October 22, 2004

10:14 PM

Adult acne & combination skin: have any MeFites won the battle over persistent & social-anxiety-creating skin problems? Want to share your secrets?
posted by anonymous to (24 comments total)

I had bad acne through my teens and into my early 20s and it kind of mellowed out around age 25 or so, but it didn't go completely away.

Then last year I started using Kiehl's cleansers everyday. This face wash, once a day before I go to sleep completely ended acne's 20 year reign on my face. It's basically an acne wash, with an astringent in it. I also use this other basic cleanser in the morning when I shower. It's a much mellower version of the above (just a nice face soap) and keeps your skin clean and fresh.

I've been using the basic cleanser for about a year, and that blue one for only about three months, but my skin has been clear ever since I added the blue stuff to my routine (I used to wash my face morning and before I sleep with the basic cleanser). It's kind of expensive (I think they're like ten bucks for a small bottle that will last a few months), but totally worth it. At least, it worked for my oily skin.

As for combo skin, I also started using skin toners and moisturizer on my non-oily parts, but only occasionally, as it seems to make my face super duper oily at night. When I apply in the morning everything's great, but by nightfall you could light a lamp off my face's oil. But no more acne for me, and I wished I found this cleanser stuff years ago.
posted by mathowie at 10:25 PM on October 22, 2004

social-anxiety-creating skin problems?

Perhaps you might have it backwards. I know a couple of people who have anxiety-caused acne. Increased stress in their day-to-day life manifested itself as persistent acne in particularly locations (e.g. - just their chin, just their forehead).

The solution for them was either change their lifestyle to better cope with stress or try and avoid it altogether. For the ones that couldn't do this, Accutane was the only solution that worked. Accutane is some pretty heavy shit, however, and if you decide to go this route you must consult with a doctor. It can cause birth defects just by talking about it!
posted by Civil_Disobedient at 10:34 PM on October 22, 2004

I used a bunch of different things throughout my teens and early-to-mid 20's - topical and oral antibiotics, salicylic acid, benzoyl peroxide, tretinoin, various OTC washes. None of it made too much difference. After all that I also tried Accutane and the problem went almost completely away. No side effects that I could discern besides dry skin during the treatment course.
posted by shoos at 10:41 PM on October 22, 2004

Mr. anonymous writes further:

I'm a 29 year old male and I started having mild breakouts at age 19. During college, my skin gradually became worse, assuming a greasier complexion and larger pores. By the time I was 24 I was experiencing cystic acne which was treated over the next few years with every drug & topical on the market. I got an inexplicable 6-month reprieve when I was 27, but went right back to breaking out, sometimes very heavily. I started skipping work on those days. I stopped making plans with friends without realizing why I was doing it. I went from work straight home every day and often even screened my calls.

Two summers ago, I realized how unsocial I was becoming. I didn't like to see people during the daytime. I became very sensitive about looking women in the eye. I starting going to two separate dermatologists so I could get two powerful prescriptions (accutane & minocycline). I took matter into my own hands, taking twice the recommended amounts, and gave myself symptomatic hepatitis. Luckily I recovered with little liver damage (just psychological damage), but the experience shook me up. I became even more withdrawn.

Summers have been hard because sweat glands create more bacteria, but winters are hard too because I'm one of those lucky combination-skin people. I'll use Retin-A and my skin becomes tight. I'll go out to lunch and bite into a sandwich, stretching my facial muscles, and when I look in the mirror afterward, my face is a mess of peeling dry skin. So I eat lunch alone in front of my computer.

For the past year I've taken two Bactrim per day + Retin-A, and things improved for awhile. But in the past few months I feel like I'm headed back down that road: new breakouts, suddenly camera-shy, not feeling myself. I was never vain before. In my early 20s, I was social and considered quite attractive. Most days now, I feel like a leper. I hate that this is happening to me, and it doesn't help that my hair is thinning, too, with help from the Accutane treatments--has anyone experienced this?

In any case, I'd be glad to hear from people who've experienced these things as an adult and what treatments finally worked for them. Man you can't get much more cliche than this--a depressed websurfer posting to a forum about his skin problems!

