Help Me Deal With These Persistent Pimples!

December 24, 2012 3:30 PM

All Metafites Who Have Battled Mild/Moderate Yet Persistent Acne: What has actually helped you? In terms of diet, products, medication, or anything else? What about for the post-inflammatory hyperpigmentation (dark marks) that remain? I prefer natural remedies, but any anecdotal suggestions/advice is very appreciated.

I'm a 20 year old lady with Indian skin. I have normal to combination skin that's been very problem-free for most of my life. Since I turned 19. I've had mild acne, some milia and some bigger under the skin bumps on my cheeks. I break out once every 3 weeks or so, I usually have some zit/pimple/bump on my face. It makes me feel ugly and unappealing without makeup.

I'm unsure whether it is hormonal or not. I do notice that the less dairy and caffeine I consume, I tend to break out less. I'm practically addicted to both, however, so although I do avoid it, it's hard to stop completely.

I cover my zits with makeup, but I'm so tired of doing this--the bumps are not covered, just the discoloration. I'm also left with a dark mark EVERY TIME I get a pimple, whether I touch them or not. I don't get any pitted scarring (the skin looks/feels pretty smooth after the pimple is gone, other than the discoloration), but the hyperpigmentation is a pain to deal with, as it lasts a few months and I have to cover it all with concealer.


To deal with this, after having a bad reaction to benzoyl peroxide (due to my own anxious over-use of the product, not really due to the bp itself) I've gone mostly natural/gentle. I use clay masks with diluted apple cider vinegar, wash my face with Fresh Farmacy, a calamine and tea tree oil based cleanser from Lush, use Cetaphil moisturizer (I'm deathly afraid of using anything else, for fear that it may break me out...However, I'm unsure if Cetaphil moisturizer is helping my skin.) and exfoliate gently using a flour-mask recipe my grandma gave me.

I'm very unwilling to take birth control or any kind of medication. Even BP and the like is stretching it for me. I'd like to stay as gentle and natural as I can, and would go more natural with my moisturizer, except that I'm terrified to change my products up.

My routine's okay. But it's not doing wonders for my skin. Neither of my parents had acne...So I'm frustrated because they don't know how to help. My dad is always like "It's just natural, leave it alone" and my mom thinks I should just ride it out.

But I'm asking you: What did you do to really help your mild/moderate but persistent acne? What spot treatments do you really like to use? What habits did you change? When did your acne disappear? Did you need to change your diet? How do you deal with dark marks or any kind of scarring? What do you do to take care of your skin in general?

Thanks so very much. Sorry for the boring question! I'm frustrated with my persistent acne and I'm tired of using makeup as a crutch :(

I've attached a gross picture of one cheek where you can see how it has little dark marks and little zits all over it. That's on my other cheek as well. Please ignore my lack of sleep and makeup :)


Thanks again!

S

posted by rhythm_queen to health & fitness (45 answers total)

Whoops!!

Hmm, seems the link didn't post. Sorry! :(
posted by rhythm_queen at 3:30 PM on December 24, 2012

Accutane. It's more problematic for women, but it's very safe now. At that level, though, and especially as a female I doubt you could get a dermatologist to go with that plan. Also, you're 20. You've still got some growing to grow out of it to do.

Speaking as a male human, though, don't stress too much about it.
posted by cmoj at 3:48 PM on December 24, 2012 [2 favorites]

Oil cleansing?
posted by k8t at 3:52 PM on December 24, 2012 [1 favorite]

Go to a dermatologist. Try to find one who specializes in acne; some doctors have practices that are all laser hair removal or hair plugs or Botox. A dermatologist can help you come up with a skin-clearing regimen and help for your dark scars.

I used accutane, which was life-changing and amazing (I had pretty much zero side effects), then a few years later used topical clindamycin after I went through a period of wearing heavy stage makeup for shows.

Now I get facials for maintenance (yes, I pay a lady to pop my zits and remove gunk from blackheads; it's very glamorous. She works at my dermatologist's office, and she's a ton better than random estheticians I've had at spas.) I also change my pillowcase at least weekly, and sometimes twice a week.

