, for others, it has the opposite effect, particularly if the pills contain progestin (the man-made version of progesterone).
It’s also common to experience an acne flare once you stop the pill. This is true even for those who have never had acne before. Once you go off the pill, there is an increase in testosterone, which increases sebum (oil production). Sebum can clog pores and result in acne. It can take months for your body to regulate your hormones and get everything back in balance.
Another issue is that birth control increases your usage of zinc, a critical nutrient for clear skin. So, if you’re not getting enough and are zinc deficient, that may contribute to your breakouts. Additionally, oral contraceptives can negatively impact the gut microbiome and increase intestinal permeability, (13) which again, can contribute to acne.
Like all prescription medications, birth control comes with side effects, ranging from minor weight gain and mood swings to serious blood clots and cancer (14). Because of the implications and lasting effects, it’s wise to explore alternative routes to clear skin. If you’re using birth control for actual birth control, I recommend you tune into this podcast episode on all things periods, birth control, and fertility and explore non-hormonal contraceptive options.
Why Did My Acne Come Back After Isotretinoin?
Isotretinoin, (also known as Amnesteen, Sortret, Claravis, and Absorica) hit the market under the brand name Accutane in the 1980s. It quickly became a best-selling prescription drug to treat acne, despite being linked to birth defects, Crohn’s disease, IBD, ulcerative colitis, and even suicide (15, 16, 17, 18).
It’s considered the most effective pharmaceutical acne treatment available. However, a recent small study found only 46% of patients experienced full clearance at the end of treatment (19). Additionally, it does not cure acne. Once the treatment stops, 10-60% of patients will experience a relapse of acne within 2 years (20, 21, 22, 23).
How to Reverse Acne, Naturally
If you’ve tried acne products and they aren’t working, you know first hand that they’re not effective for everyone. That’s because they treat the symptom without getting rid of the root cause. Topical acne treatments can not fully eradicate acne caused by nutritional deficiencies, inflammation, gut imbalance, hormone imbalance, blood sugar imbalance, or stress. Only targeted dietary and lifestyle changes can.
Dietary Changes That Reverse Acne
Some of the most well-known and widely accepted acne triggers are dairy, sugar, and refined carbohydrates. But they are not the only ones. Vegetable oils, processed foods, and conventional animal products can also contribute. You can read more about acne trigger foods here. While no single food may cause or cure acne, there’s plenty of evidence that certain foods exacerbate acne, while others reverse it (24, 25).
What a lot of “acne diets” get wrong is focusing on what to remove, without emphasizing what to add in: antioxidant-rich, anti-inflammatory, low glycemic foods. These foods address the common nutritional deficiencies of people with acne. My comprehensive Clear Skin Plan addresses both sides of the food equation and provides delicious, quick recipes that will help clear your skin from within.
It’s important to note that foods that make one person break out may not do the same for someone else. Each one of us has a unique biochemistry, so our “perfect clear skin diet” is going to be slightly different. The Clear Skin Plan teaches you how to discover which foods may trigger your acne, and which ones reverse it. Accordingly, you can create the perfect diet for your unique body.
Lifestyle Changes That Reverse Acne
Dietary changes will make a significant impact for some, while others need to make lifestyle changes to see full clearance. This includes limiting and dealing with stress, getting adequate sleep, and exercising regularly.
Gentle Skincare That Supports Clear Skin
While dietary and lifestyle changes do the heavy lifting of clearing acne, consider what you’re putting on your skin too. Contrary to popular opinion, harsher is not better. In many cases, common acne treatments can make your skin more sensitive, raw, red, and irritated. Instead of trying to scrub or peel the acne away, try nourishing your skin with gentle natural skincare. This allows your skin to heal on its own.
What has your experience been with the acne treatments mentioned above? Have you tried dietary and lifestyle changes? What was more effective for you?