There are few things more disheartening then your acne progress severely slows or stops after the treatment finally started working. Although the skin is usually better than it was at the start, it has not settled. There may be new spots still appearing and older ones taking time to clear. This phase of acne treatment is what we call a plateau. It is one of the most common reasons people abandon their treatment. The temptation is to think that the treatment is no longer working and hence escalate or change the approach. However in most cases this is not the case. Knee jerk reactions like switching up the treatment can actually stall or reverse your progress. In this article, we’ll review why acne plateaus after successful treatment and how to manage this.
What is an Acne Plateau?
An acne plateau refers to a period during treatment where improvement stalls. This typically occurs at least 8–12-weeks after the treatment has started to work. However it varies depending on treatment and acne type. It can also happen at any point during the treatment journey so not necessarily the initial treatment. Whilst a plateau in acne treatment is normal and not uncommon, there are many causes for it. These range from the main drivers of the acne activity changing to the treatment reaching it’s maximal effect. It is rarely every because the treatment is no longer working. As such what to do requires careful consideration and planning. Any changes or adjustments to medical treatments should be determined at follow-up once you have finished the course. This ensures that you give the treatment time to work and any action is based on how your skin responded.
Why Do Acne Plateaus Happen?
Acne treatment occurs in phases. The earliest changes tend to be driven by reduced inflammation rather than correction of the acne drivers. In inflammatory acne, papules and pustules often calm within 4–6 weeks as inflammatory signalling is dampened. For comedonal acne, early improvements may begin around 8-10 weeks as follicular turnover starts to normalise. These changes represent the first phase of response. However, beneath the surface, slower and more meaningful improvements are happening. These directly affect the behaviour of acne and the results of which typically take at least 12-16 weeks. With the right acne modifying treatments, there will be normalisation of follicular keratinisation and stabilisation of sebaceous activity. This leads to reduction in microcomedone formation. As a result there is less pore clogging and pimple formation. The time depends on acne type, drivers and severity. The two main points when people think they might have plateaus are:
- Before week 12: Usually initial improvement is due to inflammatory acne suppression. However, the longer term effects on acne formation have not yet occurred yet. This usually just needs patience with the same treatment and review after 12 weeks.
- After week 12: After visible improvement slows during this period, it may mean that the treatment is either no longer addressing the main driver of acne adequately. Here is the point were change in usage (e.g. increasing frequency if not optimal), adjustment of dose or adding in something to help tackle the acne from another angle may help.
How Do Acne Plateaus Look?
One reason plateaus are mismanaged is that it is hard to know whether progress has truly stalled or if this is the normal part of relapsing and remitting cycle of acne. This is because plateaus not only depend on the type of treatment but also form of acne you have:
- Comedonal Acne: Improvement is limited by the lifespan of microcomedones. Even with consistent retinoid and exfoliating acid use, meaningful reduction in pimple numbers often takes 12–16 weeks or longer. A slow down at 8–12 weeks of treatment is not really a plateau. It usually reflects slower clearance of pre-existing lesions rather than ongoing failure.
- Mild to Moderate Inflammatory Acne: Early improvement with antibiotics and anti-inflammatories is often faster because inflammation can be quicker to suppress. A plateau at the 8-12 week stage usually marks the point where the main acne driver is now follicular dysfunction and comedonal acne rather than active inflammation.
- Severe Inflammatory Acne: Improvement is often uneven and progress might be bumpy because of several acne drivers triggering different types of breakouts at the same time. Usually combination therapy using inflammation suppression and acne modifying drugs may reduce severity by 8–12 weeks. However reduction of breakouts commonly continues over several months. As such, slowing of progress is common and does not automatically indicate a plateau. If there’s been no progress for a 2-3 months after improvement then it may be a plateau.
- Hormonal Acne: Where the main drive of acne is sensitivity to androgen hormones, slowing down or reaching the limit of improvement after 3-4 months of hormone blocking treatment usually signals a plateau. If the breakouts continue to recur cyclically then it may be a case of needing to increase the dose or frequency of the hormone blockers. If the acne occurs but is no longer cyclical then it maybe that another non hormone driver has now become the lead driver and requires addressing.
