Acne acne, go away

September 5, 2011 4:19 PM

I have mild to moderate acne. My dermatologist is trying to push me towards Accutane, are there any other treatments out there?

20 year old male here. I have mild acne on my face and moderate acne on my back. I have tried a few prescription medication as prescribed by my dermatologist but they haven't really done the job.

My dermatologist will constantly suggest I consider Accutane but this is not something I want to use.

I feel like there is a whole world of skin care products/methods that I am not using. I will splash my face with water in the morning and shower at night, in addition to using a topical prescription cream as needed. What else can I do? What else should I be doing?

Next appointment with my doctor is in exactly one week, I would like to have some things to discuss with him. Maybe my acne is from my diet? Or I need to try a different prescription medication? Or maybe some other behavior?

posted by anonymous to health & fitness (39 answers total)

I feel like I've posted this a hundred times on the Green, but... my acne cleared up 90% of the way during my first Whole30. I had previously tried removing just dairy from my diet to no effect. To be honest I am still not entirely sure what foods make me break out (I'm try to eat very 'scientifically' right now by re-introducing potentially acne-causing foods one at a time), but it was some combination of dairy, sugar, gluten, and preservatives/artificial additives from packaged foods. I'm sure it varies for everyone, but if you really want to have a good chance at resolving your acne I'd say just do the 30 days strictly and see what happens.
posted by telegraph at 4:26 PM on September 5, 2011 [5 favorites]

We went through every option our doctor had before we finally consented to Accutane with my 17 year old son. And now we field questions from other parents about how our son has such clear skin. It seems to me the side effects are a lot more worrisome for women than men, with the risks of birth defects if you get pregnant while on the stuff. But other than being more sensitive to the sun than normal, he didn't have any issues at all while on it.

It may be the nuclear option as our dermatologist describes, it, but it does work. If let the acne scar, you'll be stuck with the scars for life.

YMMV, of course.
posted by COD at 4:37 PM on September 5, 2011

May I ask why you do not want to use the Accutane?
posted by maryr at 4:38 PM on September 5, 2011 [1 favorite]

I've had success with beta carotene supplements. But I think you should go on accutane. Accutane works for most people.
posted by DetriusXii at 4:43 PM on September 5, 2011

I've had mild to moderate acne for my whole life. I've run the gamut of rx topicals. Honestly, if you told me that I could take accutane at 20 and dealt with this... I would have. It has never completely gone away, and now I'm in my 30s and thinking of having kids and it doesn't really make sense to do something like accutane. But man, just let him do it if he wants to. I wouldn't want to sentence anyone to a life of topicals or a very strict diet to deal with what many people get for free.
posted by ch1x0r at 4:49 PM on September 5, 2011

Wait, are you actually washing your face in the morning and before bed? With, preferably, something like salicylic acid or benzoyl peroxide. Is your dermatologist aware that you're aren't (if I'm reading "splash my face with water" correctly)? I would certainly give that a shot first.
posted by J. Wilson at 4:50 PM on September 5, 2011 [1 favorite]

Sorry for some reason COD's post made me think this was parents asking for their own son. Duh. Anyway, do it if you want to and don't feel bad about it.
posted by ch1x0r at 4:51 PM on September 5, 2011

Start eating a teaspoon of organic coconut oil every couple of days. It is the only thing that will stop me from breaking out.
posted by mleigh at 4:52 PM on September 5, 2011

Di you read the famous thread at Reddit recommending a freshly-laundered towel on your pillow every night?
posted by planetkyoto at 4:52 PM on September 5, 2011 [2 favorites]

I have suffered from acne (mostly on my chin, but sometimes elsewhere) since puberty. I learned a lot about skin care from Paula Begoun, and based on her information, I came up with a plan that works. It may be that you need a combination of products, like me. Here's my routine, that I follow in the evening after washing my face:

Sunday/Tuesday/Thursday: I apply 2% beta hydroxy acid all over my face, wait a minute or two, then apply 5% benzoyl peroxide on the chin. After a few minutes I apply a lightweight moisturizer. I used to use 1% beta hydroxy acid and 2.5% benzoyl peroxide, but it wasn't working as well as I liked, so I upped the concentration. Both of these items are over-the-counter skincare products.

Monday/Wednesday/Friday: Differin (adapalene) all over my face, then after a few minutes I apply a lightweight moisturizer. This is a prescription.

Saturday: Just a lightweight moisturizer.

Here is some info from Paula Begoun on fighting acne.
posted by LaurenIpsum at 4:54 PM on September 5, 2011

Accutane isn't permanent. And, IMHO, the side effects of dry skin, peeling lips, etc. make it not worth it.

