I don't want wrinkles and spots at the same time.
February 11, 2010 6:29 AM   Subscribe

You Are Not My Dermatologist: And you should probably be happy about that fact, because he seems to be very overworked. Questions about adult acne within.

I have an HMO. My medical group, while otherwise pretty stellar, only has one dermatologist at the moment, so I can't see anyone else. He is a friendly and jovial man, and has promised to do fix my acne, but he seems dismissive of my concerns.

He's pushing pretty hard for me to go on Accutane. I don't want to go on Accutane. The side effects are terrifying, especially the ones relating to depression and suicidal ideation He, of course, says that none of his patients have ever finished a course of Accutane and been depressed and that Accutane actually stops their depression because, yes - their acne is gone. He also says that low doses are just as effective and there are less side effects.

He has also suggested Spironolactone, which also concerns me, as it has been linked to depression and random stomach bleeding (!).

He says that I do not necessarily have a bad case of acne, just a stubborn one. And that it most likely will not get better unless we treat from the inside as well as the outside.

Except I have tried most oral antibiotics - I am sure one day when the SuperBacteria arrives I will be the first to go. I have tried nearly all of the topical antibiotics. I'm currently working my way through tropical retinoids. I've spent thousands of dollars at Sephora. I sleep on a clean towel every night. I don't touch my face except to wash it. My skin is oily and dry at the same time (and I don't mean I have combination skin, I mean that it's flaky with a sheen of oil over the top). Nothing has worked.

Last week I started Differin in the evening, and clindamycin solution in the morning. I'm currently experiencing a pretty awful initial flare-up and I'm just starting to get the awful retinoid dryness and peeling - although not nearly as bad as when I was on Retin-A.

Anyway, that's my back and current story. My questions are these:

Is he right about the Accutane? Will a low dose be effective and will there be less side effects? Has anyone else done this? Did it work for you?

Spironolactone - did you have any side effects and did it work for you?

I've checked old AskMe's and saw that a few people were happy with Differin. How long did it take to work? What can I do about the dryness besides moisturize? Moisturizers make my skin a million times more oily, even the oil free and mattifying ones.

And do you have any other suggestions? I feel like I've tried everything and I'm getting nowhere. I'm nearly 33 years old and I don't want the face of a teenager anymore.
posted by elsietheeel to Health & Fitness (41 answers total) 9 users marked this as a favorite
This is purely anecdotal, of course, but a person I was close to in high school had really bad acne. It was so severe he had acne on top of his acne on his chest to the point the sores were open and it was painful for him to shower. He took accutane for maybe three weeks as well as something else for any infection from the sores. It, too, was a low dose, and once he was done with the accutane, his bad acne was gone for good. Really. He still got normal late teenage acne (few zits here and there on a regular basis with the occasional outbreak), but he never again had such an awful case of it.

I say if you've exhausted other resources and nothing else from just washing your face with water to applying egg whites to your face to every over the counter treatment isn't working, then pursuing a prescription option like accutane may be worth it. At least for the person I knew on it, he just needed something to get rid of it for good and then it stayed gone. YMMV, though.
posted by zizzle at 6:42 AM on February 11, 2010

FWIW, my son (a teenager) just started on Accutane last week, after about a year of trying everything else. As I understand it, most insurance plans will not approve Accutane until you've tried everything else first. His dermatologist also mentioned that in all his years of practice he has never seen many of those side effects. So far, we haven't seen any real problems with dry skin, etc.

The side effect that seems to be the biggest concern is birth defects. My son had go online and certify that he understood the risks of birth defects etc, which is sort of amusing since there is zero chance of him becoming pregnant :) I probably shouldn't make light here - Accutane does lead to some horrific birth defects if a women gets pregnant while taking it.
posted by COD at 6:48 AM on February 11, 2010

My wife took Accutane. No depression or any of that, just some areas of uncomfortably dry skin.

However, it didn't totally clear up the problem, either. It worked in the short-term and perhaps produced some degree of permanent improvement, but it was not the final answer the doctors seemed sure it would be. YMMV and all that.
posted by Phanx at 6:50 AM on February 11, 2010

As always, the plural of anecdote isn't data, but... I went on accutane back in high school, and it worked like magic - it took a few months and I was pretty much acne-free aside from a few occasional outbreaks. (I can't remember what dose I was on - think it was the standard course - but the worst side-effect was some dry skin.)

