Hey, I know it always isn't the best thing to say, but it really does look mild, I would say her skin looks more dry and irritated rather than full blown acne. Maybe all the harsh treatments before are to blame, but her skin tone is nice and she doesn't look like she has any scars at all so once she finds a routine that works she will have lovely skin. I can only speak from personal experience what has worked for me. I have been using differin now for six months, I know it can be drying, but maybe reducing use to a few nights a week or moisturising afterwards might help. I also stopped using harsh soap cleanser and I use a cream cleanser instead and make sure to use lots of moisturiser (something nourishing that wont break you out). I have also been taking birth control, has your girlfriend tried this? Different pills work in different ways, so if she is on one maybe it is the wrong type? I would say the main thing would be switching to a skin care routine for sensitive skin, gentle products and an acne cream like differin or dans regimen only in moderation or every other night. It has taken me a good six months to really see improvement so it is important to stick to a regimen unless it is cause your skin to look worse or flare up. I hope this helps, and it's such a nice thing to do to help your girlfriend out.

Agreed, Keep working at it and do not give up. She is VERY lucky there is no scarring at all. Once she finds a routine (as hard as this seems) that clears her up all shell have to work on is some red marks leftover that heal naturally with time but can be accelerated to some extent with certain topicals. I do know how much stress it puts on a person though, trying year after year to get clear but not being able to get even half way there. Once you have scars it brings this whole new physiologically cringing aspect to the condition. What is her diet like?

Thanks for the responses. She is not on any birth control. The weird thing about the acne is that rarely come to a white head. It acts as a form of rosacea. She's going to try changing her eating habits, organic/gluten free and see if any changes take affect. I told her to stop all the products, and just get back to a normal bodily system. She was thinking about getting one of those saliva testosterone tests to see if she has some kind of imbalance.

I feel for her, but it doesn't make her embarrased as she won't even wear makeup to cover it up. She's a great girl with lots of confidence. I wish I was more like her..

Thanks again!

To me, this doesn't look like hormonal acne, more like mild irritation probably from the harsh products she has been using. She needs to balance the PH of her skin. When products dry out the skin, it means that the PH becomes too acidic. What she needs to do is find gentle balancing products that restore the skin's PH to its healthy levels (around 5.5 is optimal). Products that say "balancing" or "restoring" are usually what's needed to achieve this. Make sure she avoids SLS and other sulfates because those will just make the redness worse.

Honey masks (with pure honey, not raw though) might help, but tell her to spot treat first for a few days to see how her skin reacts. Whenever I had mild acne like hers, all it took for it to go away was stop using harsh topicals, wash my face with filtered/spring/distilled water, and use gentle products to balance my skin's PH. If she can afford to visit a qualified esthetician, that may help too. But the most important thing would be to lay off the topicals for now and give her skin a rest.

Antibiotics are a temporary fix, if that. Her acne isn't even severe enough for antibiotics - it doesn't look infected, just irritated. Infected zits usually contain a lot of greenish pus and tend to spread out more across the face.

I get mild acne on my cheeks and using a mild cleanser with no chemicals, one treatment and then a pure moisturiser (like jojoba oil) twice a day keeps things under control for me, except when I break out from my hormones (I have PCOS and high levels of testosterone). Also, make sure she doesn't pick at it as it can spread the infection.

Looks more like rosacea with the redness on her cheeks and chin. I would try Finacea cream.

I tend to agree that it looks more like rosacea than acne...especially if the papules don't "come to a head". Also, since it seems more inflamed than infected, you might focus on treatments meant to reduce inflammation. One thing that experts seem hopeful about is a very low-dose (sub-microbial) of doxycycline daily. I know antibiotics are the devil (and I seriously don't condone their long-term use) in general, but in this case, a dose of 40 mg of doxy a day decreases inflammation by mitigating the immune responses release of chemicals in your skin that cause cellular destruction (this is what inflammation is at a very simple level). The very low dose does not cause side-effects and is too low of a dose to cause any kind of resistance (it can't kill any bacteria, as such, there is no need for the bacteria to build a resistance to it). Might be worth looking in to simply lowering her dose of doxy. Also, I hear great things about Finacea cream as the above poster suggested.

Since her acne looks very mild, i would say to eat more fresh fruits and veggies and less cooked stuff. And drink "green smoothies" morning and night everyday. (Go on youtube or anywhere on the internet to find a green smoothie recipe). Also, Queen Helene Mint Julep Mask helps dry up pimples, plus try to find non-comedogenic(non-pore clogging) face products. Has worked a little for me, but my acne is way worse than hers.

I don't know exactly what rosacea looks like, but this could be it. It looks similar to acne, and it is accompanied by redness and dryness. Most likely, she has been treating it as acne, but in reality is is rosacea, which might be why she didn't get results.

If she had rosacea her doctor would have diagnosed it as such since doxycycline didnt help she needs to be on one of the broad spectrum antibiotics great for acne-like bactrim or one of many of the cephalosporins as in duricef or cephalexin etc... good luck ;