Why do I have acne and red marks despite taking medicines?

Hello,

Welcome to icliniq.com.

Thank you so much for sharing your query with me.

Thank you for trusting me with something that is clearly frustrating and emotionally draining for you. Dealing with persistent acne, redness, sensitivity, and burning or hot flushing for over a year is not easy, especially when even gentle products seem to make things worse.

Based on your description of ongoing acne, tiny and deep bumps, red marks, burning or hot flushing sensations, and intermittent itching or pain, you are having papulopustular rosacea. This pattern suggests a combination of acne with a very sensitive, inflamed skin barrier, and possibly an acne rosacea overlap. When the skin barrier is compromised, strong acne medications often worsen inflammation, which explains why your skin reacts even to minimal products like a basic wash and sunscreen.

At this stage, the most important step is calming the inflammation and repairing your skin barrier before targeting the acne aggressively. Using harsh or drying treatments while the skin is inflamed can keep the cycle going.

In rosacea, any form of retinoid and Benzoyl peroxide can be tricky. Although they are sometimes used, they often trigger rosacea flare-ups, usually in a reversible way. For now, it is best to pause strong active treatments such as Benzoyl peroxide, Tretinoin, scrubs, acids, or exfoliating toners.

Keeping your routine simple for a few weeks allows the skin to calm down and reduces flushing, burning, and irritation. During this time, avoid hot water on your face, spicy foods, alcohol, and excessive sun exposure, as these can worsen redness and heat sensations. When flushing occurs, gentle cooling measures like a cool splash of water or applying your moisturizer chilled from the refrigerator can provide relief.

For your morning and night routine, start with a gentle cleanser. Avoid harsh scrubs or using Salicylic acid daily, as frequent use can damage the skin barrier and increase sensitivity. In the morning, apply Clindamycin 1% gel in a thin layer only on active pimples, not all over the face, to control acne-causing bacteria. Follow this with a non-comedogenic moisturizer to keep your skin balanced and less reactive. Finish with a broad-spectrum sunscreen (SPF 50) every morning, even if you stay indoors, because sunlight can worsen redness and dark acne marks.

At night, after cleansing and moisturising, apply Azeane (containing 15% Azelaic acid) or Skinoren cream (containing 20 % Azelaic acid), which is safe in topical form in pregnancy. This will help with blackheads and clogged pores. Apply a pea-sized amount for the entire face on alternate nights, preferably under a light layer of moisturizer, to reduce irritation.

Firstly, apply your moisturizer and wait for five minutes. Then apply sunscreen, and after that, apply another thin layer of moisturizer to avoid any kind of irritation. This is called the sandwich method. With patience and regular use, azelaic acid helps unclog pores, reduce blackheads, prevent new acne, and give the skin a healthy glow.

Stick to this routine for a few weeks, avoid picking at your skin, and keep your makeup and skincare products oil-free, fragrance-free, and non-comedogenic. Make sure to remove makeup gently before sleeping. Keep your pillowcases and towels clean by changing them regularly, and clean your phone screen to reduce the transfer of bacteria to your face. Follow this routine for at least eight to 12 weeks to completely transform your skin.

I hope this answers your questions.

Thank you.