That said - yes, the side-effects of accutane can be pretty gnarly. So I'd say give it a try, but keep watch for the side-effects just in case.
posted by The Shiny Thing at 6:51 AM on February 11, 2010

I have/had "stubborn" acne, as your derm puts it. Accutane is, frankly, incredible. I went on a round of it about... 7 years ago, now? and for the first 4 years after my face was absolutely perfectly clear, and for the last three I've stayed clear so long as I've maintained a 2.5% benzoyl peroxide regime. Sunscreen and moisturizer, and avoiding alcohol, are crucial while you're on it, and the initial breakout is pretty dire (if you go on Accutane, try to time the start of it for a stretch of time when you won't have any special social committments — when I started, I looked like Two-Face for a couple of weeks as first one side of my face and then the other broke out fiercely).

I tend to believe the statistics that say that acne itself is a more frequent cause of depression than Accutane, though as someone whose life was radically changed for the better[1] by the drug, I'm more than a bit biased. I suspect if there is any correlation between Accutane and suicide risk, it's of the same sort as the correlation between Prozac-type antidepressants and suicide risk: frequently people can't see how down they are until they're starting on the way up.

[1]: Like, seriously, being badly broken out made me thoroughly shy and stomped on my self-esteem, and that caused me to miss out on a lot of major life opportunities.
posted by You Can't Tip a Buick at 6:57 AM on February 11, 2010

I have been acquainted with this sort of problem via a friend of mine.

Have you ever been checked for Polycystic Ovary Syndrome (PCO)? One of the things that is worth bothering about is trying to understand the causes behind the acne. Otherwise you take the drug, and it will certainly work, but unless you stay on it forever, the problem may just return after a while.

I've seen a course of chemical peels work well, but this is also a temporary solution. In the end, whatever treatment you adopt, you need an 'exit strategy'- potentially a skin care treatment/routine that you can live with for the rest of your life.
posted by leibniz at 7:02 AM on February 11, 2010

Accutane is the way to go. I struggled with mild acne throughout my teenage years and early twenties until a course of Accutane left me with beautiful, healthy skin. Other than the occasional nosebleed in the first few weeks and dry lips throughout the treatment, I was lucky to not suffer from any of the side effects that my doctor quizzed me about every month.

I wish Accutane had been available to me when my skin first started breaking out: it would have saved me a decade of frustration and disappointment – like you, I had tried just about everything before I learned about Accutane.
posted by halogen at 7:04 AM on February 11, 2010

I answered a similar thread to this. I have had cystic acne that was so bad I was actually one of the first Accutane patients. This is gonna be long. Brace yourself.

IANYD or a D, just firsthand experience of this.

As was explained to me by my dermatologist (If anyone reading this is in New York, they should go see her she is a genius best dermo I've ever had.) Acne is most often caused by overactive sebaceous glands which means more sebum than your pores can get rid of which means bacteria which means acne.

The point of this is that Accutane works by pretty much screwing up your sebaceous glands so they don't produce much of anything. As you would expect for a drug like this, it can also screw up a lot of other things. While I am frankly suspicious of the Accutane - depression link, since so many people who are on Accutane are depressed because of their acne to begin with.

It is, however, a *serious* drug with *serious* side effects. Because of the side effects, it was originally intended only for *severe* cystic acne that leaves permanent scars when everything else fails - that is not just persistent but persistent and severe. That was my case. Accutane was an absolute freakin' wonder drug. The best treatment I ever had. I can also tell you that the scary side effects you read about, at least for me, never materialized, a bit of dry lips that was all. But w/o Accutane with my severe Acne, I would have been suicidal.

I had a second treatment at a lower dose when I was in my late thirties (still had it, yeah) and it was very effective too. I am surprised he is so insistent on it though since the side effects can be severe, especially for women of childbearing years. The risk of birth defects are so great that I believe in the US now, you are *required* to prove you are using two forms of birth control, even if you are not sexually active, (even if you are a nun, I guess.) It is called i Pledge or something. Being male I never had to deal with that.

So if you are already not on some sort of birth control pill or device, you'd have to. (Birth control pills themselves are actually sometimes pretty beneficial for women with acne, for the same reason that Spironolactone is, it inhibits the androgens (DHT) that make the sebaceous glands go into overdrive. I guess benefits if you were a man is that you might not go bald ;-)

But the literature shows that the correlation is slight, and all these horror stories you hear about drugs are sometimes just CYA amongst lawyers, so they won't get sued. I am not saying all the time, but a lot of the times.

