Caring for angry facial skin
February 6, 2024 1:25 PM Subscribe
I took some prescribed topical medication for acne and things did not go well. Now my skin is very upset and reactive. How should I treat it until I can see my doctor again?
To start things off: Please no advice around treating acne. No drug recs, no homeopathic remedies, no acne-reducing routine suggestions. Thanks!
I was prescribed Winlevi by a dermatologist last month - it's a new drug that reduces androgens in the skin (imagine a topical Spironolactone). I was advised to stay on it for 3 months to give it a chance to work. It does not cause purging. Unfortunately once I started using the cream, my acne immediately increased in severity, and 4 weeks later I'm dealing with horrible, huge clusters of cystic lesions. I have a mass of about 12 on my chin, and clusters of 3 or 4 on other parts of my face, including areas that have never been affected by acne before. I normally have 3-4 cystic pimples total. Nothing approaching this level of severity.
I stopped using the cream on Saturday, but things haven't calmed down much. I was ignoring the constant burning/stinging/crawling sensations because that's a common side effect of Winlevi, but on closer inspection it seems that some of the cysts might actually be blisters and that's what's so uncomfortable. I also have a couple of small scabs that don't seem to be acne at all.
My concern now is babying my skin as much as possible to reduce any further damage. I already know I'm going to have a lot of scars once this all heals. Does it seem like a good idea to take Benedryl or another allergy med if some of these things are blisters? I wash my face twice a day with Spectro sensitive and moisturize with La Roche-Posay's Toleriane Creme (no fragrance or actives). Should I add another moisturizer? Winlevi turned my face into a shocking ball of grease, if that matters. I also use prescribed azelaic acid (15%), but have been applying it sparingly and avoiding the inflamed areas of my face. I'm nervous about stopping it entirely because the last thing I need is more cysts.
I see my GP on Monday, but it's for another matter so we may not be able to discuss my face until I can get another appointment. I can't see the derm for another few months. Is this in a pharmacist's wheelhouse maybe?
To start things off: Please no advice around treating acne. No drug recs, no homeopathic remedies, no acne-reducing routine suggestions. Thanks!
I was prescribed Winlevi by a dermatologist last month - it's a new drug that reduces androgens in the skin (imagine a topical Spironolactone). I was advised to stay on it for 3 months to give it a chance to work. It does not cause purging. Unfortunately once I started using the cream, my acne immediately increased in severity, and 4 weeks later I'm dealing with horrible, huge clusters of cystic lesions. I have a mass of about 12 on my chin, and clusters of 3 or 4 on other parts of my face, including areas that have never been affected by acne before. I normally have 3-4 cystic pimples total. Nothing approaching this level of severity.
I stopped using the cream on Saturday, but things haven't calmed down much. I was ignoring the constant burning/stinging/crawling sensations because that's a common side effect of Winlevi, but on closer inspection it seems that some of the cysts might actually be blisters and that's what's so uncomfortable. I also have a couple of small scabs that don't seem to be acne at all.
My concern now is babying my skin as much as possible to reduce any further damage. I already know I'm going to have a lot of scars once this all heals. Does it seem like a good idea to take Benedryl or another allergy med if some of these things are blisters? I wash my face twice a day with Spectro sensitive and moisturize with La Roche-Posay's Toleriane Creme (no fragrance or actives). Should I add another moisturizer? Winlevi turned my face into a shocking ball of grease, if that matters. I also use prescribed azelaic acid (15%), but have been applying it sparingly and avoiding the inflamed areas of my face. I'm nervous about stopping it entirely because the last thing I need is more cysts.
I see my GP on Monday, but it's for another matter so we may not be able to discuss my face until I can get another appointment. I can't see the derm for another few months. Is this in a pharmacist's wheelhouse maybe?
