Era Acne Vulgaris

October 14, 2011 8:15 AM

How do I handle hormonal acne as an adult, after going off birth control?

Due to questionable blood pressure issues, I went off birth control several months ago. Since then, I've dealt with horrible periods, but worse (in my opinion) is the onset of acne.

Because I was on birth control from age 16 until 23, I never really dealt with teenage acne. I definitely had my share until then, but luckily have had relatively clear skin for years. Two months after going off birth control, it's been active again.

I have a section of my jaw that consistently breaks out- and I have been diligent about cleaning phone surfaces and pillowcases, washing my face with gentle cleansers, using topical benzoyl peroxide. I have to be careful about my choice of products, because I also have eczema on my face and body.

My dermatologist suggested spironolactone but I am naturally a little concerned about jumping into a pill treatment- I would love to go back on birth control for many reasons but am worried about blood pressure issues. I considered progestin-only options, but hear they not only aren't recommended for acne treatment, they may worsen it.

Have you dealt with adult hormonal acne? What treatments helped for you? I realize experiences are individual, but would love insight regardless- and I can always use them to bring up other options to my doctor.

This has really been killing my self-esteem, coupled with the eczema flare-ups and my generalized anxiety.

Hope me!

posted by rachaelfaith to health & fitness (23 answers total)

When over-the-counter benzoyl peroxide wasn't doing the trick for me, my dermatologist prescribed Benzaclin and Tazorac.
posted by ThePinkSuperhero at 8:26 AM on October 14, 2011

I definitely needed gentler products as an adult than I did as a teen, and a lot of the acne skin care products have higher concentrations of active ingredients than an adult really needs. I have better luck with salicylic products than benzoyl peroxide, which helps clear the blemishes but just wrecks the skin around them (BP worked fine for me as a teen).

I use Mario Badescu's skin cleanser and some of the associated products (the drying lotion is terrific) and even though they're higher priced, they're so worth it to me. You can get samples through the website, each is enough to get a feel for whether it will work for you before you invest in them. There's a skin questionnaire that will help you figure out what will work with your eczema, or you can call and speak to an expert.
posted by padraigin at 8:28 AM on October 14, 2011

My teenage/young adult dermatologist (also my mom's derm for many years with much the same advice) was kind of low-intervention, especially on that jaw area. The first thing he'd want to know was if it responded to plain old over-the-counter 1% or 2% hydrocortisone. If it did, well, there you go - and stop touching it with your filthy hands, and come back if it came right back. If it didn't work we'd end up with various little sample tubes of topical ointments. 20 years later, that's the first thing I try.

But if it recurred over and over in the same place like it sounds like yours does, a round of antibiotics might be necessary to break the cycle.

One of the joys of aging, especially during times of hormonal turmoil, is the appearance of weird, misbehaving facial hair! Are you getting ingrown hairs? Your doctor ought to recognize it if you are, but it might be worth specifically asking him. Using acne treatments in that case might be counter-productive.
posted by Lyn Never at 8:31 AM on October 14, 2011

Spironolactone was great for me. I was on it for maybe six months over two years ago and now barely ever break out. No side effects, either. The derm also prescribed a mild medicated face moisturizer that I still use - I can look up the name when I get home tonight if you're interested.
posted by kyla at 8:35 AM on October 14, 2011 [1 favorite]

My adult acne (coupled with sensitive skin and eczema) has cleared up almost entirely after I started washing twice a day with Cetaphil (specifically this bar and using this lotion afterwards). It made a huge difference almost immediately and cleaned me up after a bad turn with oil-cleansing (ugh).

I recommend going over and reading some of the advice at acne.org. They are not shilling anything specific over there, and it was their good advice (via AskMe, of course) that led me to Cetaphil. I love that it works, but I equally love that it is cheap, lasts forever, and is available at drugstores. I wish I'd found these products years ago.