Personally, I'd try the Spironolactone before the Accutane, but I wouldn't recoil in horror because of all the scare stories about Accutane (except for the birth defects one). Accutane should still be the drug of last resort. So you really have to ask your dermatologist why not Spironolactone.

As for Differin, frankly for stubborn acne no matter if it is not severe, topical stuff won't do much, you have to treat it systemically, and you have to treat *not* by stopping the bacteria which is impossible and might mess up your bodily flora, but stopping the sebaceous glands from being so overactive that they create a culture medium for the bacteria.


Oh and since Askme will bombard you with "alternative" diet and herbal stuff, as a 30 year sufferer who's acne scarred back is in some Dermatology medical journal, let's get the facts out there now.

With one *possible* exception, what you eat will have little difference on acne. It isn't caused by chocolate, coffee, or anything else. The one *possible* exception is a LOT of refined carbohydrates. This is because that might cause an insulin spike, which can cause your body to produce a lot of cortisol, which can cause your body to produce the DHT which will make your sebaceous glands go into overdrive. But in healthy people who can live and manage with sweets, it might not be a factor at all. And despite what the anti caffeine crowd says, you'd have to drink a TON of coffee to cause the insulin/cortisol spike. Like ten cups a day or something. Drinking lots of water is fine, makes you feel good, makes you probably not want to snack, but you know, won't do crap for your skin, really.
posted by xetere at 7:06 AM on February 11, 2010 [6 favorites]

Also, I never had the dreaded initial breakout: my skin was completely clear within a couple of weeks of starting the drug and has been ever since.
posted by halogen at 7:07 AM on February 11, 2010

For what it's worth, I went on accutane during college and had no psychological side effects at all, at least none that I could dustinguish from the pms that hits me now and then. In my experience, bc pills were so much worse, so much that I stopped those, but never thought about stopping the accutane.
posted by CrazyLemonade at 7:10 AM on February 11, 2010

Accutane will probably not make you suicidal, but it will make your eyes much, much dryer than ever before, and this effect can last long after your course of Accutane is over. This is only an issue if you have dry eyes already. I can't use Accutane because my eyes are already dry enough.

Differin is not strong enough for me, although I have dry skin. Retina-A Micro works better. The key to using Differin or Retin-A without letting it make your skin fall apart is to always let your face dry for at least twenty minutes after washing before applying the medication. Wet skin is more vulnerable. The manufacturer claims that Retin-A Micro doesn't require this drying off period, but, for people with sensitive skin, it does. Also, use it only once a week at first and only gradually increase the frequency of use. It's a terrible idea to start with daily use. Retin-A Micro is less irritating than other formulations of Retin-A; start with the weaker strength of Retin-A Micro. Use only a very gentle cleaner on your face (I like Eucerin Anti Redness). You must use some sort of non-irritating non-comedogenic moisturizer with sunscreen during the day to help with the dryness. You can also apply a night cream or other moisturizer twenty minutes after applying the Differin or Retin-A at night, but no sooner.

Clindamycin gel during the day is great, but I think the clindamycin solution may be too drying, which could be irritating. The lotion has far less alcohol and should be less drying. Don't ever switch to Akne-mycin because, while the antibiotic in it works nicely, the base causes more acne (what were they thinking of?).
posted by Ery at 7:14 AM on February 11, 2010

That came out sort of wrong, I took the accutane way before the time I was on the pill (or sexually active, so no risk on the birth defects issue.)
posted by CrazyLemonade at 7:15 AM on February 11, 2010

I can't speak to the side-effects of Accutane, since I've never taken it. However, I have been using Retin-A micro for a few years now and while it keeps my skin looking pretty clear, I have the exact same problem you do with peeling, oily skin (isn't it amazingly horrible??). The best solution I've found is this: every morning, I use a light exfoliating face wash (I think it's made by Olay) AND actually scrub my face with a washcloth, then follow up with a moisturizer. I know, I know--this goes against everything you've ever heard about best face washing practices. You shouldn't go overboard with the scrubbing, but don't be shy, either. I've found that if I skip this step, no amount of moisturizer in the world will put those skin flakes back together.

