Adult acne - cystic - one spot at a time - advice?

[user1498990621]

Hi everyone,

For the last 4 years since I turned 25 I have been dealing with adult acne. I went to bed with totally clear skin and woke up to a cluster of large inflamed cysts the following morning and have had these problems since. It is mainly localised to my chin and I usually only have one or two at a time. I have had a few months of no cysts but will then go through a period of having one every 6 months. I have tried the following:

6 months of antibiotics
Epiduo
Differin
Benzoyl Peroxide
Vitamins
Diet changes (including elimination)

I think it is hormonal as skin seems to be worse about 10 days into my cycle. I don't have any children and not currently TTC.

I have just had another term appointment and they suggest Lymecyline for 4 months with differing and, if successful, a further 6 month course. They said this is often all it takes, as although I have cystic acne, it is localised and only one at a time (leaves marks that take 6-12 months to fade though so my skin looks like I have loads of acne on it because of these marks as well as any new or current cysts).

I have been reading up about antibiotics and it seems they either do work but stop once you take them or don't work at all. I am wondering whether it is worth bothering?

My wedding is at the end of August and I am so terrified of having a massive cyst on the day. I currently organise my social calendar around my skin, trying to schedule things in when my skin is most likely to be behaving during the month (usually I get a week where I have nothing active). My confidence and self-esteem is very low because of my skin issues.

A bit of background:

Clear skin until aged of 25 - maybe had 5 spots my entire life before then. Had normal skin, not oily

Skin now gets slightly oily in t-zone but not too bad.

I use Cetaphil cleanser AM and PM and Epiduo at night. No moisturiser as derm said to stop putting on my face as it isn't dry so I shouldn't add anything.

Diet wise - very little dairy, low sugar, lots of veggies and organic meat. I cook from scratch every day, don't eat processed foods. I drink at least 2 litres of water every day. Usually have one coffee in a morning (black, no milk). Drink alcohol moderately - usually wine at a weekend.

Came off the pill 8 years ago and was diagnosed with PCOS a year later following a scan and hormone tests. Skin was clear and remained so for further 3 years. Slowly my periods returned to normal (28 days) and tests showed hormone levels back to normal, scan showed cysts had gone. However, since the PCOS disappeared, I have got acne. Seems to be the wrong way around!

I take oral vitamin b12 for a deficiency. I can absorb b12 fine but don't get enough, despite a diet rich in foods which have high levels of b12!

Advice very much appreciated. I am considering Accutane at the moment but term says to try antibiotics first.

Thanks :)

So sorry you are suffering with this-they are horrible. My old foundation was causing mine so they have stopped now I've stopped using them. Also sugar seems to make them worse so try to not have too much.

Have you told the doctor you are organising your social life around this issue? I think there is stronger stuff than lymecycline they can use provided you aren't ttc. Lymecycline did work for me and also pro-activ I find great - the best stuff you can use on skin. Previous creams I tried just took the skin off which In a way was worse to try and conceal with makeup. Hope you get it sorted.

I haven't tried it but spironolactone is used to treat hormonal acne (It's an androgen blocker). You can only get it from derm though. Dianette is available from gp and has anti androgen in and synthetic eostrogen so can be used as bc whilst treating acne.

Spearmint tea is also used as androgen blocker and has been shown to be fairly good in studies.

Inositol is meant to be good in helping acne in people with PCOS.

OP I have familiar skin, my cystic acne is around my chin/ jawline too. I'm 25 too, acne started few years ago. I been taking Lymecycline for last 6 months, it helped with The big spots but as soon as I stopped taking it, it comes back (literally within days of not using it). Derm wants to me start Accutane given all my bloods results ect are fine!
It's so stressful having crappy skin :(

Are your hormones balanced? Perhaps some evening primrose oil and star flower oil may help?

Thanks for all of your replies.

I think my hormones are balanced now. I don't have PCOS anymore - two testosterone blood tests in last 18 months came back bang on normal, scan of ovaries showed no cysts and my periods are every 28 days. I have a theory that my pill protected me from acne while I was young and, when I came off it, I wasn't ovulating properly for a few years and had PCOS which also prevented the acne. Now my hormones have balanced themselves and the PCOS is gone, I ovulate monthly and this is causing the acne. I could be wrong but that seems to make the most sense to me.

I will take the antibiotics for the next couple of months as hopefully they will help me get to my wedding without any issues, but after that I fear I am going to have to resort to Accutane. The only side effect that bothers me is potential permanent hair loss. I know that sounds vain but my hair is about the only thing I like at the moment and it has taken me years to get it to the length and condition it is in :( the horror stories of people losing their hair is what has put me off so far, but I have tried pretty much everything else now.