When I get a little lazy and don't wash every morning and night with it, I start to get minor pimples, especially at the turn of the seasons (this time of year and March/April) when I really get greasy. But then I know it's working. I also take some vitamin A, which I swear helps, but YMMV.
posted by aabbbiee at 8:49 AM on October 14, 2011 [4 favorites]

I opted to go the prescription medication route because nothing OTC/Natural was working and my acne was actually painful (cystic). This started back when I was a teenager. When I'm on birth control, it will mostly clear up.
I recently went off my birth control and had a painful outbreak and took antibiotics. I used to take them when I was a teenager for my acne issues - long term use with no side effects. But most doctors don't like prescribing them for long-term use anymore. Anyway, the antibiotics killed my initial breakout and I started Benzaclin and wash with cetaphil.

If it's not really that bad, you may want to start with OTC and natural products if you're worried about taking prescriptions. Tee tree oil, apple cider vinegar clay masks, etc.
posted by KogeLiz at 8:55 AM on October 14, 2011

I went off of birth control and spironalactone at the same time about six months ago, and my acne flared up big time. I didn't really change my routine (wearing only mineral powder foundation, washing twice a day with Olay gentle foaming cleanser, followed by Aveeno moisturizer, with OTC topical acne cream overnight occasionally), and after several months, my face is pretty much clear (knock on wood). I think it might have just taken a few months for my skin to adjust.
posted by Safiya at 8:55 AM on October 14, 2011

This is probably really vain, but I'm supposed to fly out to meet my boyfriend's family around Christmas, so I'm kind of desperate to find a treatment that works (at least partially) by then. I know it's a lot of trial and error, and I know waiting it out might work, but there you have it.

As for what I do now, I wash and moisturize with Cetaphil. I also use a prescription moisturizer called Mimyx, and occasionally use corticosteroids for eczema flareups. I have some tea tree oil and am also interested in natural approaches- but would they work on hormonal acne?
posted by rachaelfaith at 9:07 AM on October 14, 2011

I alternate between foamy benzoyl products and sulfur soap. Sulfur soap can be tricky to find (it's available online, or sometimes the Hispanic or 'ethnic products' section in the store will have it for cheap) and like all acne treatments may not work. I found out when I developed eczema that it is occasionally recommended for that as well, so I started using it on my affected areas to no detriment and possible improvement. (Hard to tell since I started an aggressive moisturizing routine at the same time.)
posted by cobaltnine at 9:23 AM on October 14, 2011

I went off birth control about 2 months ago too and had bad acne flare ups. I started using a Neutrogena 3-step process that I got at the grocery store and it has helped tremendously. I still get acne around my period, but it has tapered off quite a bit. Have you considered Proactiv? I hear that is a god-send.
posted by ThaBombShelterSmith at 9:28 AM on October 14, 2011

I've had great results with spironolactone, but it did take nearly a year for things to be perfect. And I've had a couple little spots here and there since I switched from Nuvaring to the minipill.
posted by elsietheeel at 9:40 AM on October 14, 2011

How bad is your blood pressure? I had some issues and put a pillow under the end of my mattress to slightly raise my feet when I slept. Darned if that didn't lower my blood pressure.

Of course I may just be trivializing your problems, but what about approaching it from that angle instead - lowering your blood pressure so you can go back on the BCP?

Anyway I don't blame you for feeling like this, you can call yourself "vain" but I have never ever felt good when my own face was infected. I mean, it is a skin infection, that's just inherently not fun even though it's not life-threatening and even though superior adults just get sooooo much enjoyment out of sneering at it as a "teenage" issue. So, I would encourage you to keep pursuing a solution and f*ck the haters.

I would also encourage you to follow your dermatologist's advice because acne is a really stubborn disease. Throw eczema into the mix and it's really tricky.

One suggestion I'd make, if it doesn't make your eczema worse: in the morning, after washing, apply Cetaphil Daily Advance Ultra Hydrating Lotion, or the Mimyx since it was prescribed to you, and let it sink in for 10 minutes.

Then, apply 2.5% benzoyl peroxide (it's hard to find but PanOxyl does it) so that you have the least amount of irritating ingredients (though PanOxyl does contain alcohol, eh, what can you do). Leave it to bind to your skin for 30 minutes. No-one will tell you this, but unless you leave a treatment of any kind on for at least 30 minutes, it probably won't work. Once I knew this, benzoyl peroxide started making a major difference.

After the 30 minutes, you can apply more moisturizer, leave it for 10 minutes (or as prescribed) and carry on.