(By the way, I think your skin looks perfectly okay. Not perfect, but I definitely wouldn't say, "Eek! The acne!")
posted by purpleclover at 3:54 PM on December 24, 2012 [1 favorite]

I know it is a huge bummer, but the pill is the only thing that worked for me. Around 30, 31, my skin calmed down in a hurry. Until then it was no fun.
posted by skbw at 3:55 PM on December 24, 2012

How's your diet? You already noticed dairy causes acne, but I also found generally that white flour, sugar, junk food etc. made it worse. Whole foods for every meal helped a lot.

Also, putting LESS stuff on my face helped, including washing less. I think some of it was oil glands working overtime because I was drying my face out too much.

It may also be your makeup, but I'll let someone else speak to that since I don't use makeup and never really have.

Good luck!
posted by rabbitrabbit at 3:57 PM on December 24, 2012 [1 favorite]

My acne is largely hormonal and food allergy/sensitivity related, so being on birth control and cutting out the offending foods (caffeine, dairy, processed sugar, hydrogenated/fractionated oils) has made a tremendous difference. Drinking tons of water and replenishing some missing nutrients (zinc is something I get deficient in very quickly) has also plumped up my face and helped my scars heal faster. I eat a lot of Indian food and it was only recently that I realized that if I have anything with ghee in it my acne levels sky rocket -- dunno if that's something that applies to you too. I also wash my pillowcases weekly and make sure I clean my iPhone's screen often.

Mostly though I see a noticeable shift in my skin's texture, quality, and color now that I consistently use only two product lines as my face wash, acne gel, and moisturizer:

Acnedote Face Wash & Scrub at night and in the morning, respectively
Arcona AM Acne Lotion for breakouts
Arcona Magic White Ice Moisturizer

You could also try the Arcona for Problem Skin line -- that was what really got me on the right track for my skin in the first place.

The hyper-pigmentation issue is one to bring up with a dermatologist, however -- if you have access to one, definitely go.
posted by These Birds of a Feather at 3:58 PM on December 24, 2012

Here's a thing I wish I had known, though--I had skin about like yours, troubling to me but far from objectively awful. Now, at 35, I do have scars that didn't show up then. They are not horrible scars, it wasn't horrible acne, but still, I might have complied a little better with the pill (or whatever works for you) if I had known.
posted by skbw at 3:59 PM on December 24, 2012

I had pretty serious acne when I was young and the only thing that helped me was anti-biotics. Could you use that idea and use natural products that are either anti-biotics or anti-inflammatory instead? Like garlic and fish oil? Don't be put off by fish oil thinking you don't want more oil in your body, just try it - it is a powerful anti-inflammatory.

I think mine was caused by hormones but I didn't want to take the pill.

I completely stopped eating chocolate because I felt like it made it worse. I don't really know if that helped or not.

My skin stopped breaking out at about 35.

I would persist in finding a good dermatologist if I were you. Skin is so important to one's outlook on life, IMO.
posted by cda at 4:02 PM on December 24, 2012

Besides dairy, another catagory to consider is citric acid: oranges, grapefruit, lemonade; lot of sodas also have a good amount of citric acid. At least with me, citric acid is even worse than chocolate, and I LOVE oranges and orange juice!
posted by easily confused at 4:10 PM on December 24, 2012 [1 favorite]

Salicylic acid worked very well for me. I used a toner with SA every night after washing my face. It prevented blemishes and blackheads, but didn't do anything to clear up an existing breakout. It can take 6 weeks or more to start showing results because it can take that long for a pimple to form under the skin.

Also, I found that my skin was clearer when I used a moisturizer with some oil in it. I know that's contrary to the rules of skincare, but as long as you're trying things, you might consider it. I'm over 50 now and free of pimples, but the oil cleansing method still works great to control blackheads.
posted by wryly at 4:10 PM on December 24, 2012

Thanks : )

I hadn't thought of these before! I don't drink nearly enough water everyday, even though I've tried in the past--it's hard to do so when I crave coffee, and my thirst for liquids is temporarily quenched.

I'm a vegetarian, btw: I'll have to find an alternative to fish oil...I DO eat lots of veggies and fruits (the orange thing is a bummer to read) but I also love greasy ghee-filled sweets and curries : P

I'll try to cut out the dairy, but it will be SO hard! I love it so much : P for those of you who've been able to cut out dairy...HOW? Do you drink your teas/coffee black? Can almond milk replace dairy effectively? (I love almond milk)

Was wondering, for those who have tried many product lines--what are the specific ingredients in those that seem to work for ya? Salicylic acid is indeed something I've heard about many, many times.