You should probably wait until your initial flare-up has subsided before you try this routine, though.
posted by Jemstar at 7:16 AM on February 11, 2010

Regarding the Spironolactone, I've been told by a dermatologist that birth control was highly suggested (required?) while using the drug due to possible birth defects specifically in male fetuses.
posted by collocation at 7:22 AM on February 11, 2010

I've never been on accutane, but I have been on: clindamyacin, oral antibiotics, differin, a prescription-strength benzoyl peroxide wash, spironolactin, and birth control. Here's my experience:

Clindamyacin - seemed to do nothing to clear up my skin

oral antibiotics - worked wonderfully but not worth the side effects in the long run

diffferin - absolutely horrible, and I tried it at two different points in my life. The "flare-up"
stage lasted two months for me, in which I still had acne but an additional angry red layer or flakey skin. I gave up on that.

face wash - seemed to do a decent job, but have started to buy it over the counter

spironolactin - awesome. awesome awesome. However, needs to be taken with birth control because it inhibits testosterone (IANAD and this is totally second-hand). I had to go off of it because it affected my potassium levels because I was taking it with ..

the pill (yaz) - this was my last resort, a few years after I went off of oral antibiotics and my skin was pretty bad. It was magic. My skin is totally clear. However, I want to go off of it because I'm not too crazy about the side effects. I'll be watching this thread.

My understanding is that it's much more effective to treat acne from the inside out. Unfortunately, this means that you've got to swallow the nasty side effects that go along with each pill. I would try out accutane.
posted by pintapicasso at 7:26 AM on February 11, 2010

And do you have any other suggestions? I feel like I've tried everything and I'm getting nowhere.

Try dandruff shampoo.

It has cleared up my acne like nothing else I tried ever did. And I didn't even have severe dandruff; but I had run out of shampoo and the only thing in the house was dandruff shampoo. I used it and my acne just went away in a few days. And it's never come back.
posted by Ziggy500 at 7:29 AM on February 11, 2010 [1 favorite]

Just as another data point, I have known someone who became suicidally depressed as a side effect of Accutane (one of my best friends in high school). She stopped taking it, but she was still glad that she tried it, because she would have always wondered if it would work for her otherwise.
posted by ocherdraco at 7:43 AM on February 11, 2010

I took Accutane. It cleared up my skin beautifully for exactly one year and then it returned to it's annoyed, congested state with the permanent bonus of being more easily irritated. I definitely had the depression with it, if your derm is minimizing that I'd be a little worried about his judgment. Ditto on the oral antibiotics - anyone who says there won't be some kind of long term effects (increased tolerance, yeast infections etc etc) is someone whose judgment I would regard with skepticism.
Starting Differin and clindamycin at the same time is likely incredibly irritating for your skin right now, with the bonus of being a little too drying. Scale back on the clindamycin, maybe every other day or so, while you are getting used to the Differin.
There's a new-ish med, zinia, that's a combo of retnoid and topical antibiotics. I have not tried it but it's the next thing on the list that I want to try. Since you are on a regimen of retinoid and antibiotics maybe it's worth looking into this one? Maybe the combo would be a little gentler on your skin.
posted by 8dot3 at 8:04 AM on February 11, 2010

Response by poster: Wow, so many responses already. Thank you so much.

leibniz: I have been checked for PCOS. I don't have it.

xetere: I don't eat a lot of refined carbs (or a lot of anything actually - gastric bypass a year ago) and I don't consume caffeine, so the alternative diet crowd can't help me there anyway. As for the birth control, my derm says he can't force me to take it, but rather I just have to pledge that I won't get pregnant while on Accutane. I'd have to go into the office once a month for blood tests and to take a pregnancy test before they'll give me the rx. Which is sort of annoying, as I'm already on one other triplicate prescription which requires office visits to pick them up. Birth control never really helped my acne.

Ery: The letting your face dry is a good tip, thank you. I've been on Retin-A micro before, it didn't do anything for my acne and made my face peel so bad I was too embarrassed to leave the house. I'll ask the MD about the gel.

Accutane users: How severe is the sun sensitivity? One of the antibiotics I was on last year made me so sensitive that any sunlight on my skin hurt, even if I'd just gone outside. And while I'm not a sun junkie, I do live in California and my main summer recreation is kayaking and gardening. I do wear a sunscreen and long sleeves and a hat, but is the Accutane going to make me miserable if I'm out in the sun?
posted by elsietheeel at 8:12 AM on February 11, 2010

I didn't have much of a sun sensitivity problem at all, but
  1. I was fanatical about always applying the highest SPF sunblock I could find whenever I even thought about going outdoors, regardless of the weather.
  2. I lived in Seattle at the time. Your Californian mileage may vary.

posted by You Can't Tip a Buick at 8:18 AM on February 11, 2010

I had moderate acne as a teenager, and the one thing that worked for me was improving my sleeping hygeine. Specifically, a fresh towel over my pillow, changed every night.