Response by poster: Derm wouldn't talk to me without an appointment.
posted by Stoof at 1:38 PM on February 6, 2024
posted by Stoof at 1:38 PM on February 6, 2024
For something this painful that requires real treatment, I would try an online dermatologist like Sky MD if your derm won’t help you. Obviously, you’ll have to decide if the cost is worth it and there are doctors licensed for your area, but I have had good luck with them. If they don’t have anyone, there may be other online services who can help. This sounds like it really does need a professional’s input. I’m so sorry this is happening to you!
posted by corey flood at 1:45 PM on February 6, 2024 [1 favorite]
posted by corey flood at 1:45 PM on February 6, 2024 [1 favorite]
I would call the derm's office back and say "I am having a severe adverse topical reaction to the drug I was prescribed and I need medical advice."
I'm sorry this happened, it sounds so painful. I really like the hydrocolloid acne patches that are so prevalent these days, whatever healing they may or may not do aside, they keep the angry skin spots clean and protected and that makes me feel much better.
posted by phunniemee at 1:50 PM on February 6, 2024 [24 favorites]
I'm sorry this happened, it sounds so painful. I really like the hydrocolloid acne patches that are so prevalent these days, whatever healing they may or may not do aside, they keep the angry skin spots clean and protected and that makes me feel much better.
posted by phunniemee at 1:50 PM on February 6, 2024 [24 favorites]
Your doctor is responsible for managing a severe reaction to the treatment he prescribed. A few months is not acceptable. Use phunniemee's suggested language.
I do also think that a Benedryl or Claritin or similar is a good idea and will do no harm. Maybe a good dose of Advil as well.
posted by HotToddy at 1:54 PM on February 6, 2024 [6 favorites]
I do also think that a Benedryl or Claritin or similar is a good idea and will do no harm. Maybe a good dose of Advil as well.
posted by HotToddy at 1:54 PM on February 6, 2024 [6 favorites]
A lot of acne treatments make things worse before they make things better - that was certainly the case for me, my skin was the worst it's even been at the point you're at now. I'm gonna buck the comment trend and encourage you to keep going, give your prescribed regimen the full 12 weeks.
posted by ThePinkSuperhero at 3:12 PM on February 6, 2024
posted by ThePinkSuperhero at 3:12 PM on February 6, 2024
I had a really bad dermatological flare that was probably seasonal but could have been a reaction to a medication. When my derm said she couldn't see me for 2 months, I booked a next day online appointment with my PCP practice and saw a doctor - not my doctor - who looked at my flare, said "yeah that's pretty bad but urgent care is terrible at dermatology things" and put me in as a STAT referral to a well-regarded dermatological practice in my area who called me 2 hours later to schedule a next day appointment. That derm was great. Maybe you can do something like this?
I have now fired my previous derm because she was too overbooked to keep a reasonable quality of care.
posted by A Blue Moon at 3:13 PM on February 6, 2024 [9 favorites]
I have now fired my previous derm because she was too overbooked to keep a reasonable quality of care.
posted by A Blue Moon at 3:13 PM on February 6, 2024 [9 favorites]
Like others have said, make sure you talk to your dermatologist about this reaction.
In the meantime be gentle gentle gentle. I had pustules on pustules from a bad rosacea flare a few years ago. It was like my cheeks were inflamed and the pustules were weepy. What I did was use CeraVe Hydrating Cleanser and CeraVe Moisturizing Cream making sure not to rub any reactive places too hard (friction is the enemy). I eliminated anything else in my skin care routine. I also cleansed with cool water and used cool compresses whenever I could to help ease the inflammation. It was massively uncomfortable and I found those things all helped ease that discomfort.
I also took an antihistamine, desloratadine (aka Aerius). Most things I've read say to avoid Benadryl completely these days in favour of newer second-gen antihistamines. So Aerius, Claritin, etc. But I'm not sure if it actually did anything.
Once things got less reactive I added a niacinamide serum and witch hazel toner. But I'm not sure how much those matter either. They felt nice.
I don't think in this case the specific products matter as much as being super gentle, eliminating all but cleansing and moisturizing, and just keeping things clean, cool, and moisturized. Almost like wound care. Maybe even reduce your cleansing to once per day. It took me a fair few months of up and downs to get things under control. YMMV because I also didn't have a clear cause of my flare up, and you seem to have clear cause for yours.