Thanks again! Lots to ponder. <3
posted by rhythm_queen at 4:18 PM on December 24, 2012

Next time you see your doctor, ask about a nutritional screening. It might help if you find and fix certain deficiencies.

P.S. Try not to let it stress you out. You're lovely.
posted by 2oh1 at 4:19 PM on December 24, 2012 [1 favorite]

My mom, who is also Indian, would always put lemon juice on my pimples; it worked wonders. It's a wonderful spot treatment that, if put on "potential pimples" (the red bumps that later turn into full-fledged zits), also works as a preventative. That said, if you have sensitive or dry skin, I would mix it with a bit of honey to counteract its drying effects.
posted by krakus at 4:26 PM on December 24, 2012 [1 favorite]

When I was 24, I suddenly broke out with horrible cystic acne. I went to a couple dermatologists, and tried salicyclic acid (made it much worse), antibiotics (helped by maybe 25%, which was not nearly good enough for me), and finally the pill. From day 1 on the pill, my acne stopped, and I get maybe one tiny pimple every 3 or 4 months now. I have not since had a cystic pimple. I wasn't too gung-ho about the pill but I would never go off it now if there were any chance of my skin going back to the way it was! Sorry this may not be relevant to you, but it was my experience.

I will say I had non-cystic acne as a teen and that completely cleared with antibiotic use.
posted by queens86 at 4:30 PM on December 24, 2012 [2 favorites]

I gave up dairy. That was extremely helpful.

I am also using a mild retinoid and I'm on hormonal birth control.

We live in a world that's crawling with chemicals. Acne is a medical issue, and you need to turn to modern medicine if you're serious about getting your skin under control.
posted by ablazingsaddle at 4:31 PM on December 24, 2012 [1 favorite]

Accutane gave me beautiful skin. Is not a comfortable treatment by any stretch: 5 months of regular pregnancy tests because of the horrific birth defects it can cause, painfully dry skin while on it, bloody noses from dried out mucus membranes, peeling cracked bleeding lips, bad flare ups of acne that magically come out and disappear almost overnight...


But afterwards? Gorgeous clear skin. If for some reason I was faced with the choice of going through it all over again, I would in a heartbeat.
posted by cecic at 4:41 PM on December 24, 2012

I had what is called cystic acne as a kid. It was quite disfiguring at the time, though miraculously I did not scar. I tried many things to help. Finally, after about 17 years I did accutane. If I could go back, I would have started it day one. I marred my entire social life from 14-24, suffered badly, really for no reason.

Looking backward I would gladly have paid any amount for the benefit that accutane gave me. Those are years I can never get back. Recommend you at least consider it.
posted by jcworth at 4:44 PM on December 24, 2012 [1 favorite]

I eliminated dairy about two months ago and my acne cleared up immediately. Like magic. I started gradually adding back small amounts and haven't hit the trigger point yet. I think the big triggers were probably the milk in my coffee and in my cereal. I substituted coconut milk in my coffee and used vanilla syrup and honey for sweetness while I made the transition. And I started eating toast instead of cereal.
posted by bq at 4:50 PM on December 24, 2012 [1 favorite]

You like natural remedies? I'd do oil cleansing, tea tree oil for spot treatments, and something with vitamin E in it for the scarring.

(I know it's kind of a crapshoot, though -- while overuse of BP gave you a bad reaction, I know people who've had great success with the acne.org treatment, and the foundation of that is basically CRAZY AMOUNTS OF BP.)
posted by clavicle at 5:08 PM on December 24, 2012