I'm not sure how much effect this would have had with genuine acne, but the combination of this and some milder treatments may be effective enough for you. I'd strongly suggest at least giving it a go.
posted by jozzas at 8:31 AM on February 11, 2010 [1 favorite]

I was on Accutane for a bit several years ago. I'd say the worst side effect was that my lips were constantly chapped and peeling. No amount of Blistex or anything really helped much. Never had any depression symptoms - I remember having some bouts of being irritable and short tempered but it was difficult to say if that had anything to do with the drug, it could just as easily have been simple stress (and annoyance that my skin wasn't clearing as fast as I wanted!)

I'd say the Accutane did clear up the "cystic" side of my acne - the big, under-skin bumps that just lingered and kept recurring. It did not clear it all up for good, though, I still get breakouts only they're far more manageable than they used to be. When I had another breakout a couple years ago I went to a new dermatologist hoping to get a scrip for Differin or something but instead he prescribed Brevoxyl, a prescription face wash with a mild amount of benzoyl peroxide in it. I was highly skeptical but in the end it worked just fine. I've since found that Neutrogena has a product "Clear Pore Cleanser/Mask" that's very similar - a mild (3%) benzoyl peroxide amount, which is less drying than the 10% products out there. And the Neutrogena product doubles as a daily face wash or a longer "mask" treatment if you want. I find it now about as effective as the prescription stuff but less expensive!

Re: your dry + oily skin at the same time. I once read someone give a tip that turned out to be true for me - my skin was not "oily skin" it was only oily in that it was actually dry skin, overproducing oil to compensate. So I started going for milder face soaps and only once a day instead of twice. That helped.

Also, you mention you sleep on a clean towel every night - I was going to suggest something like that too. This is maybe a little icky but it turned out one of the biggest issues for me was just old pillows. I've started tossing out pillows every couple years no matter what. I buy "pillow protectors" in addition to regular pillowcases or shams, and they all get washed super frequently.
posted by dnash at 8:43 AM on February 11, 2010

Accutane was the best thing I ever did for myself. I took it in college and it completely changed my complexion for the better. The dryness factor from it was the worst part - cracked bleeding lips, endless bloody noses, peeling skin that was painful at times. But it was so worth it to me for 5 months of discomfort to have years of acne-free skin.

I have been taking Spironolactone for a year for PCOS (Poly-Cystic Ovarian Syndrome) to eliminate the excess hair growth from the condition and have zero side effects from it. Bonus side effect, my skin has never looked better (the birth control pills also help I'm sure).
posted by cecic at 9:12 AM on February 11, 2010

Accutane definitely works great. One tip is to try to have the majority of your accutane treatment in the summer, as it tends to be more humid during that time of year, which will reduce the dry skin related side effects (which is most of them).

One thing about the "depression" and "suicide" side effects - I'm fairly certain there's no causal relationship between them and accutane - i.e. accutane likely does not cause these things. In fact, I've read statistics that say that the rate of suicide among teenagers on accutane is lower than the rate for those not on accutane - so while some people on accutane have committed suicide, there's no reason to believe it was because of accutane.
posted by Diplodocus at 9:13 AM on February 11, 2010

Except that, as with my friend, she was only suicidally depressed when she took it? Perhaps it's correlation and not causation, but there was certainly some connection.
posted by ocherdraco at 9:18 AM on February 11, 2010

Response by poster: 8dot3: I've been on the clindamycin for about five months. It helps in the sense that SOME of the spots go away faster, but it doesn't stop all of them, and it doesn't keep them from happening in the first place.

dnash: Benzoyl peroxide has never had an effect, no matter what concentration I used. Salicylic acid either. My face was oily and flaky even when I washed only with water, or with Cetaphil, or with the most hardcore cleanser out there. It's also flaky and oily no matter if I moisturize or I don't. Excellent thought about the old pillows though. I may head to IKEA and invest in a new set of pillows, protectors, and cases. Thank you.