I've never been to a derm because I don't have access to one. But if you can get into yours sooner rather than later that's the best course of action. But you're right that a pharmacist may be able to offer advice. It doesn't hurt to ask.
posted by eekernohan at 3:18 PM on February 6, 2024 [1 favorite]
In the meantime be gentle gentle gentle. I had pustules on pustules from a bad rosacea flare a few years ago. It was like my cheeks were inflamed and the pustules were weepy. What I did was use CeraVe Hydrating Cleanser and CeraVe Moisturizing Cream making sure not to rub any reactive places too hard (friction is the enemy). I eliminated anything else in my skin care routine. I also cleansed with cool water and used cool compresses whenever I could to help ease the inflammation. It was massively uncomfortable and I found those things all helped ease that discomfort.
I also took an antihistamine, desloratadine (aka Aerius). Most things I've read say to avoid Benadryl completely these days in favour of newer second-gen antihistamines. So Aerius, Claritin, etc. But I'm not sure if it actually did anything.
Once things got less reactive I added a niacinamide serum and witch hazel toner. But I'm not sure how much those matter either. They felt nice.
I don't think in this case the specific products matter as much as being super gentle, eliminating all but cleansing and moisturizing, and just keeping things clean, cool, and moisturized. Almost like wound care. Maybe even reduce your cleansing to once per day. It took me a fair few months of up and downs to get things under control. YMMV because I also didn't have a clear cause of my flare up, and you seem to have clear cause for yours.
I've never been to a derm because I don't have access to one. But if you can get into yours sooner rather than later that's the best course of action. But you're right that a pharmacist may be able to offer advice. It doesn't hurt to ask.
posted by eekernohan at 3:18 PM on February 6, 2024 [1 favorite]
If you can stand it, stop washing your face entirely. Just splash your face with cool water, or let a warm - not hot - shower do that for you. Only moisturize clear areas, and when you do just gently pat it until absorbed, do not rub. While you aren’t washing your face do take measures to keep it clean, like don’t wear makeup, avoid dirt-adjacent activities like gardening and hiking, keep your hair out of your face if you use products in it, stuff like that. If you must wash your face use cool water. Don’t dry your face with a towel, use a blow dryer on low instead. Avoid any and all friction. Give your skin a chance to calm down.
posted by Mizu at 3:33 PM on February 6, 2024 [1 favorite]
posted by Mizu at 3:33 PM on February 6, 2024 [1 favorite]
Yes, please call your dermatologist. Winlevi has a 'moderate' interaction with azelaic acid, but what you're experiencing is not moderate. Winlevi interactions full list, including brand names and combination drugs.
posted by Iris Gambol at 5:09 PM on February 6, 2024
posted by Iris Gambol at 5:09 PM on February 6, 2024
For context before I get into my answer (and please disregard if you already know this): Winlevi, in theory, is meant to regulate how your skin produces sebum and its overall level of inflammation. It's not like trentinoin, which is a retinoid that increases skin cell turnover and thereby works more to unclog pores and prevent new acne from forming. There are some doctors who may prescribe the two together for this reason. Whether or not such a thing would be right for you is obviously between you and your doctor and not what I know you were looking for here, but it can be helpful to know.
It sounds like your skin barrier may be damaged. Are you applying a decent face sunscreen (at least 40SPF) during the daytime? If not, the Winlevi could very likely be making your skin photosensitive. This does not make Winlevi "bad," as retinoids and plenty of other amazing skincare products do the same thing. It just means you need to religiously use SPF. Photosensitive skin is vulnerable to sun damage and can lead to a weakened skin barrier, which unleashes all kinds of inflammation and acne in spite of what the Winlevi is trying to accomplish. For the Winlevi to do its job as best it can, there needs to be additional protection against sun damage.
I have rosacea and, for this reason, a very regimented skincare process that is designed to "baby" my skin when I have exactly this type of flare up.
YMMV and this is NOT anti-acne advice, I'm just sharing what *I* do. Take it with a grain of salt. You're asking how to baby your skin but you also don't want recommendations for how to stop acne, so I'm not sure how to thread that needle because babying your skin = taking steps to strengthen your skin barrier to prevent further inflammation, and a healthy skin barrier is less acne prone these types of advice can incidentally go hand in hand. Again, just a disclaimer. If you want to ignore everything I'm about to say then please feel free!
