One of the most demoralising acne things about dealing with acne is recurrence. Any acne sufferer will be familiar with the ecstasy of when the treatment finally works and skin clears. However, when you stop treatment, within weeks or months, the acne returns. Even worse often this relapse maybe even more severe than before. The natural conclusion is almost always the same. Most people will think that either the treatment failed, or worse, the acne has become resistant. Although this seems logical, thankfully it is usually wrong. In this article we explore why acne improves and then returns after stopping treatment. We also review the best way to maintain results and prevent acne recurrence.
Why Does Treatment Only Improve Acne Temporarily?
The key thing to understand is that acne is a chronic skin condition with a number of underlying drivers that include hormones, inflammation, excess oil production and abnormal cell turnover. Which of these is the main driver varies from person to person. The end result is either non inflammatory lesions like whiteheads or blackheads, inflammatory acne like pustules, papules and cysts or a combination of both. Most acne treatments work either by suppressing acute inflammatory activity or modifying the underlying drivers of acne. When effective, acne treatments can:
- Reduce inflammatory signalling
- Slows down pore clogging
- Prevent microbial overgrowth
- control oil production
Suppressors of active inflammatory acne such as benzoyl peroxide and antibiotics are excellent for resolving acute acne breakouts. They are not normally used long term. Acne modifying treatments like exfoliating acids, hormone blockers and retinoids can normalise oil production and cell turnover. This helps prevent pore clogging which leads to acne formation. These modifying treatments work as long as you use them long term. When treatment stops, then the acne comes back.
What Can the Pattern of Acne Recurrence Tell Us?
Recurrence after stopping treatment is not random. The way acne comes back can provide helpful clues as to why this happened. The key patterns of acne to detect are if recurrence is:
- Rapid: This suggests that there are strong underlying drivers of acne that were not fully addressed by the treatment.
- More Inflammatory: In this case it is likely that whilst treatment was effective it caused a lot of irritation or skin barrier damage.
- Cyclical: This usually points toward hormonal drivers of acne that were controlled by the treatment. You may not see recurrence straight away and when it returns it relapses and remits.
Which Treatments are More Likely to Cause Acne Relapse?
Short-course treatments, particularly antibiotics, often cause the acne to come back after stopping. This is because they reduce bacterial growth and inflammation which can dramatically improve inflammatory acne pimples. However, because they do not address the underlying causes of ace, when you stop them the pore blocking and eventual inflammation returns. iIn this case, recurrence is almost inevitable after stopping antibiotics. If there is no acne modifying long term treatment in place for maintenance. It does not mean that there resistance to antibiotics or treatment failure.
The same applies to tretaments that modify acne behaviour such as roaccutane, topical retinoids, hormone blockers, chemical peels or lasers. Whilst these treat the underlying cause of acne, they require either ongoing use or something for maintenance. Without this, the skin eventually returns to its baseline behaviour and the acne comes back.
What Not to Do When Acne Returns
A lot of people make the mistake of thinking that once their acne has cleared, they should stop treatment and see if it comes back. Then when it does, they jump to the conclusion that the treatment was a failure. In reality, the treatment worked whilst it was present like it was supposed to and the acne came back because it was withdrawn. This is not a failure of treatment but a misunderstanding of something crucial. No acne treatment is permanent. Most people will need to continue the same treatment or use something appropriate for maintenance. Unfortunately, due to this mis-understanding, when acne reappears, most people respond in one of two ways:
- Restarting treatment at a higher strength
- Layer additional active products to “catch it early”
Both of these aggressive approaches often worsen the acne recurrence either by causing irritation, flare-up, purging or sub-optimal treatment. Skin that has recently stopped treatment and where the acne is relapsing is often less tolerant to actives. The skin barrier may still be recovering and there might be higher background inflammation. This means that the relapse can look more severe and be harder to control.
How to Prevent Acne from Coming Back
Preventing relapse is usually not about adding something new, but about deciding what remains in place once improvement has occurred. Acne is very likely to return if there is no ongoing maintenance which can be achieved through some simple measures:
- Retinoids: Topical retinoids like tretinoin or adapalene reduce relapse by normalising follicular behaviour over time. As such they help prevent pore clogging and acne formation.
- Exfoliants: Chemical exfoliants like acids or enzymes can help reduce skin congestion and acne formation. However, use them no more than 2-3 times a week in a tolerable strength as they can cause irritation and skin barrier damage.
- Antibiotics: Oral or topical antibiotics can be effective for quickly controlling acute inflammatory acne breakouts. However, they are only for short term use and its best to avoid repeat courses if possible to reduce the risk of antibiotic resistance.
- Benzoyl Peroxide & Hypochlorous Acid: These two agents can reduce bacterial load and inflammation. Like antibiotics, they are most useful as spot treatments for active acne breakouts. Overuse of benzoyl peroxide or hypochlorous acid can cause dryness and irritation.
- Oil Control: Ingredients that absorb or modulate oil including certain clays or mattifying agents like zinc pca can help reduce acne breakouts. However, excessive oil stripping may lead to dryness and rebound oil which can worsen acne so use them mindfully.
- Hormone Blockers: In hormonally driven acne, medications like spironolactone can help reduce the impact of androgen hormones on the oil glands and hence control acne breakouts.
- Barrier Support: Ingredients like niacinamide can reduce low-grade inflammation, support skin barrier recovery and improve tolerance to strong actives like retinoids.
Acne is a chronic condition that requires long-term management. So don’t fall into the trap of thinking that acne that improves and then returns after stopping treatment is a sign of failure. It’s not. All it means is that the treatment was doing its job while it was in place and that skin requires a suitable maintenance routine that combines ongoing acne modifying treatments as well as intermittent suppressors for active flare-ups.
At City Skin Clinic, we are beyond passionate about personalised skincare. Our virtual skin clinic offers safe and effective custom acne skin treatments. Where appropriate our doctors use ingredients such as Tretinoin, Hydroquinone, Azelaic acid, Clindamycin and Spironolactone to treat skin conditions like acne, hyperpigmentation, melasma and skin ageing. Start your online consultation today. The journey towards great skin starts here.
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.
