Unexplained scabs with acne

[AcneQuestion]

Hi, DD is 22. She has really bad acne. It was at one point controlled by milder antibiotics, but no longer any success with this, and she may go on roaccutane shortly, although has been hesitating because of the side effects.

But one thing she has, that no other person seems to, and the three dermatologists she has seen are mystified by, is the fact that her spots scab over, then disappear, then scab over again. She does not touch her skin at all. One doctor thought it was maybe a secondary skin infection, but the treatment for this has not worked.

These aren’t normal scabbing/scarring issues caused by acne - it’s something different and quite weird. It’a causing her a lot of distress, and she doesn’t know whom else to ask.

She has a very healthy vegan diet, doesn’t drink or smoke, and is otherwise healthy. Very puzzling.

Has anyone come across this before?

Thanks a lot.

They wont be interested in the whys.

I took accutane, it was fine.

I had this and I did some research and bought Tazorac .1% and azelaic acid 20% and it cleared up.

It will get worse before it gets better and you need to be very careful about sun protection and protecting the skin barrier.

I started off using them every third day for about a month and then every second day on month two.

Tazorac is very strong so she would need to listen to her skin and stop if it gets too irritated.

Cleanse with a balm and then second cleanse with a water cleanser.
No harsh rubbing, no flannel.

Wait for skin to dry.

Mix the Tazorac and Azelaic Acid together (a pea sized amount of each).

Pat into skin avoiding the nose, under eyes and lips.

(If she finds it irritating she could buffer with moisturizer and sandwich the products.)

Vanicream is a good moisturizer and non-irritating and then sealing it in with an oil like rosehip.

I never found the cause for my acne, but my whole lower face was covered! It only started in my late 20's.

I now have worked up to using Tazorac every night and the bonus is that it is good for anti aging.

No idea why op sorry... but I took Roaccutane and it was the best decision I made. Spots all cleared up nicely and the side effects were non existent.

Thanks, all, really appreciated.

@Indoorcatmum , thanks so much for sharing your experience. Did you use any other acne creams during this time or stop completely? It seems you still applied sunscreen. And were you taking antibiotics too?

So you really had scabs that disappeared and reformed? Not seen anyone else with that experience so far, so that’s really helpful (but sorry you had to go through it of course).

Thanks very much.

Hey!

No problem :)

I had cystic acne that didn't seem to heal. They would get to maybe 75% of the way there and then it was almost like a new one formed in its place. I imagine it was just a constant reinfection of bacteria.

Tazorac and Azelaic Acid make your skin extremely sensitive to the sun, so sunscreen is a MUST every day.

Tretinoin World is where I purchased mine.

You can't use cant other actives alongside them as they are so potent.
So, no BHA OR AHA's etc.

Just a very simple routine.

Double cleanse face.
Gently pat dry (never rub).
Apply vasaline to lips and a touch around the nostrils to protect them.
When face skin is 100% dry apply both the Azelaic Acid and Tazorac mixed together.
Then moisterise with Vanicream or Lipidz Barrier cream from the same website as above. That actually was my favourite.
Then seal moisture in with either Rosehip Oil or Squalane Oil.

Do this every third day.
On the off day, simply cleanse and moisterise and apply oil.
You want to give skin a chance to rest between.

Make up aggravated the cysts so I moved to mineral powder foundation and it was a game changer.
Lily lolo is the brand and it really helped!

I tried to only wear makeup when necessary, but the Lily Lolo products were the only ones I found that didn't leave me with a new spot by the evening.

I don't know if this is what she has too, but I know the cycle of the spots never healing and constantly going around in a circle.

Tazorac speeds up the healing time, helps with collagen production and is generally the gold standard for acne and anti aging. Azalaic helps with inflammation and redness and other things.

Another tip is make sure she isn't drying her face on her body towel.
Pillow cases also need to be changed ideally every day, just get some cheap ones from Amazon.
Also brush teeth BEFORE skincare as toothpaste is very harsh and can affect the skin around the mouth.

Sorry, Tretinoin World is where I got the Tazorac, Azelaic Acid and Lipidz cream.

For sunscreen I used Supergoop.

You’re a star, thank you @Indoorcatmum , I’ll let her know. Looks like you didn’t need to go down the antibiotic route. Thanks for the detailed plan.

Really appreciate the advice.

No problem!

I had tried a topical antibiotic called clindamycin, but it never worked.

If she does decide to try these products, warn her that she may purge at first and to only move up to more days a week once she feels her skin can handle it.

She will do more damage to her skin by rushing to apply them everyday :)

I think it took me around 3 months in total to feel like my skin had adjusted and by the 5/6 month mark my skin was completely clear.

I have carried on with the Tazorac every night as it is great for anti-aging and fading acne scars.

And I still sometimes use the Azelaic Acid if I get a few spots on my cycle.

Great to know, I’ll def pass it on, thank you!

Before she goes on roaccutane I would look into iiaa skin micro biome and accumax, I worked with them for years and found they worked as well as the roacctane but without the side effects they are vitamins.
The skin has a micro biome just like the gut, p accnes are the main bacteria and they feed on skin cells and sebum, if these get out of balance then they cause inflammation and breakouts so a good probiotic will help her whole system.
Be careful ordering prescription skin care online as every skin will react differently.
Regular exfoliation is key. As a previous poster said so is a good sunscreen
I'd recommend speaking to a skin therapist trained in a high end brand, I was a Dermalogica expert therapist for 10 years, I'd recommend anyone experienced in Dermalogica, guinot or Bio Therapeutics.
I hope she gets sorted

Thanks @JudeGarret , really appreciate you taking the time to comment - I’ll pass your points on to her.