Anyway, based on what you're saying, if I had to guess, this sounds like a damaged skin barrier from photosensitivity induced by the Winlevi. Of course, it's impossible for me to actually know what's going on or what would work for you, but I can share with you what I do when my skin barrier is damaged. I will include product recommendations only because I want to be specific; most are Korean brands which not only tend to be more affordable but can also be more effective than high-end products produced in the US.
- I use a gentle pH-balanced gel cleanser. Our skin is naturally slightly acidic at about 5.5 pH, and needs to be so in order to balance our skin's natural oils and fight off the "bad" bacteria. CosRX's Good Morning Gel Cleanser is a staple for me.
- This is optional, but I find it to be soothing and moisturizing to follow this with a pH-balanced serum. I like Dear Klairs Supple Preparation Toner and they have a fragance-free version if you’re concerned about sensitivity.
- Gently press a ceramide-based moisturizer into the skin. Ceramides are key. Benton’s Ceramide Cream is my go-to budget choice for this, but a good high end option is Dr. Jart's.
- Use a high quality, high SPF face sunscreen that's at least 40SPF. Supergoop and La Roche Posay are good options but Korean brands are great for this, too. I like Missha's Sunmilk.
- Other commonly overlooked tips that personally go a long way in reducing major inflammation to my skin (once again, feel free to ignore if this doesn't suit whatever it is you're looking for): always wash your hands before you wash your face; always use lukewarm water to wash your face, never cold or hot; use LIGHT pressure and get a good gentle lather going when you're washing; change out your pillowcase every 2-3 days (silk pillowcases are pricey but less frictious and DO make a difference, ask me how I know); don't touch your face!!!; add a probiotic to your diet (Garden of Eden's women's daily probiotic makes a huge difference in my skin health, I always notice when I go off it for longer than a week); ramp up your water/electrolyte consumption and healthy, high-five foods.
posted by nightrecordings at 6:53 PM on February 6, 2024 [1 favorite]
It sounds like your skin barrier may be damaged. Are you applying a decent face sunscreen (at least 40SPF) during the daytime? If not, the Winlevi could very likely be making your skin photosensitive. This does not make Winlevi "bad," as retinoids and plenty of other amazing skincare products do the same thing. It just means you need to religiously use SPF. Photosensitive skin is vulnerable to sun damage and can lead to a weakened skin barrier, which unleashes all kinds of inflammation and acne in spite of what the Winlevi is trying to accomplish. For the Winlevi to do its job as best it can, there needs to be additional protection against sun damage.
I have rosacea and, for this reason, a very regimented skincare process that is designed to "baby" my skin when I have exactly this type of flare up.
YMMV and this is NOT anti-acne advice, I'm just sharing what *I* do. Take it with a grain of salt. You're asking how to baby your skin but you also don't want recommendations for how to stop acne, so I'm not sure how to thread that needle because babying your skin = taking steps to strengthen your skin barrier to prevent further inflammation, and a healthy skin barrier is less acne prone these types of advice can incidentally go hand in hand. Again, just a disclaimer. If you want to ignore everything I'm about to say then please feel free!
Anyway, based on what you're saying, if I had to guess, this sounds like a damaged skin barrier from photosensitivity induced by the Winlevi. Of course, it's impossible for me to actually know what's going on or what would work for you, but I can share with you what I do when my skin barrier is damaged. I will include product recommendations only because I want to be specific; most are Korean brands which not only tend to be more affordable but can also be more effective than high-end products produced in the US.
- I use a gentle pH-balanced gel cleanser. Our skin is naturally slightly acidic at about 5.5 pH, and needs to be so in order to balance our skin's natural oils and fight off the "bad" bacteria. CosRX's Good Morning Gel Cleanser is a staple for me.
- This is optional, but I find it to be soothing and moisturizing to follow this with a pH-balanced serum. I like Dear Klairs Supple Preparation Toner and they have a fragance-free version if you’re concerned about sensitivity.
- Gently press a ceramide-based moisturizer into the skin. Ceramides are key. Benton’s Ceramide Cream is my go-to budget choice for this, but a good high end option is Dr. Jart's.
