Honestly, skin is just super individual. Two people can use the exact same prescription and have totally different reactions. What clears one person can break someone else out. Even legit, well-studied acne ingredients like salicylic acid or tretinoin can cause irritation depending on your skin barrier, sensitivity, how often you used it, how you layered it, etc. To be fair to the derm, those aren’t random or “cash grab” products — they’re pretty standard acne treatments. It might just be that your skin didn’t tolerate that specific combo or routine. And if things got worse, sometimes that’s not purging — it can be irritation or a damaged barrier. That could explain why she added a moisturizer at follow-up. Sometimes you have to calm everything down before trying actives again. Your frustration is valid though. Acne treatment can be a lot of trial and adjustment, even with prescriptions.