Another thing my derm has suggested is light therapy three times a week. Does anyone have an experience with that?
posted by elsietheeel at 9:18 AM on February 11, 2010

I took spironolactone for years and it was the ONLY thing that ever worked for me (topical stuff, accutane, anti-bios were all tried). Well, accutane worked, but it didn't have a long-term effect. And my dermatologist never suggested that I needed to be on birth control while I was taking spironolactone. I didn't have any side effects from it and my potassium levels were always fine. I stopped taking it when I was pregnant (though no one told me I had to; I guess it's good I had a girl) and just never started taking it again after she was born. I think being pregnant and having a baby did something to my hormone levels to stabilize them now since it's been over two years since I got pregnant and I still don't think I need the spironolactone again.
posted by otherwordlyglow at 9:40 AM on February 11, 2010

Do some research of your own on Accutane. I trust my dermatologist about as much as I can for two reasons: First and foremost, he's pleased and thorough with my numerous questions. That's enough for me, usually. Second: I found him by asking the Dean of Dermatology at the local med school (Dallas) who the best dermatologist in the area was. I went there.

Anyway, aside from the fact that it's already worked at least a hundred times better than anything else I've been on here's what he told me: The studies may have been flawed from the beginning. You're talking about taking data from a group consisting mostly of teenagers with severe acne. Teenagers with severe acne miiiight be just a little more depressed than average. On top of that, we really have very little idea of why acne happens and, again, we're dealing with a population that is variable in ways that we can't know about or control for. Nevertheless,there was a push to stop using it. Dermatologists said, "no." The patent expired and there was a reformulation of the stuff. Some subsequent studies have actually show the opposite to be true; that Accutane actually alleviates depression. Again, we're talking about teenagers with severe acne going away. At any rate, if you experience unacceptable side effects, they go away in a couple of weeks once you stop taking it.

This is my experience with the stuff: It worked. Flat out. I might not need another round, even (25, male, cystic acne since I was 13 or so). I'd suffered from mild to not so mild depression off and on for about that period. Not really any more. Now, I had been making some other major changes, like my diet and exercise habits, which couldn't have hurt, but I'm sure you know that it's hard to be all that confident with disfiguring, painful sores on your face.

Give it a try.
posted by cmoj at 10:19 AM on February 11, 2010 [1 favorite]

If you have some money to burn, find a good laser-whatnot clinic and check out levulan. Summary: get drug rubbed on face, get light treatment, go home; skin peels a bit, skin clears -- including cysts. I thought it was miraculous.

I also thought Accutane was fantastic stuff. Antibiotics never did a damned thing, but Accutane works. I had no (noticeable) side effects.

I have nice skin nowadays thanks to those two fiddles, and thanks to periodically dousing myself with acid. The results from 20% salicylic acid are unrelated to the results from the salicylic acid whatnot sold in drugstores. Their glycolic stuff is worth a try, too.

Knowing what I know now about levulan and high-test acids -- I would still take Accutane again.
posted by kmennie at 10:23 AM on February 11, 2010

Also i should chime in that a lot of the Accutane depression link started when Rep. Bart Stupak of Michigan's son killed himself. He was on Accutane.

I can understand why Stupak wants to lash out and blame someone or something for transforming his good kid to a monster. I can't imagine the pain and guilt a parent feels when a teen-age child commits suicide. If I were a parent and my kid killed himself I'd do the same thing. But then again, if you are a US Congressman able to hold hearings, one family tragedy can transmogrify into a "connection." I really don't think there is.

But I still say that Accutane which was a literal godsend to me should be reserved for the very worst acne that doesn't respond to anything else.
posted by xetere at 11:15 AM on February 11, 2010 [1 favorite]

I had bad skin for years - and some of what you are describing, "oily/dry" skin as well. What saved me was:

1) Alpha-hydroxy acid products. They are a godsend - the greatest thing since toilet paper, IMO. You might want to experiment using the lower strengths first to find one that doesn't irritate your skin too much. BTW, Olay is just as good as the expensive Sephora brands.

2) More lean protein, fruits and veggies and fewer refined carbs. That's actually good for you all around. In my case, it's helping to resolve insulin resistance issues and had the nice bonus of making my skin look a lot better.

3) Clean towel over pillowcase always, hair away from face, no hands in face, wash makeup brushes after each use.

