Acne in 40's - advice desperately needed

[cclare]

Hi
I have been suffering with acne for about 10 years. It goes through phases of being a bit better and then much worse. I've been to the doctor a number of times over the years and they are not particularly sympathetic and just say go on the pill (don't really want to as was on it for many years when younger), or give me creams which make my already dry skin become painfully dry and flaky, or give me antibiotics which does not seem to be a long term solution. They also told me not to wear make up which is completely unhelpful given I need to boost my confidence not make it worse by exposing my terrible skin particularly at work.
I don't really know what products to use for the best and try things but am not convinced they are helping or working well together. I have dry and sensitive skin, now getting wrinkles and big painful lumpy spots.
Do you have any advice for nutrition, products or dermatologists in the London area. I'm at the point that I'm willing to try anything!

[EyUpDuck]

I have also had acne for 10 years (I am 25) and have tried every single thing I've seen recommended. I have spent a fortune on different skin regimes and other things but nothing ever really improved it. I bit the bullet and went to my GP asking to be referred to a dermatologist. They couldn't refer me until I'd tried all the antibiotics they could prescribe me, so it took around a year to finally get a referral but it was so worth it. I've been seeing my Derm every month since December and I've been on Roaccutane since Christmas. It has made such an amazing difference and I would really recommend seeing a Derm if you can get referred or afford to go private. It's seriously changed my life! I haven't finished treatment yet (still have a few months left) but this is the difference 3 months in. The top photos weren't even my skin at its worst so you can imagine how pleased I am with the result

[Thelwell]

Wow Eyupduck you look amazing.

Cclare have you tried Retin-A yet? I have used this for many years for anti aging, but it's commonly prescribed as acne medication.

Best of luck.

[cclare]

That looks amazing Eyupduck! And in such a short space of time. I'm going to try and get a referral although GP wasn't massively keen to do it when I suggested it and instead tried to get me to do other stuff.

I haven't tried Retin-A. My main concern is that although I've read up about salicylic acid, bonzoyl peroxide and Retin-a, how do you know how often to use them and if they can be used in the same skincare regime? Worried I could do more harm than good.

[LazyCake]

Have you tried looking at the discussion board on this website? www.acne.org/messageboard/

I've have been reading about people who have been having great success with use of sulphur soap, dairy-free diets and other unlikely things. My acne was brought under control using Dianette, although it's been many years now since I took this drug. Nowadays, I find that oil cleansing and regular application of salicylic acid pads mean that it's unusual for me to have more than 1-2 spots a month.

Good luck. I know how undermining to your confidence skin problems can be.

[Buzzardbird]

The pill actually work though, so if other methods don't work for you, maybe give it another thought.

[EyUpDuck]

I think they have a protocol they have to follow where you go down the list of medication the GP is allowed to prescribe you, and if none of it works then you can have a referral to a dermatologist. I believe they can't just refer you outright. It's definitely worth doing. It only seems like 2 minutes since my very first GP appointment!

The above things mentioned are worth looking at - I did try dairy free, sugar free, benzoyl peroxide etc but it just never worked for me. Seeing a Derm was the best thing that I've ever done.

[cclare]

Thanks Lazycake, I try not to let it get to me but it's so obvious and I find it so embarrassing particularly at work.

Good to know eEyupDuck, I'm going to book another GP appointment and hopefully I've got through enough stuff on the list for them to refer me!

[RobberBride]

Dealing with acne is so much trial and error, you have my immense sympathy. I've posted this before but a few things really helped me:

• giving up milk. I really didn't want it to work - I love milk - but the difference after about a month was astonishing. I now drink Koko in tea and coffee if I'm at home/work, and soy milk if I'm in a cafe.
  
• using Paula's Choice directory and the blog www.clemmiesbigsister.co.uk/ to scrutinise every ingredient in every product coming in contact with my face (including shampoo, conditioner and toothpaste). It took forever, and involved throwing out anything containing parfum and various other triggers, but was worth it.
  
• Getting my GP to prescribe Finecea, 15% azelaic acid. It is much milder than many topicals, so it doesn't make the skin angry or flaky. It also helps to fade acne scars.
  

Good luck!

[Arsenicinthesugarbowl]

If you need a recommendation for a derm then look at sam bunting. I followed her advice on her website/blog and it cleared up my acne (which was utterly depressing me). I'd been taking antibiotics and found GP less than helpful. I changed the way I cleanse, the products I used and started taking a fish oil supplement.
I imagine if you can actually see her the results would be amazing. I haven't had acne for about a year now after being plagued with cystic acne which looked awful, was really painful and I now spend much less on products for my face!

