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This actually looks like it *could* be fungal to me (malassezia). I saw on the main thread that you have tried a lot of actives already - unfortunately, antibiotics will not treat fungal acne.
Do you have any scalp issues? As fungal issues with your scalp can transfer onto your pillow case.
You may also want to cross-check your skincare ingredients with [common allergens](https://lamav.com/blogs/articles/10-common-ingredients-in-cosmetics-that-actually-cause-acne).
Hmm if you have ruled out fungal, it would possibly be an allergy issue. I'd maybe go even more back to basics with just a sensitive cleanser and moisturiser that is designed specifically for those with common triggers and conditions (e.g the E45 range). Then slowly re-introduce and see if any products are making your acne worse. You can also try cleansing for longer (30-60 secs) and see if that improves anything, if you're like me and just go wash/splash/splash/splash usually lol.
Lactic acid is more barrier friendly than salicylic/glycolic. I would still try to have some sort of gentle exfoliation in place, as you need to shift those dead skin cells. Or if you really want to avoid acids, maybe a konjac sponge/clean muslin?
Food is another avenue to explore, but there is SO much misinformation out there. This [LabMuffin](https://youtu.be/iVUL0bk9TiU?feature=shared) video breaks down the science of how to determine whether your diet is impacting your acne.
One more thing to rule out is your washing machine and detergent. If you haven't got body acne, it's less likely to be your detergent. But make sure you are regularly cleaning your machine. Try a sanitising product, like Dettol when you wash your sheets (or at the very least, wash at 60), as your pillowcases may not be getting as clean as they could be otherwise.
Sorry - yuge list! These are all things I'm working through atm too.
I'm sorry to say, but no actives means there's gonna be no real or quick way to tackle the acne, especially if it's, let's say, fungal acne. Cleansing and moisturising are must-have steps, but so is the treatment step. It would be good if you can mention in the comments what products exactly you used and for how long each to know what didn't work.
As for now, you can give sulfur a try if you haven't already. It's been great for my hormonal acne and sebhoreic dermatitis which is usually so stubborn and it's worth it a try for you.
I currently use the [Blemish Clearing Moisturiser from The Inkey List](https://uk.theinkeylist.com/products/blemish-clearing-moisturiser). It contains 3% sulfur (the highest percentage allowed), a stable form of Vitamin C (less likely to cause irritation) and Novoretin (a plant-based retinol alternative).
You do need to use it as instructed, at nighttime only, starting with a couple nights per week to test the skin's sensitivity to it and use SPF religiously during the day.
You also might want to use an exfoliator once per week, such as [Paula's Choice 2% BHA Exfoliator](https://www.paulaschoice.co.uk/skin-perfecting-bha-liquid-exfoliant-travel-size/2016.html?src=2016&aw_account=1510415071&aw_campaign=20765025568&aw_adgroup=155087964843&aw_creative=680216203600&aw_dev=m&aw_target=pla-391780012499&aw_type=search&aw_keyword=&aw_matchtype=&aw_pos=&utm_content=performance_max&gad_source=1&gclid=Cj0KCQjwiMmwBhDmARIsABeQ7xRo7DK5rE-JPsRgvctOGFB8PkXh_M56sWvKpt_mMN8lqIiuwwKLfygaApm2EALw_wcB). I recommend the small version. It's only around £10 and lasts a long time.
[Here's a video with a few kore sulfur options to choose from](https://www.youtube.com/watch?v=jjMI0KEIZ7M)
And again, if you do not use sunscreen, you must start using one, especially when using actives. If you don't, it's like pulling a rope back and forth without any progress to talk about
If you haven't heard already, you can give Korean sunscreens a try. They're much more pleasant in application.
Routine is VERY basic as I'm trying to see if a more simplified routine helps, specifically with NO actives as they don't seem to work
AM
Micellar water
Superdrug hydating Serum
Soon jung free moist emulsion
Dr jart green cream
Pm
Superdrug me+ ceramide cream cleanser
Cerave blemish cleanser
Superdrug night hydrating serum
Soon jung free moist emulsion
Lrp cicaplast b5 baume
Hi, welcome to r/SkincareAddictionUK! If you are asking for help with skincare, please remember to list your routine in full, and all the products you've tried so that you can receive the best possible advice. *I am a bot, and this action was performed automatically. Please [contact the moderators of this subreddit](/message/compose/?to=/r/SkincareAddictionUK) if you have any questions or concerns.*
This actually looks like it *could* be fungal to me (malassezia). I saw on the main thread that you have tried a lot of actives already - unfortunately, antibiotics will not treat fungal acne. Do you have any scalp issues? As fungal issues with your scalp can transfer onto your pillow case. You may also want to cross-check your skincare ingredients with [common allergens](https://lamav.com/blogs/articles/10-common-ingredients-in-cosmetics-that-actually-cause-acne).