I use a supplement called Inositol and Choline, this has cleared me up about 90%, and I've had hormonal acne on my cheeks and jaw since my mid 20's, with hyperpigmentation/scars resulting from even mild pimples (I'm 41 now). What has helped with the hyperpigmentation is glycolic or lactic acid peels and some people recommend the intense rla oil from Pure Deming---I did not have good luck with that, and it made me break out worse. What did work for hyperpigmentation was emu oil, the peels, and also tamanu oil. I have also had good overall results in dark marks with the anti-aging light stim . I am able to make a good acne moisturizing gel out of niacinamide powder, hyaluronic acid and sea kelp bioferment mixed with distilled water in a glass bottle. The sea kelp formula seems to have changed to have a blue color since I last ordered it, so I'm not sure if it's the same formulation. Acne.org was very helpful in my quest for clearer skin. And if you want to really dig deep for more beautiful skin, these women have a lot of recipes and advice. PM me if you need any clarifications.
posted by Issithe at 5:19 PM on December 24, 2012

I tried to manage on my own, but could not. Seeing a dermatologist and getting a prescription acne cream (5% benzoyl peroxide/1% clindamycin- I'm on Duac) was the fastest, easiest thing for me.
posted by ThePinkSuperhero at 5:24 PM on December 24, 2012

Also got a Retin-A product (Tazorac) that helped with the scarring I had on my checks from it (looks like you get acne in the same place I do).
posted by ThePinkSuperhero at 5:41 PM on December 24, 2012

The only thing that has helped me is prescription medication, specifically Ziana (clindamycin/trentinoin.)

As for getting rid of dark spots, Clinique's Even Better Dark Spot Corrector worked - not cheap, unfortunately.
posted by Anima Mundi at 5:43 PM on December 24, 2012

Eliminating carbs (especially sugar) and dialing down the processed food and dairy cleared mine up and made my skin glow.
posted by schroedinger at 5:50 PM on December 24, 2012 [1 favorite]

Doing an overhaul on my diet (eliminating sugar, processed food, and dairy) for a month got my skin looking really clear after a HORRIBLE breakout right around when I turned 24. Then I stopped using cleanser (I had been on Proactiv) and started using just water to wash my face and putting honey directly on any blemishes (with the occasional baking soda rinse to exfoliate). My skin has never been happier since I stopped washing it with cleanser, and honey really works to calm whatever acne might pop up if I'm eating too much sugar or dairy.
posted by luciernaga at 7:17 PM on December 24, 2012 [1 favorite]

Something odd that worked for me was to dye my hair. Throughout high school, I always put highlights in my hair and never had a problem with acne. Once I got to college, I decided I didn't want to spend the money on my hair anymore. About a year after I stopped dying it though, I had the worst acne of my life. I tried everything, including prescription Differin (from what I've heard, this stuff is ineffective for everyone though). The acne persisted for the next year and a half until I finally broke down and had my hair done again this summer. Within 3 or 4 days, my acne was 10 times better and has stayed better for the past 6 months!

Now over the counter products like Oxy 10% benzoyl peroxide products are enough to get me through the little bit of acne I get when I have my period. I have no idea why this happens, and I've never heard this working for anyone else, but it made a huge difference for me so I thought I'd chime in.
posted by Oliva Porphyria at 7:20 PM on December 24, 2012

Here's a fun tip: sleep on a hand towel! I never wash my pillowcase often enough, and your face is on it one third of the day. I don't have enough pillowcases to switch everyday, so I use a hand towel.
posted by dobi at 7:31 PM on December 24, 2012

I'm a bit older than you, and my acne is different - like you, I always have at least one zit (and often/usually more), and tend to scar. But I get acne exclusively on my chin and around the corners of my mouth. So bear that in mind.

I started getting acne when I was 17. Tetracycline worked for a while, but I'm on other (more necessary) medications that suppress my immune system, so I just got sick all the damn time and it wasn't worth it. My acne stayed basically the same for years and years, which sucked - it was bad enough that people (old folks and kids - I work in a public library) would actually comment on it. There weren't even that many zits, but the couple I had were pretty big and hard to cover up. Benzoyl peroxide made my skin peel, salicylic acid did nothing except give me blackheads, sulfur solutions helped the zits go down faster, but didn't prevent anything. Face washes, creams, masks - they all made my skin worse.