[cclare]

Thanks Robberbride and Arsenicinthesugarbowl.
It's not a great time to give up sweets and dairy with Easter on the way but I think you have all been so supportive that I have become more positive about it. I will definitely check out the websites you have suggested.
Thanks again

[Drinksforeveryone]

Another recommendation to re-visit your GP and say that you want to be referred to a Dermatologist.

I am in my 40s too - and have had acne since a teenager. Over the years have been on the pill (combined pill - mini pill makes acne much worse), antibiotics, face washes, creams etc. The combined pill worked for me - Dianette in particular - however I was diagnosed with a blood clotting issue at 38 so was no longer prescribed it. ( I did however stock up on it whenever I had a trip to Spain, as you can buy it over the counter there!)

A couple of years ago I was so fed up that I booked an appointment with a private dermatologist- who agreed that I did have an issue but that it wasn't bad enough for Roaccutane - which is what I figured I would have to resort to. She did refer me to another dermatologist -who works on the NHS, so I didn't have to pay any further. Nice.

This was a very successful appointment. The dermatologist listened to my concerns - and prescribed me Spironolactone, to be taken daily for as long as I need/want along with using Epiduo a couple of times per week.

I have been on this regime for just a year now - and can count the number of significant spots I have had since then on one hand. It's amazing.

Spironolactone acts on the way that testosterone affects my skin - similar to what Dianette does. I do have to have a liver function test every three months before my prescription repeat is fulfilled but so far so good. I don't see the dermatologist, she passed my care over to my GPs so it's much easier to sort out the blood tests and the appointments overall. Only side effects I have are sore boobs now and again, the same as pre period - but to be honest that could be down to being in perimenopause either. Spiro is a diuretic - so have to drink more water - again - a good thing!

It is worth doing some reading up on all the pros and cons of your options before seeing your GP so you can get a referral.

Good luck - it is worth sorting it out.

[RobberBride]

cclare just to add that while I did cut back on other dairy, it is milk that seem to be the real trigger. So I still have cheese, yoghurt etc if I fancy it, though I try to make sure it is high quality (organic if poss, with as little processing as possible). So you can still have some Easter Egg :)

[Daisyandbabies]

Proactiv (original, not +) bought only from US or Canada is brilliant. The European version does not contain benzoyl peroxide and is rubbish. I'm 29 but I know of people in their 40s who use it. I recently decided to stop it and try Effacalar duo after amazing reviews...massive mistake! I got severe acne (maybe about 40 spots, one of which was a big cyst which needed antibiotic cream to clear). Within 2 weeks of being back on US proactiv, not a single spot. It can be bought on eBay but like I say, make sure it's the USA version and not the UK version X

[cclare]

Sorry for going quiet for a few days, really appreciate all of your advice. I don't actually have that much milk although probably have a bit too much cheese. My big weaknesses are wine and sweet things. I think I may need to cut down or at least try cutting down to see if it makes any difference. Have done that in the past and didn't find it helped that much but could try again.
It sounds like I need to keep trying stuff to see what works best for me. I would never have know about all the stuff mentioned though so thanks for letting me know.

[msrisotto]

Hi cclare. Sorry to hear your skin is being shit. Mine was shit until I took Dianette - a contraceptive pill that you can no longer take for over 6 months. I was on it for 10 years but every time I tried to come off, the acne came back. I am off it now though, I found the acne.org website to be helpful. It was there that I found an alternative that involved another contraceptive plus Spironolactone which combined to make a similar chemical composition which had worked for me. I did have to find the original research and take it to my gp but she was ok with it.

I had been to a Dermatologist before to talk about other options and she was all about the Roaccutane. I was reluctant having heard some horror stories, but to be fair she will know hundreds more cases than me and she said it was safe.

Does your GP have an interest in women's health or dermatology? Usually the practice website will have a little biography of the staff where they might say.

[msrisotto]

By the way, I quit sugar around the time I changed pill. It has made a difference, now I notice that if I have a binge, I definitely notice I am spottier.

[msrisotto]

Not that I think quitting dairy/sugar/whatever else will definitely make a difference for you, I think it is very individual. I have loads of milk and dairy and it makes not a jot of difference to my skin.

[MrsT2007]

I have sensitive skin and those big lumpy sore type spots that feel like you're growing a second face.

I was on dianette until I had the kids, and it definitely helped a huge amount.

That said I've found double cleansing makes a huge difference. I use the Una Brennan cleansing oil with a Muslim or bamboo cloth, than I wash with Avene foaming cleanser, and then use the superdrug 'clearly youthful' range (serums and moisturiser) which has spot and wrinkle fighting ingredients and their spot gel in any threatening areas. I've been very impressed with it especially considering the price.