Thanks guys...
posted by mathowie at 11:13 PM on October 22, 2004

Crap. Well, I would say whenever health problems turn one anti-social it's time to maybe consider seeing a shrink. Seriously, I think talking to a psychologist would help you out of your shell and hopefully feel better.
posted by mathowie at 11:16 PM on October 22, 2004

Yow, that truly sucked to read. I really feel bad for the guy.

Only thing I can think of, and I really do mean this seriously, is spending time in the ocean. Not a lake or a pool but the ocean. Its better and the salt will help dry out the skin.
posted by fenriq at 11:48 PM on October 22, 2004

The summer before last I spent a lot of time with a girl I was becoming good friends with and we were also lightly exploring dating. She was very attractive but had developed a fairly substantial acne problem which made her highly self conscious. It was in fact a bit of a blight on her beauty but when it came down to it I wasn't seeing her because she had perfect skin and it really didn't put any drag on our relationship at all.

This isn't to say that I don't think trying to clear things up isn't a good idea: it is. But open up to some people who are your friends about it. Chances are they'll tell you they still like you fine.
posted by weston at 11:52 PM on October 22, 2004

Queen Helene Masque, Mint Julep
St. Ives Medicated Apricot Scrub for Oily or Acne Prone Skin

Both of these products help me. You can use the scrub everyday if you want, and the mask once a week, or so.
posted by sadie01221975 at 11:53 PM on October 22, 2004

Did you try taking the Accutane at a normal dosage for a perscribed period of time, or did you double things up right off the bat? While it does "cure" acne in lots of cases (it did for me) I understand it's an incredibly harsh medication.

I'm thinking that the heavy dose may have been counterproductive - not unlike some antidepressants, if you take more than you're supposed to, you end up feeling terrible. Further, I recall receiving warnings that Accutane can actually make things worse for a time before your skin starts to clear up.

I'd go to the dermatologist again, explain your previous abuse of the medication, and ask if going on it once more - at the prescribed dosage - is possible. Give it another shot and, perhaps more importantly, give it time.

If things are still looking bleak, you've no choice but to simply live with it and perhaps take comfort in the thought that it will probably go away of it's own accord eventually. This is easier said than done, of course.

Good luck! Remember that the inner man is far more important than the outer.
posted by aladfar at 12:06 AM on October 23, 2004

Please do not despair. Educate yourself about the different dermatology therapies available. Laser treatments in particular have become incredibly advanced. It doesn't always help with active acne -- at least not as a stand-alone treatment -- but the results for reducing scarring are consistently good when you are treated by a skilled doctor.

At the linked site above, you can locate a board-certified dermatologist in your area. Make sure to also read the material on psychological impacts. You aren't alone in your feelings.

You may not be a good candidate for drug therapy, but there are so many physical therapies out there -- dermabrasion, chemical peels, lasers -- that you can really believe the AAD's statement that "today, virtually every case of acne can be resolved." Hang in and get help. I wish you well.
posted by melissa may at 12:25 AM on October 23, 2004

This may get me labelled as a crackpot, but sulfur soap was recommended to me by a naturopath, and it's helped my skin substantially for the past few years. Before that, I was prescribed anti-acne antibiotics, and Differin - the sulfur soap has better effect, no side effects, and costs a lot less.
posted by vers at 5:10 AM on October 23, 2004

It would be great if you could find a really good dermatologist, someone who really knows their shit and who you trust, and then just resolve to follow whatever routine they put you on (consistently and correctly) for six months and see what happens.

A lot of the prescription acne drugs out there take a while to start working. Some even cause an initial flare-up where any acne that was "brewing" comes to the surface. Be patient though, and if you haven't seen results after faithfully following the routine to the letter, you can go back to the dermatologist and see if there might be something else they can prescribe for you.

Just because there are 101 acne products lining the drugstore shelves doesn't mean a person needs to try them all before resorting to prescription medications.