- Use a high quality, high SPF face sunscreen that's at least 40SPF. Supergoop and La Roche Posay are good options but Korean brands are great for this, too. I like Missha's Sunmilk.
- Other commonly overlooked tips that personally go a long way in reducing major inflammation to my skin (once again, feel free to ignore if this doesn't suit whatever it is you're looking for): always wash your hands before you wash your face; always use lukewarm water to wash your face, never cold or hot; use LIGHT pressure and get a good gentle lather going when you're washing; change out your pillowcase every 2-3 days (silk pillowcases are pricey but less frictious and DO make a difference, ask me how I know); don't touch your face!!!; add a probiotic to your diet (Garden of Eden's women's daily probiotic makes a huge difference in my skin health, I always notice when I go off it for longer than a week); ramp up your water/electrolyte consumption and healthy, high-five foods.
posted by nightrecordings at 6:53 PM on February 6, 2024 [1 favorite]
Response by poster: Look, I know it's coming from a good place, but I really don't want routines/acne advice. I'm too tired to share why, but trust that I find advice around acne stressful and overwhelming at this point in my life and it is very much unwanted. Which is why it's one of my first requests in the Ask. Please stick to my question(s). Thanks very much.
posted by Stoof at 7:45 PM on February 6, 2024 [5 favorites]
posted by Stoof at 7:45 PM on February 6, 2024 [5 favorites]
I couldn't tell 100% what your question is. Is it: How should I treat it until I can see my doctor again? or Is this in a pharmacist's wheelhouse maybe?
For How should I treat it until I can see my doctor again?
I'm not sure how to answer this without giving acne advice, but maybe you want advice on how to handle your skin more generally with this flare up? For this, I think there is a lot of advice in this thread as to how to treat your skin. In my experience though, skin is very person-specific and what works for one person, doesn't necessarily work for others. When I have a cystic acne outbreak that is red, blistering and itchy, I use green clay masks (just green clay powder with water added) and it calms my skin a lot. When I have hives, which are also red, blistery and itchy, I use Benadryl or an equivalent, and Cerave cream.
For Is this in a pharmacist's wheelhouse maybe?
I think yes, since you seem to be having an allergic reaction, you could contact your pharmacist and share that you are having an allergic reaction.
posted by Toddles at 8:57 PM on February 6, 2024
For How should I treat it until I can see my doctor again?
I'm not sure how to answer this without giving acne advice, but maybe you want advice on how to handle your skin more generally with this flare up? For this, I think there is a lot of advice in this thread as to how to treat your skin. In my experience though, skin is very person-specific and what works for one person, doesn't necessarily work for others. When I have a cystic acne outbreak that is red, blistering and itchy, I use green clay masks (just green clay powder with water added) and it calms my skin a lot. When I have hives, which are also red, blistery and itchy, I use Benadryl or an equivalent, and Cerave cream.
For Is this in a pharmacist's wheelhouse maybe?
I think yes, since you seem to be having an allergic reaction, you could contact your pharmacist and share that you are having an allergic reaction.
posted by Toddles at 8:57 PM on February 6, 2024
This may sound counterintuitive but when my skin gets very angry I need something slightly richer to help calm things down like LRP Cicaplast B5 baume. So washing with a gentle cleanser, fairly substantial barrier supporting cream. If you want to keep using the azalaic acid I’d layer that over the top. For my skin, to stop washing all together would not help and not too strong acids tend to help, not hinder. Also, if I don’t get enough sleep that prolongs any inflammation (skin/joints etc.).
posted by koahiatamadl at 1:48 AM on February 7, 2024 [3 favorites]
posted by koahiatamadl at 1:48 AM on February 7, 2024 [3 favorites]
Response by poster: Solved! The medication caused my previously very mild rosacea to become severe, which I am now being treated for.
posted by Stoof at 10:09 AM on April 20, 2024 [1 favorite]
posted by Stoof at 10:09 AM on April 20, 2024 [1 favorite]
This thread is closed to new comments.
FWIW it probably won't hurt to take Benadryl.
posted by oneirodynia at 1:36 PM on February 6, 2024 [3 favorites]