5 Signs You Need a Prescription Acne Treatment Instead of the OTC Stuff

“Acne that’s deep under the skin and doesn’t connect to the surface, feels painful, and lasts a long time is usually cystic acne, which is caused by hormonal imbalances,” says Bowe. (Other signs your acne is hormonal: It develops along your jawline or lower face and comes with your period.) The crummy news is that hormonal acne doesn’t usually respond well to topical treatments. “At that point, you’re either going to need a birth control pill or a pill like spironolactone (a prescription med commonly used to treat high blood pressure), which regulates the hormones,” says Bowe.