The routine that's working for me is washing with Cetaphil and using Differin gel. It took around 2 months before seeing any improvement, and six months before my skin was completely clear. If I stop using it, I break out again.

I'm sorry you're having to go through this. I, too, didn't get acne until my twenties, and I know how embarrassed and unattractive it can make you feel.
posted by bonheur at 7:49 AM on October 23, 2004

Definitely go see one *great* dermatologist, bare all of your past attempts, and follow their recommendation to the letter. Overdosing on various powerful acne medication (or any medication!) is not only potentially dangerous (as you discovered), but also very counter-productive. As others have mentioned, these things take time, and giving up on one before it has a chance to work is like yo-yo dieting. Combining this with a self-esteem booster (counseling, books, meditation, sports team, yoga whatever floats your boat) will get you back into physical and emotional health in good time. One thing that worked for someone I know was volunteering to walk dogs - she got exercise (always a mood enhancer), practice interacting with other people on a regular basis who were happy to have her there, and unconditional love from the dogs. It was a win-win situation for everyone.
posted by fionab at 9:17 AM on October 23, 2004

I've been up and down with acne problems for years - pretty much all of my 20's. (I'm 35 now). A few years ago it was even bad enough I finally had to go on Accutane, which did clear it up. For a while I used clindamycin and Differin after that, but it didn't always keep the problem away consistently.

Sometime this summer I read something about omega-3 fatty acids being good for skin problems, and flax seed oil as a good source (if you don't eat much fish). So I started taking a tablespoon of flax seed oil daily (often mixed in protein/fruit smoothies in the mornings). I also started taking vitamin A supplements in addition to my usual multi-vitamin. And my skin really cleared up quite well. I don't use any prescription stuff anymore. I wash twice a day with Johnsons' Clean & Clear face wash - about twice a week I use Zirh's "Scrub" instead. Also I try not to drink much Coke or sugary sodas. This all seems to work really well - when I do get breakouts now, they're small surface ones that go away quickly, instead of the big bad cystic ones I used to get.

A couple of caveats on the supplements I mentioned, though. You can have side effects from too much Vitamin A. Currently I'm not taking the extra Vitamin A anymore and seem ok without it now - I was taking one 10,000 IU capsule ("50% acetate, 50% beta-carotene") a day. You don't want to take any more than that. Also, my dad (who's very into vitamins and reads up on stuff like this all the time) told me there have been some studies that link taking flax seed oil to increased risk of prostate cancer in men, but that men seem to be able to use ground flax seeds instead without that risk. I haven't tried that yet but will when I use up the oil I already have.
posted by dnash at 10:35 AM on October 23, 2004

I just wish to point out that Roxane's not bothered by Cyrano's nose.
he is.
posted by matteo at 10:40 AM on October 23, 2004

Just pop 'em all. I know from personal experience that chicks dig acne scars.
posted by jonmc at 3:17 PM on October 23, 2004

I had bad acne in my college days, and despite that they're using infomercials to market themselves, Proactiv actually worked really well and got rid of my acne when no other solution that I tried did.
posted by gyc at 3:48 PM on October 23, 2004

I am in my mid forties and was still having some breakouts. What helped me was exercise. Not sure if it was the regular sweating or the burning off of funky stress hormones, but it worked.
posted by konolia at 5:48 PM on October 23, 2004

See a dermatologist.

But also:

Take a look at your diet, and make sure it's balanced and healthy.

Make sure you're hydrated.

Don't smoke.

Exercise.

If none of that seems to affect your issues, and a dermatologist is no help, see if you can get a referral to an endocrinologist.

