Your skin can't become immune to benzoyl peroxide. It's impossible. Sounds like a hormonal issue perhaps. Usually by the end of menopause, most women see acne pretty much go away.

But...that could be a while, so, question: Did you say the regimen + AHA was working for you? Not sure if that's what you meant. If that was working, I would say go back to that just for a little while longer until your body calms down hormonally.

If you do decide to go back on isotretinoin, ask about low dose. That can cut down on side effects.

And lastly, have you thought about other things that might be causing it? Started using a new product, like a new sunscreen or something? Some products can wreak havoc on the skin.

6 hours ago, Cana said:

Hi everyone,

I've had acne since I was a teen and I'm now 46. I am now in peri-menopause and since that began, my acne has flared up. I have used the regimen for 12 years withgreat success, gratitude and confidence. Apart from isotretinoin, it's the only thing that has worked for mebut nowit'sstopped working and my faceis covered in large, swollen cystic acne and I really don't know what to do for the best. I added the AHA to my regimen last year when my acne began to flare as I was using the wash, the benzoyl peroxide 2.5 and a moisturiser previously. I stopped using the AHA so regularly after a few months as I was still getting painful acne cysts and spots.My dermatologist has suggested that I go back on isotretinoin again but I'd rather not. Has anyone else been in a similar situation? Can your skin become immune to the regimen?

Did the dermatologist ever run any tests to determine the underlying cause of your skin issues?Any tests for bacteria, fungus, hormones or demodex skin mites?

You may not have acne. It might be Rosacea Subtype 2 with papules and pustules. Rosacea Subtype 2 is frequently misdiagnosed as bacterial acne especially if your face isn't particularly red from the rosacea. When the usual bacterial acne treatment doesn't work it may get written off as "hormonal acne". This happened to me for decades. 4 board certified dermatologists misdiagnosed the condition as bacterial acne. The 4th one said "gee you have had this a really long time, maybe its hormonal". None of them ever ran any tests, just performed the "10 second glance exam".

A large number of people with Rosacea Subtype 2 also have Small Intestinal Bacterial Overgrowth (SIBO). Most of the human immune system is in the gut. SIBO affects the immune system allowing microscopic demodex skin mites to become severely overpopulated on the skin resulting in Rosacea Subtype 2. Everyone has a few of these mites - a healthy immune system keeps the population under control. The mites eat skin oil and possibly skin cells. The mites live on a 2 to 3 week cycle. When they die they form pustules of dead mites.The smaller Demodex Brevis species live in the oil glands and may cause deeper cysts.The cyclical behavior can sometimes lead to a hormonal acne misdiagnosis. Skin symptoms may include: large blackheads, pustules, papules, folliculitis, body acne, scalp acne, red eyes, ocular rosacea/blepharitis demodex. etc.

SIBO can treated in 1-3 weeks with the right antibiotic. The types of antibiotics used to treat bacterial acne are not the ones they give to treat SIBO. Any given antibiotic only works on a small number of types of bacteria. To clear the infection the correct antibiotic has to be used. To diagnose the bacteria causing the SIBO they do an endoscope test to collect a small sample of fluid from the intestine. The fluid is tested for bacteria and fungus. It is possible to have a fungal overgrowth (SIFO) instead of a bacterial overgrowth. So they check for fungus as well as bacteria. The doctor can then select the correct antibiotic or anti-fungal oral drug to clear the overgrowth.

Here are 2 medical studies that tested 2 different antibiotic treatments shown to clear demodex skin mites. The first study tested Oral Ivermectin alone versus using a 2 drug treatment Oral Ivermectin + Oral Metronidazole. Adding Oral Metronidazole to the treatment was far more effective than Oral Ivermectin alone. At the time of the study, the medical researchers were not certain why Oral Metronidazole helped so much. Oral Metronidazole is highly effective against 2 different bacteria known to cause SIBO. The combined treatment worked for me after having Rosacea Subtype II misdiagnosed as bacterial acne along with SIBO for decades. Oral Ivermectin and Oral Metronidazole are available as inexpensive generic drugs.

https://www.sciencedirect.com/science/article/pii/S120197121201315X

The following medical study from 2016, tested the expensive antibiotic Rifaximin on Rosacea patients confirmed to have SIBO. It worked in a large number of cases. Rifaximin is highly effective against E. Coli bacteria which is known to cause SIBO. Rifaximin does not work against all types of bacteria known to cause SIBO. That why the endoscope test results are important to select the right antibiotic for treatment.

https://www.jaad.org/article/S0190-9622(12)02330-4/fulltext

Treatment with Accutane/isotretinoin may temporarily make the skin look better as it starves the mite population down by drastically reducing the skin oil. But the mite population can rebound after the Accutane is discontinued. In the long run if SIBO is the problem, Accutane is not the answer, it only treats the symptoms not the gut issues that are causing the real problem. Accutane also has a lot of dangerous side effects making it a drug to avoid if at all possible. The following short medical study reports a patient misdiagnosed with bacterial acne and treated with Accutane. It seemed to help at first but his skin rebounded after treatment ended. Further tests showed his skin issues were caused by a demodex mite overpopulation. Treatment with Oral Ivermectin cleared his skin in 2 weeks.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5489393/

Eating a healthy well balanced diet low in sugar along with probiotics and drinking plenty of water can help keep the gut healthy.

For surface skin infections, there is a really good topical treatment option, Hypochlorous Acid (HOCL) spray to treat surface skin infections caused by bad bacteria, fungus, viruses or juvenile demodex skin mites. HOCL is a chemical produced by the human body in response to infections. HOCL is a very weak acid but a VERY strong antibacterial, antifungal, antiviral, and kills juvenile demodex skin mites. HOCL has been shown to break up biofilm on the surface of the skin.

HOCL is non-irritating but very potent killing 23 strains of bad bacteria in one study. HOCL does not kill the "good" bacteria that is a normal and healthy part of the skin's environment. Unlike Benzoyl Peroxide and retinoids, HOCL will not irritate the skin or cause peeling.

HOCL is used to sanitize hospital ICUs and operating rooms, medical and dental offices. The medical industry has used HOCL since WWI to clean battlefield wounds when they didn't have antibiotics. Tattoo artists and Piercers recommend HOCL spray to their clients to help them heal up clean.

HOCL is non-irritating to the skin and eyes. HOCL spray has no preservatives. HOCL is made by putting electrodes into salt water. There are no other ingredients but HOCL, a pinch of salt and water, so its super safe, non-irritating and highly effective. Zero safety warnings.

You can buy it on Amazon. There are numerous brands that are good including Heyedrate, Occusoft Hypochlor and BrioTech. I've used the others but currently use BrioTech since it is very affordable. Currently its $11.95 for a 4 ounce bottle. This is the same brand that the Tattoo Artists and Piercers recommend to their clients to heal without infection. Here's the Amazon link:

https://www.amazon.com/BRIOTECH-Topical-Skin-Spray-Hypochlorous/dp/B00YZDHMWW/

Dan and Elaine, thank you so much for your replies. In the UK the drs and dermatologists dont really test you for anything if you have acne. They just run the standard treatments that theyve always done. They probably wouldnt look into it unless I went private which would be really pricey.
Im going to fully look into all that you have suggested, Elaine. Thank you for your help! xxx

Good luck, Cana!

Have you tried micro Retin-A. Prescription retinol has worked very well for me. I had the same issue where benzoyl peroxide stopped working for me. I'm 52 now and retinol is my holy grail.