I'd try a BP-based regime before going to Accutane unless you have cystic acne.
posted by k8t at 4:54 PM on September 5, 2011

Is there an antibiotic you could take a course of instead? There can be downsides, but this is a pretty common course of action to take to clear up mild acne.
posted by limeonaire at 5:02 PM on September 5, 2011

@k8t: The dry skin and peeling lips can be alleviated with moisturizer and lip balm. And my acne came back after a five year break. But when my acne came back, my peeling lips disappeared.
posted by DetriusXii at 5:04 PM on September 5, 2011

The thing that helped my acne clear up the fastest and has been the most consistent is drinking water. I currently drink about 6-7 glasses a day, but even drinking 4-5 a day helped clear my skin up. I also use AcneFree (benzoyl peroxide face wash, toner and moisturizing lotion with BP) which is over the counter. I keep the toner in a little spray bottle and spray it on after I've washed and dried my face, as the coolness helps to close the pores (and applying it with a cotton ball was over-using it, in my opinion). I also apply the lotion with a cotton ball rather than my fingers, and I wash my hands frequently throughout the day because I'm always touching my face. And, yeah, keeping my bath towels clean and fresh (I have a separate towel for my face, beware the BP will discolor it), and my pillow case cleaned has helped as well.
posted by sarahnade at 5:07 PM on September 5, 2011 [1 favorite]

You have to make sure you cleanse your face (not just wash it w/ water). I use this cleanser, which is amazing, but you can find one that works for you. Then I tone using this (full disclosure this is my in-laws' company). Then this for day, and this for night.

Now that works for me, but you will need to figure out what works for you. But you def. need to clean your face properly as just washing it / water won't do much. If you have any questions I can get you in contact with my sister in law who's an aesthetician or you can find a local aesthetician to ask.
posted by pyro979 at 5:26 PM on September 5, 2011

pyro979, is that advice specific to the OP's situation? Because when I cleanse my face I get acne or even eczema. When I just splash water on it, it's pretty happy. I would like to credit my healthy lifestyle or some such horseshit, but it's just genetics. For something as personal as skin, there is no correct general advice.
posted by small_ruminant at 5:33 PM on September 5, 2011 [2 favorites]

I was in your situation exactly (I'm male, your age, and have the same severity of acne), about a month ago.

After having tried everything (prescription topicals/antibiotics; every home/natural remedy you can think of), my dermatologist was ready to put me on a strong dose of Accutane. I balked -- mainly because I didn't feel my skin was bad enough to warrant some of the possible side effects (I've heard some wicked stories about hair loss; the whole depression bit really freaked me out, too).

Instead, I opted to go with a pretty heavily concentrated Retin A cream, as well as a new, stronger antibiotic. The dermatologist explained that, chemically speaking, the Retin A cream is more or less the same as Accutane, just not nearly as intense. Honestly, so far it's the best topical I've ever been on -- it doesn't stain/bleach anything, and you only use it at night.

Yeah, it will make your skin look terrible--and I mean really quite terrible--for several weeks. After that, though, things should improve. Definitely check it out.
posted by lobbyist at 5:35 PM on September 5, 2011 [1 favorite]

I had mild to moderate acne growing up, and I still fight it at 24. I've found that eating well, getting exercise, and using this all natural cleanser work well for me. I even shave using their soap instead of using shaving cream. Stress is another factor, but that's hard to control. I've tried Differin, Benzoyl Peroxide, Salicylic Acid, Antibiotics, etc. Never went on Accutane because I was afraid of the side effects. I just didn't think it was worth it. You might see a specialist to see if you have a food allergy to something like dairy or gluten as well.
posted by uncannyslacks at 5:38 PM on September 5, 2011

Sorry to keep the anecdata rolling in, but for me the number one determinant seems to be amount of sleep. Being underslept always gives me more acne.
posted by threeants at 5:44 PM on September 5, 2011

Just piling on the "this may work for you" stuff just in case it helps you or others-

I was travelling, and my friends had well water which, while drinkable, had sodium in it which made it taste funny. Anyway, I found that my acne cleared up really well while using it, so now I'm back home and on city water, I'm trialling washing my face in salt water to cure the acne.

(I'm also female and find my hormonal cycle causes the acne to get bad- I'm told that men have a hormonal cycle too (just not the periods) so perhaps this happens for you too?)
posted by titanium_geek at 6:02 PM on September 5, 2011

I will splash my face with water in the morning and shower at night, in addition to using a topical prescription cream as needed.

This is not right, in my experience. You should thoroughly clean your face in the morning (with a light, natural soap, ideally, but your mileage will vary. I don't like the commercial soaps; they feel too "stripping" to me). You should also clean your face before applying any creams.

