Which Type of Acne is the Hardest to Treat?


Acne is one of the most common skin conditions, affecting people of all ages. However, not all acne is created equal. Some types of acne are more difficult to treat than others. So which type of acne is the hardest to treat?

Which Type of Acne is the Hardest to Treat

What Causes Acne?

Before diving into the hardest acne to treat, let's first look at what causes acne in the first place. Acne forms when dead skin cells, oil, and bacteria clog up hair follicles (pores). This leads to different types of pimples like whiteheads, blackheads, pustules, and nodules.

Several factors can trigger acne, including:

  • Hormonal changes - especially during puberty, menstruation, pregnancy, or menopause
  • Stress
  • Oily skin and hair products
  • Certain medications
  • Family history and genetics

For many people, acne is just a temporary annoyance during adolescence. But for others, acne persists well into adulthood and can be quite difficult to manage.

Which Acne is Hardest to Treat?

With that background on what causes acne, let's look at which types tend to be the most stubborn. There are a few contenders for the "hardest acne to treat" title:

Hormonal Acne

Hormonal acne is triggered by fluctuations in hormones like androgen. It often appears along the jawline, chin, and neck in adults. Women are more prone to hormonal acne outbreaks during menstruation, pregnancy, and menopause.

Since hormonal acne is an internal issue, it can be very hard to control with topical creams alone. Hormonal therapy through medications like birth control pills or spironolactone may be required to regulate androgen levels. Make sure to see a dermatologist or gynecologist to explore hormonal treatment options.

Cystic Acne

Cystic acne consists of large, painful bumps deep within the skin. It forms when acne penetrates deeper into the skin, causing severe inflammation and rupture of the hair follicles.

Cystic acne is challenging to treat because the pimples are deep-rooted and can lead to permanent scarring if not handled properly. Topical products cannot penetrate deep enough into the skin to tackle cystic acne.

Oral and injectable drugs like isotretinoin or steroid injections are often required. See a dermatologist immediately if you have severe or cystic acne. Don't try to pop or pick cystic pimples, as this will make the acne worse.

Acne Conglobata

Acne conglobata is one of the most severe forms of inflammatory acne. It features numerous interconnected pimples that form deep abscesses under the skin. It often leads to extensive scarring and disfiguration if not treated early and aggressively.

Acne conglobata is rare, affecting less than 1% of acne sufferers. But when it does occur, it can be highly resistant to treatment. Long-term antibiotic therapy, draining of abscesses, corticosteroid injections, and oral isotretinoin are often needed to control acne conglobata.

Gram-Negative Folliculitis

This type of acne is caused by colonization of gram-negative bacteria like Klebsiella, Escherichia coli, and Proteus species in hair follicles. It can result as a side effect of long-term antibiotic acne treatment, which kills off gram-positive bacteria while allowing gram-negative strains to proliferate.

Gram-negative folliculitis appears as stubborn, pus-filled bumps unresponsive to common acne therapies. Oral isotretinoin and topical azelaic acid may help, but relapses are common after treatment ends. See a dermatologist if your acne worsens while on antibiotics.

Acne Fulminans

This sudden, explosive onset of cystic acne with fever and body aches is very rare. Acne fulminans can lead to rapidly progressive scarring and damage to bones and joints if left untreated. Isotretinoin is the treatment of choice to control scarring, along with corticosteroid injections to reduce inflammation.

Key Takeaways on the Hardest Acne to Treat

  • Hormonal acne, cystic acne, and rare severe forms like acne conglobata, gram-negative folliculitis, and acne fulminans tend to be the most stubborn types of acne.
  • Topical products are often not sufficient - systemic oral and injectable medications are usually needed to treat moderate to severe acne.
  • See a dermatologist promptly if you have painful cysts or acne unresponsive to over-the-counter methods. Trying to pop or pick severe acne can worsen scarring.
  • Have patience - the hardest acne to treat often requires 3-6 months of sustained treatment to achieve clearing. Stick with your treatment regimen.

Now that you know which types of acne can be the trickiest to manage, what are some best practices for getting any form of acne under control?

Tips for Treating Stubborn Acne

No matter what form of acne you have, here are some tips to get breakouts under control:

  • See a dermatologist - don't delay if acne is severe, painful, or not improving with basic methods. A skin specialist can prescribe stronger medications.
  • Try combined therapies - attack acne with multiple mechanisms at once, like pairing topical retinoids with benzoyl peroxide.
  • Give treatments time - acne medications can take several weeks or months to work. Be patient.
  • Avoid picking/popping - this can worsen inflammation and lead to permanent scarring.
  • Watch your diet - avoid foods that spike blood sugar and androgens, like dairy and refined carbs.
  • Reduce stress - try yoga, meditation, or journaling to lower stress hormones that trigger breakouts.
  • Cleanse gently - harsh scrubs and soaps strip skin of protective oils, aggravating acne.
  • Shampoo regularly - keep hair oils and products from clogging facial pores.
  • Protect skin from sun - UV rays worsen acne inflammation and scars.

