If You Have Acne, It's Likely Not Because Of Anything You’re Doing Or Not Doing

I’ve been dealing with acne for nearly 30 years. My skin lies somewhere in the middle of the acne spectrum, between the more severe acne cases — the painful, inflamed, cystic kind — and the milder kind that consists of a small breakout coinciding with a person’s menstrual cycle. My acne is the kind of acne that you can’t help but notice but also doesn’t quite make you think, “Oh, yikes.”

Basically, my acne is the type that makes clear-skinned people want to recommend their skincare regimen to me.

I appreciate the help. I’ve accepted it, and tried it all. I’ve diligently adhered to the skincare regimens of my perfect-skinned friends, attempting to replicate whatever it is they do to achieve their spotless, glowing perfection.

I’ve tried washes with salicylic acid and gentle, “nothing added” washes. I’ve used every over-the-counter topical cream you can think of. I’ve used benzoyl peroxide treatments (helped clear my skin but dried it out so badly that it gave me wrinkles). I’ve let my skin “purge,” because with some products, supposedly “your skin will get worse before it gets better.” I’ve drank all the water. I’ve cut out dairy. And gluten. And sugar. One at a time, and all three at once. I’ve only ever used gentle, noncomedogenic moisturizers. I’ve used, and continue to use, expensive serums with hyaluronic acid.

I’ve given them all a chance. I’ve tried everything but Accutane.

Nevertheless, apart from a few months during each of my pregnancies and a period of time when I was on hormonal birth control, I have always had at least a few pimples on my face. Occasionally, my breakouts do get so bad that they could draw a “yikes.” I have images saved on my phone that make me cringe to look at them.

Currently, my acne is tenuously controlled thanks to two prescription topical medications — Aczone and tretinoin (Retin-A). I still deal with nearly constant breakouts, though less so than when I don’t use these medications, and my pimples at least are not raised and inflamed. A year ago, when I had a change in insurance and had to ration my prescriptions because I couldn’t get to the dermatologist, my acne came back with a vengeance.

I came across this video on TikTok a few weeks ago though, and felt validated about my skin in a way I never have.

As you can see in Dr. Chouake’s stitch above, for folks dealing with acne, we get down on ourselves and convince ourselves we’re doing something “wrong.” Our fresh-faced friends really want to help, and they really believe they have the answer. After all, their skin is dewy and blemish-free. Why wouldn’t my skin react to the same regimen that works for them? It’s all skin, right?

The thing is, when these regimens help a little — but only a little — it’s hard not to assume that the reason they don’t work great is that we’re doing something wrong. We’re missing something. As Dr. Chouake states, though, this simply is not the case. “Acne is an inflammatory disease of the skin,” he says. “And it’s not your fault. It’s nothing that you’re doing.”

This is exactly what I needed to hear, and maybe it’s what you need to hear, too.

Lately, when clear-skinned people coach me about how to clear my skin, I get the same feeling I get when someone who had an easy time breastfeeding tells me what I should have done differently to have kept up my supply, or when someone with a neurotypical child tells me how I should discipline my ADHD kid, or when a lean person with a naturally high metabolism tells me what I need to do to lose weight. If you’re not personally dealing with it, or if you’re not a dermatologist, you just can’t know.

Add that feeling of “doing something wrong” to the layers of guilt for being “superficial” for caring in the first place. Fuck beauty standards! I love my skin, acne and all! I’m supposed to just accept that I have angry red marks interrupting the contours of my face. Or I’m supposed to remind myself that there are so many worse problems a person could have. Props to anyone who is able to accept their acne and honestly not be bothered by it. More power to you, for real.

Personally, though, I hate my acne. I do tell myself there are worse problems to have, and I know that is objectively true, but I still hate it. It’s just such a stupid thing to have to deal with. Like why can’t my skin just quit being a fucking asshole?

What I am finally starting to accept is, my skincare routine is not the problem. I simply have acne. My skin is fundamentally different from the skin of people who don’t have acne. My sister can sleep in her makeup and not get a single pimple, and I can engage in a twice daily 20-minute skincare routine that includes various serums and prescription medications and yet always, always have at least 10 pimples on my face.

Also, it’s totally valid for me to want to have clear skin. It’s valid for me to want my skin to be just … my skin, without a bunch of red, irritated marks disrupting its surface. I’m allowed to want that, dammit.

Lately I’ve been looking into doing a course of isotretinoin (formerly known as Accutane). It’s a serious medication with intense, sometimes permanent side effects. It’s also the only thing I haven’t tried yet, and for most people it is a complete cure for acne — as in, their acne never comes back.

I would love to know what it’s like to have clear skin. I would love to know what it’s like not to be constantly dealing with red marks all over my face.

So, if you have stubborn acne and want to get rid of it, I want to tell you two things: 1) It’s not your fault. And 2) Go see a dermatologist.

You have acne, and it’s likely not because of anything you did or didn’t do. Your clear-skinned friends’ expensive serums are awesome but almost certainly will not totally clear your skin. Your skin is fundamentally different from theirs. You need an expert’s help. And you’re allowed to ask for it.