As anecdata: I was on Accutane for a while. It was a little intense, so I can understand the reservations, but BOY did it work wonders. I wish I'd done it years before; I have lots of scarring because I waited so long to use it. That being said, it's a very personal choice. (And THAT being said, there's a reason your dermatologist keeps bring it up.)

But yes, there are more things you can use. (For some people, a nice course of antibiotics gives them a leg up for a while.) And of course much newer things. Second opinion time! Go find a nice fancy dermatologist. It's worth it to treat yourself right; I wish I'd understood about things like "health care" and been more of an advocate for myself when I was younger.
posted by RJ Reynolds at 6:03 PM on September 5, 2011

When I was 24 I had some major acne and tried tetracycline, Retin-A, and had a reaction to Benzoyl Peroxide. None was successful for my case ... everything I tried was just a temporary Band-Aid. I know you do not prefer to use Accutane, but it changed my life! I endured the dryness and redness for a few months and then it eventually all cleared up. I probably didn't have a single pimple for over 3 years after that! What a self-esteem booster! Now it's been quite a number of years since then, but I simply treat my occasional acne with salicylic acid and it keeps things in check for the most part. I know Accutane has some pretty hefty warning that go with, so you must do what you think is best for you, but I just wanted to let you know that I had a successful course of treatment with it with no other side effects besides topical - which cleared up nicely!
posted by LilBit at 6:11 PM on September 5, 2011 [1 favorite]

I had bad acne as a teen and young adult, and I tried pretty much everything at the time -- Retin-A, Cleocin, Tetracycline, a bunch of other antibiotics, a bunch of OTC and home things like Stridex, Noxzema, Hydrogen Peroxide, masks, scrubs, rubbing alcohol, etc. for years Ultimately, Accutane was what did it for me, and after I stopped taking it both the acne and the horrible side effects were gone forever.
posted by Gator at 6:11 PM on September 5, 2011 [1 favorite]

My skin has vastly improved using Retin A and Duac. My dermatologist started out with those two and an oral antibiotic, but I'm now off the antibiotic. I'm female, and I still sometimes have hormonal related breakouts, but those are much smaller in scope than what I've had before. Unlike lobbyist's experience upthread, it didn't make my skin look terrible before it got better, but as with all drugs, experiences differ wildly.
posted by JustKeepSwimming at 6:19 PM on September 5, 2011

I had mild acne as a teen I was prescribed Tetracycline and washed my face with plain old Ivory soap. After trying a lot of different things that was the combination that worked for me. Years later I still use Ivroy soap for my face.
posted by jmsta at 6:28 PM on September 5, 2011

Oil Cleansing Method. Google it...you'll see. MANY friends of mine who have battled acne for years LOVE IT!!! I'm lucky to not have major issues but my skin is amazing since I started it. It just makes sense. Don't strip your skin. Do some research on OCM and try. You'll be pleased...and it's cheap!!
posted by pearlybob at 6:28 PM on September 5, 2011

I took Accutane at about 17 years old and it's something I still regret taking. I had hair loss, sore and irritated eyes, depression and stiff back pain. It was simply not worth it. Feel free to message me if you want more info.

I'd never heard of the Oil Cleansing Method pearlybob mentioned, but my experience is similar - only by using moisturizers on my face (typically after shaving) did my acne calm down. I still get a pimple once in a while, but nothing like I had when I was using Clearasil to dry my skin into a flaking, irritated mess.
posted by letitrain at 6:42 PM on September 5, 2011

I used to have unbelievably brutal acne, of a form called cystic acne. Did all kinds of stuff to try to ameilorate it, nothing really worked. It slowed down when I hit my mid 20s, but still came up quite often. Pretty sure it was stress related, but probably exacerbated. Then, I heard about Accutane. Pretty much cured me for life. Oh, if I could only have back those years as a freakishly disfigured adolescent.

Respect to whatever your decision is, but for me it would have been lifechanging to not be so outside the norm during such a formative time. Miraculously, I have almost no scarring, very fortunate.
posted by jcworth at 6:44 PM on September 5, 2011

Isotretinoin (accutane) is great.

I had weird cystic acne for years and did the Isotretinoin thing last year finally. It works. The worst part is chapped lips, but it's not nearly as bad as it's made out to be. I was on it for a little over five months and I have zero acne now for over a year.

I had no other side effects.
posted by jeff-o-matic at 6:48 PM on September 5, 2011

I also learned a lot from reading Paula Begoun's book (thanks AskMe!), and I cleared up my mild to moderate acne in my early 30's. I stopped using harsh acne formula cleansers, and started using Cetaphil and salicylic acid. It cleared up pretty quickly.

