Why Is Acne So Hard to Solve?

These days it seems like there’s a product for every skin care concern under the sun. The beauty industry has found a way to commercialize every square inch of your skin, from whole-body deodorant to intimate vulva-care. But despite all the innovations the beauty industry churns out, it still can’t seem to crack the biggest concern of them all: acne.

Glamour recently wrote about how skin care has officially gotten out of hand, with well over 100 launches so far in 2024, according to Virtual Beauty Closet. As I scroll through my inbox full of new moisturizers claiming to be different from all the other new moisturizers, I can’t help but get annoyed. With all these products, why is there still no widely available fix for acne?

If you’re part of the estimated 40% of people who suffer from adult acne, you probably share my frustration. Sure, there are spot treatments with acne-targeting ingredients such as salicylic acid and benzoyl peroxide, which can help diminish the swelling and size of lesions. And of course, there’s the closest cure-all for acne, isotretinoin (once sold under the name Accutane), which has a 85% success rate but comes with side effects that—for some people, particularly women—can come at the cost of your mental health and physical well-being.

It’s not lost on me that acne is incredibly nuanced and unique to every person. What causes my acne can be different from what causes your acne, and so on. Not to mention, there are various types of acne, from superficial blackheads and whiteheads to hormonal cysts.

But as any consumer knows, customer satisfaction mostly boils down to instant gratification. Why don’t we have a product that can totally eliminate a blemish overnight or a magical one-time pill that rids you of acne forever?

According to Dhaval Bhanusali, MD, FAAD, founder of Hudson Dermatology and Laser Surgery in NYC and medical consultant for brands like Neutrogena, Rhode, and Solta Medical, it’s unfortunately not that simple.

“The problem is, your genes are your genes, so we do our best to adjust to those factors,” Dr. Bhanusali says. “For example, a lot of the big medical conditions that exist, like eczema, are chronic. It could go away for many months, if not years, and come back. The same with hypertension. Once you have high blood pressure, the pills just help the symptoms and keep it in check, but your blood pressure will go high without the medication. Acne is similar."

Shari Marchbein, MD, FAAD, board-certified dermatologist, adds that acne has long been marketed the wrong way, leaving its medical component out of the messaging.

“We don’t have a cure for diabetes or high blood pressure or thyroid disease, and acne is the same: It’s a chronic medical condition for which there is no cure. But we have wonderful treatments,” Dr. Marchbein says. “People think of acne as cosmetic issue, which it certainly is not. There are cosmetic implications like scarring or hyperpigmentation, but I think we really need to have a shift in the way we think about acne.”

Both Dr. Bhanusali and Dr. Marchbein insist isotretinoin is the closest you can get to clear skin, but there are new alternatives. Accure is a laser system developed for treating acne, while topical prescription cream Winlevi targets oil production to prevent breakouts. And of course, there’s spironolactone, an oral blood pressure medication used off-label to help with hormonal acne in women.

What do all these treatments have in common? They must be prescribed by a doctor. “These are medicines that need to be used under the direction and care of the dermatologist, period,” says Dr. Marchbein. “We don’t just get our own high-blood-pressure medicine. We don’t just prescribe ourselves Synthroid for thyroid disease. There’s a reason that we have board-certified physicians.”

However, we’re not too far off from an emergency overnight fix for pimples—you know, the ones that always seem to pop up before a big event.

“[An overnight treatment] will exist, and I think we’re getting better with that. I can say [from my experience] working on some things,” says Dr. Bhanusali. “The next iteration of acne patches will have targeted treatment, depending on the technology. So, on a pimple-by-pimple basis, we will have better options in the next year or two. Improvements in delivery, getting actives to where they need to be. Most pimple patches are just removing debris and waste. But you can have different actives that play a part in wound healing and pigmentation.”

Joshua Zeichner, MD, director of cosmetic and clinical research at Mount Sinai Hospital, speculates these advances could be developed in a similar way to hormone patches. “Right now, pimple patches are there to protect the outer skin layer. They’re hydrocolloid dressings, which have long been used in medicine to protect the skin barrier,” he says. “But we use transdermal delivery of actives like in the form of hormone replacement patches. So in the future, I would assume that we’ll have more sophisticated pimple patches that are able to deliver actives through the patch to the pimple."

For now, Dr. Zeichner gives his patients a DIY fix for getting rid of a pimple fast. He recommends mixing 2.5% benzoyl peroxide, 2% salicylic acid, and 1% hydrocortisone cream in the palm of your hand, then applying the mixture to reduce inflammation, dry out the pimple, and lower levels of acne-causing bacteria. “That’s kind of the best that I have been able to come up with for patients based on what’s available on the market right now,” he says.

—Dhaval Bhanusali, MD, FAAD

Dr. Zeichner, who has dabbled in creating his own acne products, says much of the difficulty in making effective over-the-counter treatments is due to FDA regulations. “There are only limited numbers of ingredients that can actually be used over-the-counter to make an acne treatment claim,” he says. “You have to comply with the FDA regulations, which only allow for ingredients like salicylic acid and benzoyl peroxide. And now even benzoyl peroxide is being thrown under the bus.”

Sofie Pavitt, licensed esthetician and founder of Sofie Pavitt Skin Care Studio, has geared her entire skin care line, Sofie Pavitt Face, toward problematic skin. One of Pavitt’s hero products, Mandelic Clearing Serum, contains mandelic acid, a gentle alpha hydroxy acid that can treat acne. However, Pavitt can’t market the serum as an acne treatment due to FDA regulations.

“The FDA is very slow on the update with new developments,” she says. “And we can look at that with sunscreens as well. Our filters and screens in the US are really, really antiquated because the FDA doesn’t have development with it.”

Just because a product is marketed as an acne product doesn’t mean it will help. Pavitt recommends sticking with brands that specialize in acne-prone skin and doing your own research. Most of the time her clients are breaking out from a cocktail of ingredients and actives. “They’re using a salicylic acid, benzoyl peroxide, adapalene, niacinamide, and then they add a mandelic to it, and that kicks everything off,” she says. “But really what they should be doing is just using the mandelic and a little bit of benzoyl peroxide and nothing else.”

And before you go looking for any of the treatments or medications mentioned in this story, it may be worth giving your skin a chance to just breathe. “I’ve had media, celebrities, whatever, come in, and all I did is stop all their products,” Dr. Bhanusali says. “They get so mad at me because they want, to your point, a silver bullet. And sometimes the silver bullet is just stopping everything and letting the skin do its thing.”

Dr. Marchbein believes a cure for acne will ultimately never exist; however, she doesn’t discount the work and constant breakthroughs happening in modern medicine. “It’s always evolving. There are so many things in the world that we just simply don’t cure. So yes, while I hope that there is a cure for acne one day, I don’t know that this is going to happen anytime soon. Acne is a very complicated multifactorial chronic condition for, again, which we have lots of great treatments, but right now no cure. No cure like so many other chronic conditions.”

In the meantime, the beauty industry—and society as a whole—should reframe the way we think about acne. “Normalizing it, letting people know that acne is not a condition where you’re dirty. It’s not because you’re not cleansing properly; you didn’t do anything wrong,” says Dr. Marchbein.

And if you’re someone who suffers from problematic skin, give yourself some grace. Breakouts, scarring, hyperpigmentation, and texture issues only indicate one thing: You’re human. “Our skin is a living, breathing thing, and there’s so many things that react to it,” says Dr. Bhanusali. “That’s why acne is so complicated.”

Ariana Yaptangco is the senior beauty editor at Glamour. Follow her @arianayap.

Originally Appeared on Glamour