Why Is Acne So Hard to Solve?

“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.”

Dr. Shari Marchbein, MD, FAAD, board-certified dermatologist and a fellow of the American Academy of Dermatology, adds that acne has long been marketed the wrong way, leaving its medical component out of 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 centroid 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.”