Then a lady at Sephora (of all places) told me to just stop everything: wash my skin with water, use moisturizer. Nothing else. I was desperate, so I tried it. And it WORKED. I still can't believe it. I spend so much less money on face stuff, and while my skin still isn't perfect, it is a billion times better. Seriously. I splash my face with water in the morning and use a washcloth at night - again, just with water. I put on moisturizer (oil-free Mario Badescu - stupid expensive, but it lasts a long time and it is so wonderful) in the morning and at night. I drink a lot more water than I used to, and I am very careful to wash around my mouth after brushing my teeth or eating spicy/oily foods. I wash my pillowcase twice a week, as others have noted. Honestly I think that my overuse of acne products exacerbated the problem. I am so much happier now - and I also spend way less time on my skin than I used to.
posted by goodbyewaffles at 7:37 PM on December 24, 2012 [1 favorite]

I am 40 and still suffer from acne. I have had it since I was a teenager.

BP works for me. Proactiv and PanOxyl Bar. PanOxyl bar is just about the best thing out there in my opinion. I know it doesn't work for everybody.

I have also used a Retin-A/Clindamycin combo drug--Ziana.

Warning: Since I have been treating my acne all these years and putting harsh stuff (retinols, glycolic acid, salicylic acid, BP, antibacterial hand soaps Dial bar soap) on my face I have developed something called Gram Negative Folliculitis. People who develop Gram Negative Follicultis usually have had a history of acne. Gram Negative Folliculitis usually occurs in people who have used antibiotics long-term. I was not a long-term antibiotic user. Over the last five years I probably was prescribed antibiotics three times to treat UTI and Upper Respiratory Infection. Since I was putting the Ziana and using retinols for wrinkles, and the BP, and antibacterial soaps on my face, they killed all of the good bacteria on my face and now I suffer from folliculitis which is 100x worse than my acne. When retinols, BP and topical antibiotics are used together, they create a symbiotic effect and kill everything.

I am the person who is always coming on here and recommending all kinds of harsh stuff -- BP, salicylic acid, glycolic acid, retinols, etc. I have oily skin and felt like my skin could take anything. It can't and I have created a big problem for myself that I have battling since 2008. I recently saw my dermatologist because I had another outbreak of folliculitis that was not going away. He told me to use PanOxyl to treat the folliculitis or any acne flareup and the rest of the time use Dove Bar for Sensitive Skin. That's what I do and I am very wary to put anything else on my face. He said to avoid all liquid antibacterial soaps. BP is antibacterial, and pretty much kills everything I hear, but he said to absolutely not wash my face with antibacterial hand soaps or bar soaps.

Sorry to bore you with my story. It doesn't really pertain to you. I'm putting it out to caution others. Be careful with your skin and use the gentlest thing available to do the job.
posted by Fairchild at 7:38 PM on December 24, 2012

I would definitely try cutting down on the dairy first, since you already know it can affect your skin. I deliberately ate yogurt for breakfast almost every day for the past year, and started eating a lot of milk and cheese as well (I was trying to increase the amount of calcium and vitamin D I was getting, as well as help my digestion), and in that time, my acne and my skin in general definitely got worse.

I recently decided to try cutting out dairy almost entirely to improve my digestion (it's become apparent that it wasn't actually helping!), and my skin has also reacted really well. That is to say, it's stopped reacting to everything.

And yeah, I don't drink milk in my tea—although I never have, so I guess I'm not missing it!
posted by limeonaire at 7:42 PM on December 24, 2012

I used the regimen at acne.org and it really did wonders for my skin. I didn't even have to use it anymore and everything was great. And now it's been chaos for about 5 months. Maybe if I'd kept at it, I wouldn't be in such a bad place right now.

Here's a fun tip: sleep on a hand towel! I don't want to disagree with anyone, but I sleep on silk to prevent (further) wrinkles... and I think a hand towel would be .... less than ideal. If wrinkles are a concern.
posted by getawaysticks at 7:54 PM on December 24, 2012

Your description of your current skin care regime sounds perfect to me. As an adult, I have experienced the same level of acne you have described. It was so frustrating, particularly the dark spots. My face cleared up after I stopped using typical acne care products on it. I wash with a gentle cleanser and moisturize with Eucerin's basic facial moisturizer now and my skin has never been clearer.

