What Causes Breakouts That Do Not Respond to Retinoids
Retinoids are popular topical treatments that work by unclogging pores and reducing inflammation in acne-prone skin. But sometimes breakouts keep coming back or get worse despite using them. This happens when other factors drive the acne that retinoids alone cannot fix.
One main reason is hormonal imbalances, especially in women. Androgens like dihydrotestosterone increase oil production in the skin, leading to clogged pores and persistent pimples. Signs include breakouts before periods, irregular cycles, or extra hair growth. These cases often need hormonal therapies instead of just retinoids.[1]
Microbial issues on the skin also play a role. Cutibacterium acnes bacteria can shift in ways that cause inflammation, forming biofilms or changing strains that resist standard treatments. Retinoids help with some aspects but not the full bacterial dysbiosis or immune response.[2]
Lifestyle and product choices make things worse too. Stress raises cortisol, which boosts oil and worsens acne. Pore-clogging makeup, heavy moisturizers, or harsh cleansers trap bacteria and irritate skin. Diets high in sugar, refined carbs, or dairy can spike insulin and inflammation in sensitive people.[3]
Underlying health problems or medications add to resistance. Conditions like polycystic ovary syndrome, thyroid issues, or drugs such as corticosteroids trigger breakouts that retinoids cannot control. Poor sleep and lack of exercise further disrupt skin balance.[3]
Even irritation from retinoids themselves can mimic or worsen breakouts. Dryness and redness make skin more vulnerable if not managed with proper moisturizers.[4]
In short, retinoids target keratinization and some inflammation but miss deeper causes like hormones, microbes, diet, and habits. Seeing a dermatologist helps identify the right mix of treatments.
Sources
https://pmc.ncbi.nlm.nih.gov/articles/PMC12691598/
https://pmc.ncbi.nlm.nih.gov/articles/PMC12735603/
https://www.westchestercosmeticdermatology.com/blog/adult-acne-why-it-happens-and-how-to-treat-it/
https://www.droracle.ai/articles/653248/what-topical-therapies-are-suitable-for-acne-in-a