I now have really nice skin if I say so myself!
posted by Rosie M. Banks at 11:44 AM on February 11, 2010

Considering everyone is different, my own anecdotal advice might not work for you. That said, however, I know EXACTLY what you're going through - I had awful cystic acne for years. Acne started when I was in 5th grade (I remember the first pimples because I remember the biting comments made at the lunch table), never went away.

Why I think my experience is relevant here is because it sounds like your acne, like mine, is not caused by a skin-down problem, but a system-up problem, and that is why everything topical you've tried hasn't done the trick. I too tried Differin (with marginal success, but lots of skin sensitivity), antibiotics (side effects galore, no help), elaborate skincare routines (nothin'), and Accutane. In my case, my problem is clearly something in my inner system, so only two things have ever really had an affect - the Accutane, and what I do now.

I did two (two!) courses of Accutane in college. Fwiw, I had no mental side effects and never have met anyone else who has. (I took Accutane during the first trial that slammed Accutane for suicidal ideation - sounded like a classic case of placing blame, and I wouldn't be surprised if that is where this warning originated.) I did suffer from other side effects - nosebleeds, chapped lips, and my hair fell out a bit more rapidly than normal (I'm told this is very rare, lucky me). Accutane worked for me, but only for a few months after the 6 month treatments, sadly, so it clearly wasn't getting to the root of the problem.

The reason for this novel is to give you a bit of an idea of how much stuff I tried and why, to my mind, none of it worked. My epiphany moment was flipping through a dermatology book at B&N one day and reading about antiandrogenic birth control pills. The author noted that some women have a higher level of androgens in their system, which can cause acne, and a few birth control pills counter androgens. Lo and behold! I went to my gynecologist, got put on one of these pills - Yasmin, fwiw - and within a couple of months, my skin was acne-free. It was like a freaking miracle, let me tell you!

Since then I've played with going off the pill - to save money, etc - and my acne has always, always come back. I'm not fond of relying on this thing for years on end, but I'm nearly 30 and my acne refuses to abate, so antiandrogens it is for me. It's been five years now, and all I wish is that I could go back to when I was 15 and start this then - I would have had so much more confidence in high school and college without this nonsense!!

Good luck to you... acne seems like it shouldn't be such an issue, but is amazingly degrading to one's sense of self. I hope you find whatever it is that works for you.
posted by AthenaPolias at 9:19 PM on February 11, 2010

I wanted to rain a little bit on the Accutane parade here. I cannot comment on Differin or Spironolactone.

I finished up a course of Accutane for adult acne about 14 months ago (having done everything up to and including the useless Retin-A). Combined with Yasmin (and I agree with AthenaPolias on the wonders of Yaz/Yasmin), it completely cleared up my acne--until about six months ago when it came back and now it's worse than ever.

I was one of those unfortunate people who experienced severe side effects on Accutane (also, I should note that iPledge is a frustrating, time-consuming, and demeaning process, especially if you are female). I was not suicidal, my face wasn't even all that dry--but my cholestrol went through the roof. I'm talking that it went from 'acceptable' to well over six times that. My seven doctors and one nurse practitioner were monitoring me constantly (that's crazy high cholestrol, btw--CRAZY high), my blood was drawn on a weekly basis, my dose was lowered to the bare minimum, and I finished the course. Barely. See here for more details on the link between cholesterol and Accutane. And like I said, the acne's come back.

My advice is to try the Spironolactone if you're given that option. Accutane definitely reserve as a true last resort. I doubt the Differin will work, but if it does, great!
posted by librarylis at 10:31 PM on February 11, 2010

Response by poster: Update: The Differin is doing absolutely nothing for my acne, but my crows feet are now gone and the skin that's NOT broken out is soft and glowing. Hilarious. Except totally not.

I've left a message with my derm asking for a prescription for spironolactone. I'm still a bit scared of it, but I'm getting desperate.

Thank you everyone for your responses.
posted by elsietheeel at 9:09 AM on February 23, 2010

Response by poster: And now I've been on spiro for three weeks. My skin is a lot less oily, so that's an improvement. But... well. I know it takes a couple months to really show an effect. It's hard to not be impatient. I don't have many new spots, but the ones I had (lots of them) are taking forever to heal and fade. I'm lucky that I don't scar heavily, it just takes some time.