Apply the benzoyl peroxide at night as well, same routine.

See if that improves matters after 2 months. It probably will help at least a bit, because benzoyl peroxide really does work. It might just be one piece of the puzzle though.

Good luck.
posted by tel3path at 9:48 AM on October 14, 2011

Are you using regular Cetaphil (i.e. "Daily Facial Cleanser") or the gentle skin version? In my travails (very similar to yours), several people have told me that the gentle skin version is much better at not stripping the moisture. Target has a generic, which works well for me.
posted by Madamina at 9:57 AM on October 14, 2011

I have really struggled with hormonal acne over the past few years and here's what finally worked: prescription Benzaclin, as ThePinkSuperhero mentioned, and a three-month prescription of Minocycline, which is a broad-spectrum antibiotic. I seriously, seriously, seriously tried everything else, including at least $1000 in over the counter washes/potions/creams. The Benzaclin and Minocycline together made a big difference in under a month.

I totally sympathize with you. Good luck!
posted by kate blank at 10:02 AM on October 14, 2011

Epiduo worked for me.
posted by amro at 10:11 AM on October 14, 2011

Thanks, all. I am definitely going to seek out some new products- of everything mentioned, the sulfur soap actually intrigues me a lot, because it seems like it's meant to work on eczema too. It also has great reviews on Makeupalley.

I have a lot to talk to my dermatologist about.

tel3path, I never really found out for sure IF I even had high BP because I never got a reliable reading. Even after monitoring it on my own for a month, I'd get wigged out and stressed when slipping on the cuff. I have also lost 20 lbs and worked out more often, so I would think it's lower, but who knows. Perhaps I will be able to go back on BC eventually- but I'm armed with lots of options to try in the meantime!
posted by rachaelfaith at 10:49 AM on October 14, 2011

I did spiro for hormonally motivated acne for a few years and had to go off it because of an unrelated illness. I've used Differin (adapalene) topical with great success. It takes some weeks to show its benefit, but until Christmas would be enough time.
posted by jocelmeow at 11:38 AM on October 14, 2011

Just one section of your jaw? You are almost definitely sleeping with your hand, wrist, or arm against your face. Or possibly just resting your face on your hand a lot while you're awake. If so, stop the prolonged skin on skin contact and it will clear up right away.
posted by serena15221 at 12:11 PM on October 14, 2011 [1 favorite]

Benzoyl Peroxide. More the better.
posted by Snorlax at 7:04 PM on October 14, 2011

Benzac, adequate sleep, zinc supplement
posted by lifethatihavenotlivedyet at 5:44 AM on October 15, 2011

I have to disagree with serena15221. Your acne is most likely hormonal, as is mine. Mine occurs mainly on one side of my lower chin, and usually nowhere else. I had tried every over-the-counter solution (Cetaphil, Neutrogena, Proactive, etc, etc), and when I finally went to the dermatologist it was almost a relief to hear her say that it's just a genetic, hormonal thing that almost 30% of women in their late 20's to early 30's experience.

She prescribed me a pretty strong antibiotic (doxycycline) to clear up the infection (it had gotten pretty bad), and then once it settled down a bit put me on Spironolactone, with Epiduo and Duoc as topical treatments as needed. I was on the Spiro for almost 8 months, and it did wonders for my face, and the Epiduo seemed to keep the few spots that did appear from staying around too long.

I'm now off of Spironolactone since I've discontinued my birth control, so now I'm on Oracia, which is a low dose antibiotic to keep things calm and quiet.

Hope this helps!
posted by elisebeth at 12:50 PM on October 17, 2011

Update: Have been diligent about using the Cetaphil Sensitive Skin Cleanser in addition to my Mimyx moisturizer, and applying prescription topical Acanya (clindamycin and benzoyl peroxide) and have seen pretty much no change. At the very least, the Acanya hasn't aggravated my eczema in the meantime, which is a small blessing.

I may give the spironolactone a shot.
posted by rachaelfaith at 5:55 AM on November 8, 2011

Last update, promise: Took my skin a while to get used to being off hormones, and it's a lot better now. I still break out around my period, but otherwise it's not as bad as it was when I wrote this question.
posted by rachaelfaith at 9:00 AM on January 11, 2012