Another data point - once my acne cleared up, I discovered anecdotally that almonds make me break out. Who knew? I'm not prone to any other food allergies/sensitivities, that I know of.
posted by vignettist at 6:59 PM on September 5, 2011

I did a course of Accutane in my early 20s and it was annoying pretty much only because I am female: for gals, you're required to jump through all sorts of bizarre hoops to ensure that you don't get pregnant and prove that you're taking that seriously. My dermatologist recommended that every time I take my Accutane pill, I also take a Vitamin E supplement -- genius! I experienced almost none of the dry skin side effects reported.

Besides dry skin, there are basically no other side effects to worry about. I resisted Accutane for a long time because it felt like a big deal to do it. It's not. It is, as a doctor friend once explained to me, one of the only medications that exists that absolutely, completely destroys the disease it targets, forever, and doesn't take anything else down with it. It's considered a medical miracle.
posted by firstbest at 7:00 PM on September 5, 2011 [1 favorite]

Accutane may not be permanent. I used to have cystic acne, and I'm not going to attempt to list all of the medications, treatments, towel tricks, soaps, talismans, and snake oils I tried. I finally asked the dean of dermatology at the local med school by email who the best dermatologist in the area was, and he was nice enough to give me a short list. I picked the closest one to me and decided I'd do whatever he said.

I should mention about my medication history that I had tried Accutane when i was about 14, and not far from the time my depression set in. That scared me off off trying Accutane again for a long time, but I started to figure, hey, I was 14 and had severe acne. It'd be astonishing if I weren't depressed. On top of that my dermatologist told me that this is the very reason that the original studies were flawed. Not only that, but they'd reformulated it since then, and later studies have shown the opposite - that Accutane tends to improve depression. For obvious reasons.

Anyway, he put me on it. It worked. This was about two years ago and it hasn't come back, Yes, my skin was super dry, but that was it. I was on a very high dosage. I was even under standing orders from the doc that I should stop immediately should any depressive symptoms emerge at all, or anything else I couldn't live with and we'd try something else.

It's the dermatologist. He listened to my concerns (that I voiced to him, which is key), and was flexible. The point is, Accutane can definitely work. The literature is unambiguous about that. And it can work without depression, or going bald, or your dick falling off. If only I'd tried it again ten years ago.
posted by cmoj at 7:00 PM on September 5, 2011

I had acne up until about my late 20's. I still get the occasional blemish. What worked for me? Proactive! Yep. I used it religiously for about 7 years. Eventually I grew out of my acne. Here's what I've heard about accutane. 1. It can work extremely well. 2. It's not permanent. 3. The side effects can be bad. There's no danger in trying proactive. I would strongly recommend trying it before going on accutane. Worst case scenario is that it doesn't work. I loved it though. It changed my life.
posted by ljs30 at 7:29 PM on September 5, 2011

Someone at my gym told me that she'd got rid of her 'bacne' by using Head & Shoulders as a body wash - the one containing selenium in the dark blue bottle.
posted by essexjan at 3:33 AM on September 6, 2011

Whatever you do, just don't do accutane. I had a friend of a friend who went on it and got severely depressed on it. It works for some people, but could have very, very harmful effects on others. This article from MSNBC is from a few years back, but this is when they were first finding out about the harmful effects. Article MSNBC
posted by melizabeth at 4:50 AM on September 6, 2011

What kind of skin do you have? What kind of acne do you get?

I do something like the Oil Cleansing Method above but with just olive oil (need to get castor/etc, but keep forgetting at the store) - when my skin starts to freak out, it really helps calm it and prevent breakouts.
posted by bookdragoness at 7:40 AM on September 6, 2011

I used Accutane and I think it's a miracle drug. I wish I had started it sooner.
posted by 2bucksplus at 9:23 AM on September 6, 2011 [1 favorite]

Consider a reliable, trustworthy dermatologist who will consider/offer a range of services including laser or chemical peels and pharmaceutical-grade topical products, i.e., Obagi. Unretouched 'before' and 'after' photos are particularly inspiring. I'd try any/all of this stuff before taking Accutane--that stuff is harsh.
posted by 4midori at 11:03 AM on September 6, 2011

"I took Accutane at about 17 years old and it's something I still regret taking."
"Whatever you do, just don't do accutane."
...
"I used Accutane and I think it's a miracle drug."

I'm with 2bucksplus. Taking Accutane is the best thing I've ever done. Of course, I was 14 with cystic acne at the time. It sucked for a few months, but it cleared me up semi-permanently (at 30 I started breaking out again) and now I just take minocycline daily.
posted by coolguymichael at 12:12 PM on September 6, 2011