I am still using the Differin in an attempt to promote some skin cell turnover; hoping to fade the wrinkles and the hyperpigmentation. I exfoliate every other day with the Clarisonic facial brush thing (X-Mas present from wealthy aunt, not the sort of thing I'd purchase for myself). Skin is less flaky and oily, clogged pores and blackheads still a problem.

Anyway. I'll update again in a couple of months/if things clear up. Maybe someone with adult acne can get some use out of this thread.
posted by elsietheeel at 8:21 AM on March 26, 2010

Hey elsie, I saw your update and wanted to come back and comment on something that's recently worked for me (hadn't been on it long enough to comment when you first made your post).

If you eventually get frustrated with the spiro (and do give it time! and follow your doctor's advice and all that fun stuff) and are in a lull between that and deciding what works next for you, try AcneFree. Yeah, the OTC stuff from WalMart and the drug store. I promise I'm not a shill for them and I've also tried everything under the sun (including Proactiv, which did nothing of course) but for whatever reason AcneFree did work for me for the most part, as it brought things down to manageable levels. Basically, this is just something to keep in your long-term thoughts as a potential off-the-wall solution. Good luck with the spiro treatment and I hope it works for you!
posted by librarylis at 5:45 PM on April 2, 2010

Response by poster: I've tried AcneFree before, it didn't work. Thanks though. Unfortunately, nothing OTC has ever worked. Not even the ridiculously expensive stuff like Perricone MD and Dr. Brandt.

So, six months later. I was still having breakouts, but greatly diminished and my skin was definitely less oily. Still taking forever to heal.

And then this past month my skin exploded, which I am attributing to stress. This stress, which we shall call "Crappy Roommate", will be gone at the end of the month, so hopefully things will calm down.

In addition, my derm just doubled my dose of spiro. I'm now taking 50mg in the morning and 50mg at night. No side effects other than the AWESOME diuretic thing.

And finally, I started Nuvaring this week.

So if my skin clears up soon we may actually never know what fixed it in the end - less stress, less androgens, or more estrogens.
posted by elsietheeel at 11:22 PM on August 6, 2010

Response by poster: Huge cystic breakout this week with no apparent cause. Biting the bullet and asking for Accutane at my derm appointment on Tuesday.

Wish me luck.
posted by elsietheeel at 5:35 PM on September 9, 2010

Sorry to hear about the setback. I recently went back to my dermatologist to see if there was an alternative to spironolactone. It works great for me but I was tired of taking a pill every day and worried about taking something that seemed to be altering my hormones in a systemic way. The dermatologist calmed some of my fears about long-term spiro use but suggested that I try topical Sulfacetamide and see if that helped since, according to her, it's often effective for people that have acne that is hormonally driven. I've been using it for almost two months now and though the spiro does a better job, the sulfacetamide is pretty okay and I prefer something topical so I'm going to keep it up. It took over a month to see any results but it definitely helped.

But Accutane wasn't too much of a hassle and the side effects weren't unbearable. It definitely cleared my skin up, it just didn't *stay* clear for the long term. But maybe you'll do better on it.
posted by otherwordlyglow at 9:06 PM on September 9, 2010 [1 favorite]

Response by poster: I got scared, waffled, and decided against the Accutane for now. My skin and eyes are already so dry that I can't imagine making that worse. So I'll keep going with the spiro until my next dermatology appointment at the end of October and then re-evaluate.

I'm still curious about light therapy. If my insurance will cover it I think I might try that as well.

Finally, I have made a discovery that has knocked the awful cysts from last week out of the water. A hefty application of PRID Drawing Salve as soon as I get home from work, and again before bed, seems to have made them all but disappear. Normally they'd have taken weeks to either stop the painful swelling or come to a head and then another few weeks to heal (or start flaring up again). I'm impressed.

otherwordlyglow: I'll ask my MD about sulfacetamide. He might have avoided it because I have an allergy to sulfa drugs on my chart, but I have no problem with topical sulfides.
posted by elsietheeel at 9:49 AM on September 16, 2010

Response by poster: Hopefully this will be my final update.

50mgs of spironolactone twice a day, PRID salve applied as necessary, and tretinoin .50% every other day at bedtime seems to be doing the trick. The spiro has reduced the number of breakouts - I only get the big cystic ones now and it's only like two or three a month, the PRID makes them disappear in less than a week, and the tretinoin is helping the old scars and blackheads to go the hell away. My face looks much better.

Thank you again to everyone who responded!
posted by elsietheeel at 5:55 AM on November 5, 2010

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