What to Do if You’ve Hit a Plateau?
The best way to see an acne plateau is a decision point in your treatment journey. depending on the suspected cause of your plateau, the aim is to figure out the most appropriate management moving forwards usually with the help of your clinician if you’re having medical treatment. The main options include:
- Continue: If acne has significantly improved from baseline, tolerance to treatment is good and new breakouts are few and far between then the most appropriate option is usually to continue as is. This is because the plateau is likely due to slowing of progress but clearly the bulk of your acne is responding well. It is likely that overtime you will see more progress. Changing or escalating treatment at this stage might actually be counter productive and lead to relapse.
- Fine-Tune Existing Protocol: Small adjustments can be more effective than changing products if you have responded well but have noticed a plateau. This may include increasing frequency or modifying application technique in the case of topical acne treatments.
- Adjusting Dose: For people who tolerate either treatment well and see some modest improvement, increasing the strength of treatment might help amplify gains. On the other hand, if there is ongoing irritation due to treatment that is limiting frequency, then reducing the strength might improve tolerance increase use and increase results.
- Simplify Skincare: Multiple products targeting the same pathway can increase irritation, reduce absorption of topical treatments and mask progress. It may be helpful to streamline your skincare routine to maximise the outcomes of your existing acne treatments.
- Add a Complementary Treatment: If you have a plateau in acne progress despite good tolerance and maximal usage and dosage of your treatment then it may be worth adding something that targets a different acne driver or augments the effects if your treatment.
What Not to Do if Your Acne Treatment Plateaus
A plateau often triggers panic and leads to the wrong kind of action. This can too often derail acne management and reverse gains. If your acne treatments plateaus the most important thing is to avoid changes that obscure response, worsen tolerance or reverse your progress. Whatever happens try hard not to:
- Self-medicate: If you’re undergoing medical treatment or have severe acne then it is important to seek professional review and help. This is because you may require a change or adjustment or addition of treatment which if not done correctly can make the acne worse.
- Escalate Reflexively: Increasing retinoid strength or application frequency at the first sign of slowing progress may introduce irritation that can then limit use and worsen outcomes. Ideally give your acne at least couple more weeks to really see if there is a plateau.
- Over-load Your Skin: Overlapping treatments often increase skin barrier stress without improving outcomes. If you are going to add new products, try one at a time and give your skin enough time to respond before making further changes.
- Stop Your Treatment: Abandoning your treatment due to a plateau may be the worst thing possible. If your skin is better than the baseline, it means the treatment is doing something. Stopping it will likely reverse your progress.
- Judge Progress Daily: Acne improvement is not linear and short-term fluctuations are common as well as periods of slower response. It is best to assess your progress compared to the baseline and also over months than on a day by day or week by week basis.
- Expect the Same Rate of Improvement: The rapid gains seen early in treatment are not sustainable indefinitely. Slower progress as your baseline and acute inflammatory drivers improve is normal. A true plateau is not a slowing down of progress but a halt in improvement.
A plateau in acne progress is normal and does not indicate treatment failure. It usually signifies that the phase of rapid change has passed or that the baseline is so improved that gains are less dramatic and harder to come by. The best way to see a plateau is as a decision point. Options range from continuing as is to modifying or adding to existing treatment depending on your progress compared with your baseline. If your acne is severe or you’re undergoing medical treatment it’s important to seek help in order to ensure that you continue to improve and avoid setbacks.
At City Skin Clinic, we believe that skincare is personal and should always centre around your individual needs. Our doctors offer custom topical skin treatments for acne using ingredients like tretinoin, azelaic acid, clindamycin and spironolactone where appropriate. If you are interested in a personalised skincare treatment please use our online skin consultation form or book a video consultation. Start your treatment journey today and take your first step towards great skin.
This article is intended for general informational purposes only and is not a substitute for medical advice, diagnosis or treatment. Always consult a qualified medical provider for any medical concerns or questions you might have.
