Tried it, didn't work. Next.

Benzoyl Peroxide? Tried it, didn’t work. Acne diet? Tried it, didn’t work. Spironolactone? Nope. Minocycline? Worked for a bit. Isotretinoin? Worked but acne came back. Banana Peel? Sea Salt method? Just no. There are so many ‘acne cures’ which work for some and not others that it's not surprising there is a huge 'didn't work for me so I'll write it off completely' camp in the acne community. Why is that?


This is the fourth (and last) part of our acne formation chain saga (confused? see our earlier posts). To recap, acne forms through a series of domino like events. This chain of events starts with genetics but lifestyle, diet and your environment can also play a part in setting the dominoes falling. Once they topple, there is a cascade of events driven by inflammation and hormones which leads to blocked pores, bacterial imbalance and inflammation. We call this cascade the acne forming chain.

Why some products work for some and not others comes down to this chain, where the chain is triggering and where a particular product works its magic.


Most products work on one (sometimes two) parts of the acne forming chain.


Antibiotics such as Doxycycline for example kill bacteria to address the bacterial imbalance which leads to inflammation which leads to acne. The logic is simple - by killing the bacteria, the skin can't go getting all inflamed and so acne disappears. But antibiotics do not stop the pores becoming clogged and an ideal place for bacteria to breed in the first place and if you stop taking antibiotics the acne resumes. Top that with the sad fact that antibiotics do have a nasty habit of killing every bacteria in the room and you can end up with a mircobiome that's completely out of balance, which by itself can lead to acne.


Isotretinoins such as Roaccutane and Claravis primarily decrease the size and activity of the sebaceous glands in the skin, reducing sebum and reducing the number of blocked pores (they also help with inflammation). No block, no big bacteria growth, no acne. But they do not stop that acne train - once treatment stops the genetics and lifestyle behind acne will continue to play with your hormones and acne can come back. Clinical experience suggests that the long-term cure rate of accutane isn't as high as some manufacturers claimed and relapse rates are between 10 and 60%.


Whether a product works for you comes down to your acne chain and what your toppling dominoes are. If the only reason you are flaring turns out to be 'that' new cleanser is reacting with your skin and toppling the inflammation domino (as if you could be so lucky, seriously?) then stopping the use of that product will work - but if (in real life, lets be honest) it happens that your skin barrier function is weak due to your hormone balance being out of whack then just stopping the cleanser isn't going to stop your acne in the long term. The same is true for diet and why for example some people need to cut down on dairy or sugar, and some don't - it's all chain specific.

am I tackling each part of the chain?

Identifying your toppling dominoes is hard to do. The most common thing is to try everything and see what works. This rarely works though. It just eats through time and money. A better solution is to think about how you can manage each stage of the acne formation chain, find what works for you and do it consistently and for as long as it takes and then some.


If you're using a huge number of products think about where on the chain they are working - do you really need them or are doubling up? Think minimal skin care regime. It'll help identifying triggers from products, reduce the chance of skin barrier damage and you can always re-introduce a product once your skin is in a better place to see if it'll work for you.


And be consistent. Consistency is another important factor in the 'it didn't work for me' camp. Products take time to work. Your body is continually producing new layers of skin which have to work their way to the surface - this takes about 28 days for the average adult and up to 60 days for granny. Active ingredients work on the layer of skin where new cells are made - not on the dead outer layer you see. This means on day 1 you apply magic product X, it will take at least 28 days for the effect of that on the skin to be seen.


Any product that promises instant results is just plumping the dead skin in some way and is always very temporary. Any products which have an affect on your hormones (changes in diet, supplements and even probiotics for example) will take even longer to work - between three and six months. As a rule of thumb, the closer to the start of the chain a change is, the longer its takes that change to be seen.


With things taking so much time it really is a great idea to track your progress with any acne treatment - whether its a block of carbon soap or an entire Roaccutane course. You can see if somethings working or not, keep yourself on track and remain positive about your progress. The proverb 'change comes when you take control' is so very true. My tip would be to take weekly photos rather than daily - in skin nothing really changes in day.


acne is a marathon, but it has a finish line.

The end to your acne is not an eternal marathon - there is a finish line. Over time, your genes will have the final say and your body will change and acne will disappear eventually (well more likely it will disappear then reappear a few times first) but you have to remain vigilant and continuously make choices to try and stop each part of the chain toppling while your genes get their act together.