I would just emphasize the importance of enough drinking water and having a clean pillow case. I started changing my pillow case weekly after someone else on Metafilter suggested and it helped so much.
posted by dchrssyr at 7:56 PM on December 24, 2012

I have to use medicine for my acne - which is worse than yours. But natural things that help me - changing my pillow case, using clean towels always, tea tree oil, not being on my period, and Neutrogena Oil-Free Deep Clean Gentle Scrub.
posted by quodlibet at 8:15 PM on December 24, 2012

I am totally nthing the recommendation for the dermatologist. It certainly can't hurt to have a professional look at it. FWIW I am a lot older then you and have noticed that acne comes and goes over the years. I really think its a hormonal thing for women. My skin colour is the same as yours and I will get scarring from acne sometimes. I stopped using soap to wash my face on the advice of my dermatologist. I use just water and very occasionally a very mild soap like Dove unscented for sensitive skin. Do you take any medications? That can sometimes affect your skin. Also is it based around your period? I do use salicylic acid as well. I prefer it to any other acne topical and have never had any problem. I am wondering if your makeup is exacerbating the problem. Is it heavy?
posted by lasamana at 8:32 PM on December 24, 2012

I had luck several years ago with the acne.org regimen mentioned by other posters, but my general laziness won out and I eventually stopped -- it just seems like a lot of effort. But for sheer "Holy crap, I don't remember the last time I got a pimple" factor, going low carb has improved my skin drastically. Now, I only get breakouts during my period.
posted by gsh at 8:35 PM on December 24, 2012 [1 favorite]

Chiming in with the giving up dairy choir! It took about three weeks for the acne to clear up. I actually can have a little dairy here and there, about the equivalent of half a cup of milk on cereal and another half cup of cream in coffee at most. If I have the occasional half-pint of ice cream or slice of pizza I'm fine. YMMV; you may find you have to give it up entirely. I often use coconut milk in coffee or on cereal, or just drink black coffee that's flavored.

I have an arsenal of backup, too: I'm female, and hormones definitely played a role in the breakouts. I started taking vitex capsules and later added DIM. Bonus: no more cramps and a more regular cycle! You can find these at your local health food store.

The other thing I do is make a tonic out of half water and half vinegar (organic apple cider vinegar and distilled water are best). I put it in a small spray bottle and spritz my face once or twice a day. Bonus: I was getting the very first inklings of rosacea...gone!

If I do get a spot, I dab clear salicylic acid gel on it, which makes it go away faster and not leave a scar. I used to have a red mark for every zit, but this regimen has cleared that all up. My skin is in great shape.

I avoid makeup like the plague, too--it can really irritate your skin. I used to cake it on too but I no longer need it.
posted by xenophile at 9:25 PM on December 24, 2012 [1 favorite]

this might sound odd but
it may be related to your shampoo.

Long story short most shampoos contain skin irritants (namely SLS and it's lovely relatives) and it may cause breakouts and just ickies.

Some time ago, I basically stopped shampooing and used baking soda and apple cider vinegar as a substitute for shampoo and conditioner. I also use a banking soda paste on my skin. I basically only get minor breakouts whenever I feel like shampooing (not very often). Around the same time I also stopped wearing make up completely, however I rarely wore it in general so, Im this may have been a contributing factor.The acne I had wasn't that bad but I had a decent amount of tiny pimples living on my face and an addition gnarly looking one somewhere too. After I stopped shampooing it cleared up within about a week. I also used to get sometimes very painful pimply bump things on my scalp and suddenly, I don't get them anymore.
posted by electriic at 10:15 PM on December 24, 2012 [1 favorite]

You are a vegetarian, if you weren't, I'd tell you to try giving up pork. It used to break me out something awful.
Some deodorants have titanium dioxide. That can break people out . Deoderant soaps as well.
For dairy, I can't deal with bovine lactose or casein. I started drinking powdered camel milk earlier this year. It's great in chai. Not that untraditional either!
I know that nomad groups in India who keep camels use camel milk in chai. Camel milk is AWFUL on coffee.
Almond milk is not great in coffee. Do not bother with hemp milk in coffee.
If your body tolerates soy, soy milk isn't bad. I would recommend trying to get PURE powdered coconut milk, and mix it with soy milk powder.
Or get some hazel-nut milk.
Hemp milk is awful. Tastes like you poured burned newspaper in your coffee.
You might consider goat milk or camel milk soap for your face. Camel milk soap has a reliable US source, Oasis Camel Dairy in Ramona CA. You can get powdered camel milk from them as well.
posted by Katjusa Roquette at 11:43 PM on December 24, 2012

