What Causes Acne That Does Not Respond to Treatment
Acne that sticks around despite treatments often stems from deeper issues like bacterial resistance, hormonal shifts, skin microbiome problems, or external triggers that standard creams and pills miss. Understanding these helps explain why some cases need stronger steps.
One big reason is antibiotic resistance. When people use antibiotics like doxycycline or others for too long or not enough, the bacteria called Cutibacterium acnes, or C. acnes, builds up defenses. This common skin bacteria then keeps fueling inflammation even after treatment stops.[2]
Hormonal imbalances play a key role, especially in women. Excess androgens, which are male-like hormones everyone has, ramp up oil production and clog pores. Conditions like polycystic ovary syndrome or even monthly cycles can make acne tougher to clear without hormone-targeting therapies.[6]
The skin’s microbiome, a mix of microbes living on your skin, can get out of balance. In acne, certain strains of C. acnes thrive in oily, blocked follicles, sparking ongoing inflammation. Not everyone with these bacteria gets acne, but shifts in the skin’s microbial community make it harder for treatments to work.[1]
Overproduction of sebum, the skin’s natural oil, creates a perfect spot for bacteria. Androgens and growth factors like IGF-1 drive this, worsening blockages from too much keratin buildup in follicles. These core changes in acne pathogenesis resist basic topicals.[1]
Lifestyle factors add fuel. For example, swimmers face chlorine drying out skin while tight gear causes friction, irritating acne-prone areas. Harsh products or environments override gentle treatments.[3]
In older adults or severe cases, acne persists due to endocrine issues, medications, or scarring risks. Standard options fail, pointing to needs like isotretinoin, a powerful oral retinoid for treatment-resistant nodular acne.[5]
Wrong dosing or mismatched therapies also play in. Severe acne might need higher cumulative doses of meds, but variability in practice leads to incomplete clearing.[4]
Sources
https://pmc.ncbi.nlm.nih.gov/articles/PMC12735603/
https://blogs.the-hospitalist.org/topics/acne
https://www.dermatologytimes.com/view/balancing-pathophysiology-and-patient-lifestyle-in-acne-management-part-2
https://clinicaltrials.gov/study/NCT07296523
https://www.ncbi.nlm.nih.gov/books/NBK525949/
https://www.dovepress.com/efficacy-and-safety-of-hormonal-therapies-for-acne-a-narrative-review-peer-reviewed-fulltext-article-CCID
https://www.pharmacytimes.com/view/the-educated-patient-clearing-up-acne
