Few things are more disheartening than acne progress that slows or stops just after your 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 the treatment is no longer working and to escalate or change the approach. However, in most cases that is not what is happening. 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 it.
What is an Acne Plateau?
An acne plateau is a period during treatment where improvement stalls. This typically happens at least 8 to 12 weeks after the treatment has started to work. However, it varies depending on the treatment and the type of acne. It can also happen at any point during the treatment journey, so not necessarily at the start. Whilst a plateau is normal and not uncommon, there are many causes for it. These range from the main drivers of the acne changing to the treatment reaching its maximal effect. It is rarely ever because the treatment is no longer working. As such, what to do requires careful consideration and planning. It is best to decide any changes or adjustments to medical treatments at follow-up, once you have finished the course. This ensures you give the treatment time to work, and that any action reflects how your skin responded.
Why Do Acne Plateaus Happen?
Acne treatment occurs in phases. Reduced inflammation tends to drive the earliest changes, rather than correction of the acne drivers. In inflammatory acne, papules and pustules often calm within 4 to 6 weeks as inflammatory signalling settles. For comedonal acne, early improvements may begin around 8 to 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 how the acne behaves, and the results typically take at least 12 to 16 weeks. With the right acne modifying treatments, there is normalisation of follicular keratinisation and steadier sebaceous activity. This leads to less microcomedone formation. As a result, there is less pore clogging and fewer pimples. The time depends on the acne type, drivers and severity. The two main points when people think they might have a plateau are:
- Before week 12: Usually the initial improvement is due to inflammatory acne calming down. However, the longer-term effects on acne formation have not yet occurred. This usually just needs patience with the same treatment and a review after 12 weeks.
- After week 12: If visible improvement slows in this period, the treatment may no longer be addressing the main driver well enough. This is the point to act. A change in usage may help, for example increasing frequency if it is not optimal. So can an adjustment of dose, or adding something to tackle the acne from another angle.
How Do Acne Plateaus Look?
One reason people mismanage plateaus is that it is hard to know whether progress has truly stalled. It may just be the normal part of the relapsing and remitting cycle of acne. Plateaus depend not only on the type of treatment, but also on the form of acne you have:
- Comedonal Acne: The lifespan of microcomedones limits improvement. Even with consistent retinoid and exfoliating acid use, a meaningful drop in pimple numbers often takes 12 to 16 weeks or longer. A slowdown at 8 to 12 weeks is not really a plateau. It usually reflects slower clearance of existing spots 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 calm. A plateau at the 8 to 12 week stage is telling. It usually means the main driver is now follicular dysfunction and comedonal acne rather than active inflammation.
- Severe Inflammatory Acne: Improvement is often uneven and progress can be bumpy. This is because several acne drivers trigger different types of breakouts at the same time. Combination therapy using inflammation suppression and acne modifying drugs may reduce severity by 8 to 12 weeks. However, the reduction of breakouts commonly continues over several months. So a slowing of progress is common and does not automatically mean a plateau. If there has been no progress for 2 to 3 months after improvement, then it may be a plateau.
- Hormonal Acne: Here the main driver is sensitivity to androgen hormones. Slowing down or reaching the limit of improvement after 3 to 4 months of hormone blocking treatment usually signals a plateau. If breakouts keep recurring in a cycle, then you may need to increase the dose or frequency of the hormone blockers. If the acne continues but is no longer cyclical, then another non-hormonal driver may have become the lead driver and needs addressing.
What to Do if You’ve Hit a Plateau?
The best way to see an acne plateau is as a decision point in your treatment journey. Depending on the suspected cause, the aim is to work out the best way forward. Your clinician can help with this if you are having medically supervised acne treatment. The main options include:
- Continue: If your acne has improved a lot from baseline, you tolerate the treatment well and new breakouts are few and far between, then the best option is usually to carry on as you are. The plateau is likely due to a slowing of progress, but the bulk of your acne is clearly responding well. It is likely that over time you will see more progress. Changing or escalating treatment at this stage might be counterproductive and lead to relapse.
- Fine-tune your routine: Small adjustments can be more effective than changing products if you have responded well but noticed a plateau. This might include increasing frequency or improving your application technique with topical acne treatments.
- Adjust the dose: For people who tolerate their treatment well and see modest improvement, increasing the strength might help amplify the gains. On the other hand, ongoing irritation may be limiting how often you can use it. In that case, reducing the strength might improve tolerance, increase use and improve results.
- Simplify your skincare: Multiple products targeting the same pathway can increase irritation, reduce absorption of topical treatments and mask progress. It may help to streamline your skincare routine to get the most out of your existing acne treatments.
- Add a complementary treatment: Sometimes you plateau despite good tolerance and maximal use of your treatment. Then it may be worth adding something that targets a different acne driver, or boosts the effects of your treatment.
What Should You Not Do if Your Acne Plateaus?
A plateau often triggers panic and leads to the wrong kind of action. This can too often derail acne management and reverse your gains. If your acne treatment plateaus, the most important thing is to avoid changes that obscure your response, worsen tolerance or reverse your progress. Whatever happens, try hard not to:
- Self-medicate: If you are having medical treatment or have severe acne, then it is important to seek professional review and help. You may need a change, adjustment or addition of treatment, which can make the acne worse if it is not done correctly.
- Escalate reflexively: Increasing retinoid strength or frequency at the first sign of slowing may introduce irritation. This can then limit use and worsen outcomes. Ideally, give your acne at least a couple more weeks to see if there really is a plateau.
- Overload your skin: Overlapping treatments often increase skin barrier stress without improving outcomes. If you are going to add new products, add one at a time. Give your skin enough time to respond before making further changes.
- Stop your treatment: Abandoning your treatment because of a plateau may be the worst thing you can do. If your skin is better than baseline, then the treatment is doing something, and stopping it will likely reverse your progress.
- Judge progress daily: Acne improvement is not linear, and short-term ups and downs are common, as are periods of slower response. It is best to assess your progress against the baseline and over months, rather than day by day or week by week.
- Expect the same rate of improvement: The rapid gains seen early in treatment are not sustainable forever. Slower progress, as your baseline and acute inflammatory drivers improve, is normal. A true plateau is not a slowing of progress but a halt in improvement.
A plateau in acne progress is normal and does not mean treatment failure. It usually means the phase of rapid change has passed. Or your baseline is so improved that gains are smaller and harder to come by. The best way to see a plateau is as a decision point. Options range from continuing as you are to adjusting or adding to your treatment, depending on your progress against your baseline. If your acne is severe, or you are having medical treatment, it’s important to seek help. That way you keep improving and avoid setbacks.
At City Skin Clinic, we believe that skincare is personal and should always centre around your 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 professional with any concerns about your skin or treatment options.