All throughout high school through college through a high stress career path in tv news production, I had persistent acne that would never bloody clear no matter what changes in diet or doctor prescribed things I did. Then I got a job in private school administration where there is considerably less stress. My skin cleared up within a few months and I rarely/never get pimples now.
posted by spec80 at 2:12 AM on December 25, 2012

Accutane was a lifechanger for me. For a year or two afterwards my skin was beautiful. When I started the pill it got worse (the pill does NOT make everyone's skin better and DO NOT BELIEVE people who tell you otherwise! This is very individual), but it was never as bad as it was when I was a teenager. I had ten years or so of okay skin. Rarely great, but usually fine.

Then I got pregnant. It was like a reset back to eighth grade. If you're thinking about procreating any time in the next couple of years, don't even bother with Accutane, because pregnancy may very well destroy all the progress you've made, and the side effects can be terrible. Accutane was not fun, and I'd be pretty pissed off if I went through it all only to become pregnant and go right back to where I was before I started.

Jury's still out on whether my skin will go back to pre-Accutane or post-Accutane status once the pregnancy's through, since there are a few months left before I get there, but just wanted to warn you that women face life events that can really screw up skin progress that many of the commenters on this thread will never have to worry about.
posted by town of cats at 3:59 PM on December 25, 2012

I had acne starting at age 16, lasted almost 2 decades. I had mild to moderate success with tetracycline, bactrim, retin-a, Ortho-tricyclen, and differin gel. I had almost no success with any OTC treatment except for proactiv, which worked fairly well but did not get my skin totally clear.
Never tried accutane.
At around age 32, i started using the acne.org regimen. it worked better for me than anything else i had tried, and the products (purpose cleanser, neutropenia 2.5% bp, and oil of Olay daily moisturizer) were cheap and easy to find. within 2 weeks i had no new zits, although my skin was terribly flaky for the first week or two weeks after starting it. Eventually my skin was clear and the flakiness subsided and for the first time in ages, I felt like my skin looked good. I was able to cut down the treatments from twice a day to once a day. It continued to work until I got lazy and quit doing it. By that time, I think my acne had naturally started to decrease just due to aging and hormonal changes or whatever.

Another thing that seemed to help was following a lower carb "primal blueprint" style diet, cutting out most added sugars and dairy.

Turning 35 was probably the best thing that has happened to my skin, my acne has largely disappeared without any special diet or cleansers.

TL; DR: definitely check out acne.org, maybe try reducing sugar and dairy
posted by Teeth of the Hydra at 7:16 PM on December 25, 2012 [1 favorite]

Oh, yeah, besides the problems with citric fruit I mentioned above or cheese/dairy products, cut way back on oily foods and nuts (which contain a lot of oil), and tomatoes (very acidic). Not saying you have to cut out tomatoes entirely, just reduce how much you eat.

Wash your face with just water, no soap; plus try to cut way back on the amount of makeup you wear --- let your skin breathe!
posted by easily confused at 3:21 AM on December 26, 2012

I had what I call mildly bad cystic acne. From age 13-25 I saw a dermatologist and tried EVERYTHING under the sun.. retin-a (made my skin so red and painful), clindamycin (nothing), differin (nothing) oral antibiotics (helped but could only be on them temporarily), the pill (helped at first, then the acne returned), spironolactone (nothing, i think). There's more but I don't remember. Point is, nothing helped. Diet changes/cleaning my pillowcases/drinking water did absolutely nothing.

I finally went on accutane last year. I guess my acne was pretty stubborn because it took seven months for it to work, but my skin is now AWESOME. I never thought I could have clear skin. I wish I had gone on accutane years ago. It's just so nice not to have to worry about my complexion. It's a serious med with serious side effects but it's the only thing that worked for me, and I'm so grateful for it.
posted by pintapicasso at 4:38 PM on December 26, 2012

There's a lot of good advice here. I also found that Laser Genesis treatment helped me with the development of cysts, in addition to having redness reduction and anti-aging effects. It's pricey but I wait for my laser centre to send coupons.
posted by Deodand at 7:58 PM on December 26, 2012