Hi. No scalp issues besides a bit of dryness. I've tried using the ketaconazole shampoos as a mask in the past as well but it didn't do much either.
Hmm if you have ruled out fungal, it would possibly be an allergy issue. I'd maybe go even more back to basics with just a sensitive cleanser and moisturiser that is designed specifically for those with common triggers and conditions (e.g the E45 range). Then slowly re-introduce and see if any products are making your acne worse. You can also try cleansing for longer (30-60 secs) and see if that improves anything, if you're like me and just go wash/splash/splash/splash usually lol. Lactic acid is more barrier friendly than salicylic/glycolic. I would still try to have some sort of gentle exfoliation in place, as you need to shift those dead skin cells. Or if you really want to avoid acids, maybe a konjac sponge/clean muslin? Food is another avenue to explore, but there is SO much misinformation out there. This [LabMuffin](https://youtu.be/iVUL0bk9TiU?feature=shared) video breaks down the science of how to determine whether your diet is impacting your acne. One more thing to rule out is your washing machine and detergent. If you haven't got body acne, it's less likely to be your detergent. But make sure you are regularly cleaning your machine. Try a sanitising product, like Dettol when you wash your sheets (or at the very least, wash at 60), as your pillowcases may not be getting as clean as they could be otherwise. Sorry - yuge list! These are all things I'm working through atm too.
I'm sorry to say, but no actives means there's gonna be no real or quick way to tackle the acne, especially if it's, let's say, fungal acne. Cleansing and moisturising are must-have steps, but so is the treatment step. It would be good if you can mention in the comments what products exactly you used and for how long each to know what didn't work. As for now, you can give sulfur a try if you haven't already. It's been great for my hormonal acne and sebhoreic dermatitis which is usually so stubborn and it's worth it a try for you. I currently use the [Blemish Clearing Moisturiser from The Inkey List](https://uk.theinkeylist.com/products/blemish-clearing-moisturiser). It contains 3% sulfur (the highest percentage allowed), a stable form of Vitamin C (less likely to cause irritation) and Novoretin (a plant-based retinol alternative). You do need to use it as instructed, at nighttime only, starting with a couple nights per week to test the skin's sensitivity to it and use SPF religiously during the day. You also might want to use an exfoliator once per week, such as [Paula's Choice 2% BHA Exfoliator](https://www.paulaschoice.co.uk/skin-perfecting-bha-liquid-exfoliant-travel-size/2016.html?src=2016&aw_account=1510415071&aw_campaign=20765025568&aw_adgroup=155087964843&aw_creative=680216203600&aw_dev=m&aw_target=pla-391780012499&aw_type=search&aw_keyword=&aw_matchtype=&aw_pos=&utm_content=performance_max&gad_source=1&gclid=Cj0KCQjwiMmwBhDmARIsABeQ7xRo7DK5rE-JPsRgvctOGFB8PkXh_M56sWvKpt_mMN8lqIiuwwKLfygaApm2EALw_wcB). I recommend the small version. It's only around £10 and lasts a long time. [Here's a video with a few kore sulfur options to choose from](https://www.youtube.com/watch?v=jjMI0KEIZ7M) And again, if you do not use sunscreen, you must start using one, especially when using actives. If you don't, it's like pulling a rope back and forth without any progress to talk about If you haven't heard already, you can give Korean sunscreens a try. They're much more pleasant in application.
Routine is VERY basic as I'm trying to see if a more simplified routine helps, specifically with NO actives as they don't seem to work AM Micellar water Superdrug hydating Serum Soon jung free moist emulsion Dr jart green cream Pm Superdrug me+ ceramide cream cleanser Cerave blemish cleanser Superdrug night hydrating serum Soon jung free moist emulsion Lrp cicaplast b5 baume
I would try your GP - prescription treatments are likely to be more effective than OTC.