Incidentally, while I never found anything to actually cure my teenage acne, I found as an adult that using less hardcore products made a huge difference. Go figure.
posted by padraigin at 10:19 PM on October 23, 2004

My second dermatologist put me on Septra (sulfamethoxazole and trimethoprim) which works pretty well for me. Seems unusual in that acne isn't mentioned in its description, but it's the first thing that's really worked for me. (I didn't try accutane.) I think it's a different class of antibiotic, so it might work even if minocycline didn't.
posted by callmejay at 1:39 AM on October 24, 2004

Also, I wash my face immediately after every time I sweat, even a little.
posted by callmejay at 1:42 AM on October 24, 2004

Here is another vote for Accutane at a normal dose if a doctor thinks your liver can handle it. Worked absolute wonders for me with no side effects other than tight skin and cracked lips. I LOVE my dermatologist - if you happen to live in the San Francisco bay area - Dr. Leslie Hilger in Alameda is the perfect amount of aggressive when it comes to clearing up acne. Good luck.
posted by Wolfie at 9:28 AM on October 24, 2004

When I was in my late teens, this regimen made all the difference. Sounds fanatical, but really, once you have the stuff in place, it's simpler than using 3 step toner-washer-moisturizer regimens and actually costs quite a bit less.

-Wash face with a dollop of Stridex face wash in the pump (liquid to foam) in the morning. I have really oily skin too, and this stuff is very refreshing and dries it appropriately, especially in the summer. Then, either right after that if you don't shower in the morning or then after showering, a greaseless moisturizer (this one's girly, but L'oreal's jarred moisturizer, at about six bucks a pop, is best I find). If you happen to have a couple really big trouble spots on that given dat, then apply the Body Shop's tea tree oil blemish stick to those spots. It is wise to do the followup moisturizing and blemish stick thing right after your shower/wash your face, when your pores are open. The moisturizer will keep the Stridex from drying your face TOO much. Trust me, even with the greasiest skin, you need to rebalance with the right kind of moisture after washing it. It's just a matter of getting a nongreasy brand.
-Wash your face at night with something less astringent. I second the recommendation above for St Ives apricot scrub for oily skin. Then, apply Retin A (you need a prescription, but with any health care coverage the stuff should be ridiculously cheap--like, the same price, around five or six bucks, that you'd pay for an otc tube of acne spot cream, and the Retin A will last much, much longer). In the morning, wash it off in your morning routine.

When you wash, make sure you rinse completely. If you leave residue of the stuff on your skin (it's prone to collect at the hairline and around the jaw line/neck), you're leaving what it collected--the dirt and oil--as well, thus causing more acne. Use either a fresh-from-the-closet towel to dry your face or one you only use to dry your just washed face. Don't be too rough when you dry your face--pat it until it's dry, don't rub it in straight lines etc.

Retin A basically speeds up the natural skin sloughing process, and as a result you need to be extra careful about sun damage. Use a nongreasy facial sunscreen when you go out.

Keep your hair away from your face. And, if you condition your hair in the shower, keep the conditioner off your face or make sure to rinse it thoroughly off before you get out of the shower.

Change your pillowcases regularly, especially if you know you sleep with your face directly on them. Also try to keep your hands off your face--it sounds stupid, you probably don't fidget with your face that much :) but it's the little things sometimes. So, just in case you do--remind yourself not to. If you wear glasses or a hat, keep them clean.

Same idea with greasy food or cooking splatters--avoid getting any on your face, and when it happens, remove it as best you can.

Get enough sleep and fresh air. Relax and unwind--stress can aggravate skin problems.

I can't say much about the shaving regimen thing, as I am a girl. But I bet one that's sensitive to your skin needs is also in order, if not already in place.

I also agree you might want to talk to someone about the social phobia aspect. Skin problems should not keep you from enjoying your life--you deserve to be happy and social either way. I'm sorry if this sounds patronizing, I really don't intend that. I know it sucked when I felt too awkward and ugly to be seen. Try to take mathowie's advice to heart.
posted by ifjuly at 10:03 AM on October 24, 2004

You've already tried Accutane, but I'll chime in as a counterpoint to the Accutane success stories for other people in the same situation that might read this. I had several side effects, including serious depression and substantial hair loss. From reading the details you provided, my acne was not as severe as yours, but it was cystic and left scars. I took Accutane as a last resort, mostly because I didn't want to have lifelong scars. I really wish I hadn't. It did make my acne more manageable, but I would never want to introduce such a body- and mind-altering powerful drug into my body ever again.
posted by letitrain at 6:34 PM on October 24, 2004