The fear of not know when a pimple will pop up and the fact I cannot control it is devastating me. I used to be so confident and now I struggle to look people in the eye. The crazy thing is that most of my face is totally acne free, but the massive cysts I get on my chin rule my life :(

I should also add that I would prefer not to go on the pill as will probably be TTC within the next year and the pill only seems to work while you are on it. Most people say it comes back, and often worse, once they get off it and given I wouldn't be on it for long, I can't see much point. I want a permanent solution so I can get on with my life and Accutane seems to be the only one?

Hi OP. I got cystic acne when I was on the POP. I now take an oestrogen containing pill. I don't get cystic spots anymore and my skincare routine gets rid of any others.

I think Accutane might be a good option, because surface-level treatments don't go deep enough. Make sure you discuss your hair concerns with your derm.

Thanks - will definitely mention it to them, although I guess it is just a risk with accurate and they won't know whether I will lose my hair until I try it :/

I've had cystic acne since I was10, now 36. I had theraclear treatment as that has now cleared it after all these years trying pills creams etc.

Hi - what is theraclear?

www.phiclinic.com/non-surgical/treatments/theraclear/

If you are near London, you can try Skin Laundry at Liberty. I did their 15 minute laser and light facial every 2 weeks for about 6 months, and got rid of most of my cystic acne. I still have breakouts but they heal a lot quicker now and not cystic anymore. First facial is free if you want to try it out. The skin looks great afterwards (I know it's a short term thing but great esp. if you're about to get married).

Thank you - nowhere near London sadly, I live in the North East of England. But something similar might be available up here. Like you say, even if it just helps short term to get me through wedding and honeymoon and I can then look at more permanent options (probs Accutane!)

I could have written your post. I'm now 32 years old and it's only starting to get better now after 10 years of suffering.

The acne you are describing certainly sounds hormonal. Since going back on the pill in March, I've not had any cystic breakouts along my jawline or chin. I'm still getting the odd breakout on my cheeks/ high cheekbone around when my period is due but it's nowhere near as bad as it used to be.

I also used a prescribed retin-a cream (Isotrex) which certainly kickstarted my road to clearer skin.

I've just ordered this

www.sr-skincare.co.uk/salicylic-acid-peel-152-p.asp

Yes, forgot to mention, of course try the usual recommended products for acne - salicylic acid as mentioned, Paula's Choice has good options. Also retinol helps. Benzoyl Peroxide on breakouts themselves (helps healing but I don' think it prevents).

Thanks all - have used Epiduo, Differin, Quinoderm, Panoxyl, Origins spot treatment, Clean and Clear salicylic cleanser etc. over the years (obviously not all at once). None have prevented the cysts. I have found some recent success with ice and then heat to bring cysts to a head which can then be popped or drain on their own, but still take 2 weeks from start to finish and then leave marks for up to a year.

For the pregnancy reasons and because I don't want to mess up hormones even more in the short term, I don't want to go on the contraceptive pill.

I have also tried supplements - vitamin D, magnesium, fish oil. I also take b12 daily because of deficiency.

I am still prepared to give other things a go but feel like Accutane is my only real option for a permanent cure :(

I haven't tried topical retin-A actually and no-one has suggested prescribing me this, only adapalene/epiduo/differin. I wonder whether I should ask for Isotrex?

I had this. Each month, massive cystic acne that would barely heal by the time the following month's started.

Salicylic acid has cleared it up if I use it morning and night. I use the Clearasil pads. It's like being a teen again. But it works for me.

Thanks Flappy - I have mainly used salicylic in either cleanser or spot treatment (origins) form and never found it hugely successful but maybe I haven't given it long enough (a month or so with the cleanser)

With Salicylic acid a cleanser doesn't really do much, cos it just washes off, and it's not supposed to be a spot treatment. The point is that it exfoliates the skin and penetrate the sebum within the pores so it helps clean the skin out. So it should be applied like a toner or cream, and it will take a while being used regularly to work.

Do check out Paula's Choice's website, it has some good advice on oily/breakout skin.

Have a look at Www.acne.org. Since following advice on there I regularly use glycolic acid lotion and my cystic spots are less frequent and go more quickly.

My acne sounds exactly the same as yours OP. Isotrex totally cleared mine up.

Should say that was prescribed by my dermatologist not GP. That said I think GPs can prescribe it. Did differin work for you? I have to switch to that now due to TTC.

Differin didn't work when I tried it a few years ago so they swapped me to Epiduo. I felt like that helped for a while but cystic spots have returned. I have been researching everything I can online and obsessively read everything on acne.org

My skin isn't really oily - most of it is normal, with a slight bit of oil on my forehead and chin by the end of the day - barely anything though. I also basically only get breakouts on my chin, so have been reluctant to slather products all over my face as I don't want to disrupt or damage the good areas. It is just my chin that causes me issues, but they are big issues. I don't know how to insert images in here otherwise I would have posted something to show you what I am dealing with :(

I have tried glycolic acid in the past with no success :(