With professional treatment and diligent skin care, even the most stubborn cystic or hormonal acne can be managed for clearer, calmer skin. Don't lose hope - be patient and keep working with your dermatologist to find the right acne treatment plan for your unique skin. Consistency and commitment to the regimen is key.

Frequently Asked Questions about Hard-to-Treat Acne

To sum up, let's review answers to some common questions about tough acne cases:

What is the most common hard-to-treat acne?

Hormonal acne along the jawline and lower face is very common and challenging to treat in adults. An internal approach is needed to regulate hormones.

Does stress cause the worst acne?

Stress alone does not cause acne, but it can worsen breakouts by increasing oil production and inflammation. Managing stress is helpful but not enough alone to cure acne.

Can changing your diet clear up resistant acne?

Diet alone will not cure acne, but eating a balanced, low-glycemic diet can help improve the hormonal and inflammatory factors behind breakouts.

How long does it take to see results from acne treatment?

Most acne medications require 6-12 weeks of consistent use for full benefits. Severe acne may require months of treatment. Have patience and stick with the regimen.

Should you keep trying different products if acne won't go away?

Do not keep switching products - give each regimen time to work. See a dermatologist to prescribe you more powerful acne medications as needed.


Dealing with constant acne breakouts can be extremely frustrating. Hormonal acne, cystic pimples, and rare severe forms of acne tend to be the hardest types to get under control. Mild acne can often be managed with over-the-counter washes, creams and gels.

But moderate to severe acne usually requires prescription medications like retinoids, antibiotics, benzoyl peroxide, azelaic acid, birth control pills or spironolactone. Partner closely with a dermatologist to find the right treatment regimen and stick with it consistently for at least several months to see results.

While it may seem hopeless when acne persists despite your best efforts, keep the faith. Consistent care and targeted treatment, even for the most stubborn acne cases, can bring the clear skin you deserve. Stay Strong through the journey - relief is possible with time and care.

Frequently Asked Questions on the Most Stubborn Acne

What is hormonal acne and how do you treat it?

Hormonal acne occurs in adults, usually along the jawline and lower face. It's triggered by fluctuations in androgens like testosterone. Treatment involves regulating hormones internally with birth control pills, spironolactone, or anti-androgens. Topical retinoids and benzoyl peroxide can also help.

What causes cystic acne and how can you get rid of it?

Cystic acne forms when acne bacteria penetrate deep in the skin, causing nodules and cysts. Treatment requires prescription oral and topical medicines like isotretinoin, antibiotics, and draining of large cysts. Do not attempt to pop cystic pimples yourself.

How does acne conglobata develop and what is the treatment?

Conglobate acne starts as multiple interconnected nodules that form abscesses under the skin. Rapid treatment is needed to avoid disfiguring scars. Oral isotretinoin, antibiotics, and corticosteroid injections are used. Surgery may be required for draining abscesses.

What bacteria causes gram-negative folliculitis and how do you cure it?

Prolonged antibiotic acne treatment allows gram-negative bacteria like Klebsiella and E. coli to overgrow in follicles, causing pus-filled bumps. Oral isotretinoin and topical azelaic acid can treat it.

How does acne fulminans start and how is it treated?

This explosive onset of cystic acne is rare, causing fever and bone/joint pain. Oral isotretinoin and corticosteroid injections are used to prevent severe scarring and damage to bones and joints.

How can you avoid scarring with severe acne?

Picking and popping pimples can worsen scarring with severe acne. Seek treatment quickly with oral and topical medications to minimize scarring. Corticosteroid injections may help reduce inflammation and scarring.

What’s the best way to cover up stubborn acne?

Use a non-comedogenic concealer one shade lighter than your skin tone. Avoid thick, heavy formulas. Look for products labeled non-acnegenic or non-comedogenic so they won't clog pores more.

When should you see a dermatologist for hard-to-treat acne?

See a dermatologist promptly if you have painful cysts, acne unresponsive to over-the-counter treatment, or acne leaving scars/discoloration. A skin specialist can prescribe stronger medications.

How long does it take to see results from acne treatment?

Severe acne often needs 3-6 months of consistent treatment for full clearing. Have patience and stick with medications exactly as prescribed. Follow up regularly with your dermatologist.

What foods or diets can help treat stubborn acne?

While diet alone won’t cure acne, eating a low glycemic diet with lean protein, fruits, vegetables, and healthy fats can stabilize blood sugar and hormone levels to improve acne.

Can you get rid of acne scars from severe breakouts?

Yes, talk to your dermatologist about laser resurfacing, chemical peels, microneedling, and filler injections to reduce the appearance of acne scars. Always wear sunscreen daily to prevent scars from darkening.

What should you avoid doing when you have severe acne?

Do not pick, pop, scrub, tan, or apply irritating products to acne-prone skin. This can worsen inflammation and scarring. Shampoo regularly to keep hair oils and products from transferring to your face.

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