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 :)

I am still in partial denial about the whole situation - to go from perfect skin to this, literally over night, still blows my mind. I keep thinking it is just a nightmare and/or at some point things will just completely clear up on their own, but after 4 years of patience and perseverance I am losing hope.

The other issue compounding all of this is my job involves being in front of people most of the day (I am a university lecturer!) Most of my students have significantly better skin than I do (probably a lot are on the contraceptive pill which I now firmly believe prevents a lot of young women getting acne but then creates problems for some when they come off it). So as well as it negatively affecting my social life and relationships, it also makes my job really hard to do and I feel constantly embarrassed and ashamed!

It's horrible isn't it! I has no spots as a teenager and then in my 20s they just appeared. I've tried every antibiotic going which worked temporarily but the acne always came back. Isotrex worked well for me but I can't use it while TTC so now my spots have come back. Starting differin tomorrow so fingers crossed. I will definitely use isotrex again when possible. They won't give me accutane due to history of anxiety. That's the only thing I know of that will keep acne away permanently. It's horrible!

Fortunately I have been pretty lucky in terms of mental health - the only thing that gets me down is my skin, ironically, so Accutane would probably lift my mood rather than affect it negatively.

Wishing you lots of luck with TTC and differin - in seems pregnancy cures acne for quite a lot of women so hopefully you will be one of them :)

Hi OP

My acne was similar to yours (only on chin/around mouth) but it was all the time. Like you I also started seeing a derm; for me it was out of desperation as I was getting married. My skin cleared up with a combo of Dianette/Lymecycline/Duac and Isotrexin all at once, in 8 weeks. Since then my acne has not returned, but I still see the derm 6 monthly and my skin has stopped responding to the Isotrexin so I have been on various other creams - have just started Differin.

I would really recommend isotrex/isotrexin if you haven't tried it. Even after my acne went, I was using it daily and my skin was perfect. Sadly it's been more of a struggle since I had to stop it!

Biscay as far as I'm aware Differin is not OK to use while TTC either. I'd be interested to know if your doctor has told you otherwise (for the future!)

Hi Blair - so has your acne now come back? Are you still on Dianette or Lymecycline? I am sure mine would clear up with birth control but want to avoid it as I would need to come off it almost as soon as I start, so it seems pointless. I am wondering about using the antibiotics and topical (isotrex perhaps or one of the others) to get me through (hopefully successfully) my wedding and honeymoon and then either TTC immediately and hoping, praying, that pregnancy sorts my skin out and then, if it doesn't, trying Accutane. I don't like the idea of being on antibiotics for long, or at all, really. I am also totally paranoid about making things worse, because at the moment it is only one cyst at a time on my chin and I am scared different treatments will trigger widespread acne and/or increase the frequency or severity.

I would love to not think about my skin again - if only :(

I'm 50 now, but when I turned 18 the acne arrived. During my whole adulthood I've had spots of some kind and more recently around my chin. For the last 2 months I've been spot-free, hallelujah. I've been using Neutrogena Visibly Clear Spot Stress Control Daily Scrub. It cleared up my spots within a week. Maybe it'll work for someone else.

I think you are right, Blair. My dermatologist swapped it to use right up until TTC rather than during. I think it must leave the system quicker than isotrex, maybe? I will stop all treatments whilst actually TTC and hopefully pregnancy will sort my face out!

The pill only worked for my PCOS acne while I was on it. Skin like a dream when on it, acne back when off it (nothing like what you're describing however)

2 years of IVF meds haven't helped, but now we're at the end of the road with fertility treatment and no chance of conceiving, can go on a proper skin regime

I'd been massively over exfoliating with AHA and BHA, leaving my skin massively dehydrated. Benzoyl peroxide stripped it too

Dermatologist gave me scripts for Skinoren and Treclin, and 6 weeks in I'm starting to see some benefits, I think. She also stripped everything back and now all I use is my LRP Toleriane cleanser and a little moisturiser if needed, plus my SPF. Skin feels so much more comfortable than with loads of serums and toners etc

Friends who had severe acne both did courses of Roaccutane when they were younger and saw incredible results - it was like night and day. Not to be undertaken lightly but they found it life changing

Good luck

Treclin is a combination of tretinoin (retin-a) and clindomycin (antibiotic) so is a two in one topical acne treatment - the Skinoren in the morning is azelaic acid

Combo is significantly more effective than any of the salicylic or glycolic treatments I'd used previously

I'm a currently coming out the other side of acne treatment.

Like you, I rarely had spots, so to wake up to these large red painful spots on my chin was awful. Sometimes my face was so painful, I would cry.

I have been on several antibiotics and none of them worked.

I am currently using a cleanser from lush and a prescription cream called Duac. My skin is clear (aside from some mild scarring) the side effects the first few days are grim but I persevered and my skin doesn't react at all to it. It took 4 weeks for the results to be seen, it's the best thing I've ever used for my acne.

Mintbiscut is spot onanything that will curb the effects of androgens, such as spiro, spearmint tea, or saw palmettowill have you completely clear.

Thanks for all the informative responses - interesting that topical do seem to work for some, even when they have cystic spots like me.

Mine is 'severe' but only one at a time, so doesn't seem severe in many ways. If you catch me during my 5-7 spot free days per month you would think I have perfect skin (obviously with concealer on the red marks) and even when I have a cyst, because it is only one, my other half constantly says he doesn't know what the problem is. My skin on my cheeks is baby soft and no acne, my forehead is pretty much clear but does get a slight sheen by the end of the day. So it is so weird to then get these issues on my chin :(

I suppose the other issue is on of patience. Having tried for 4 years, I am now reluctant to keep 'giving things a go' which are usually skin or topical products and take months to see results. I feel like I don't have months left in me to keep trying things. I am totally exhausted with worrying about my skin, obsessively checking it, organising my diary around it and pulling out of social occasions because if it. I probably waste 2-3 hours per day researching stuff on the internet trying to find a miracle cure, even though I have read everything out there more than once.

I don't think I have tried dual actually, although I use epiduo which did seem effective for a while (maybe 6 months?) but since March I have been getting a cyst every month again.

I agree with an earlier poster about totally natural Evening primrose oil, or starflower oil. You can put the oil on your spots, and take it twice a day. It balances your hormones naturally.

I also put Weleda special nappy change cream (sounds weird but it has zinc in it) after the oil it's incredibly good and it 'dries' them out IFYSWIM . It works on ll skin problems.

The other thing that might help is a look at your consumption of barbecued (burnt) food. Or high acid foods like orange juice, marmalade tomatoes etc. Maybe keep a diary of the foods that you ate 2 days before the outbreak, or even the actual day before. We all get more sensitive to foods than we used to be.!

Thanks @ppeatfruit.

I don't eat BBQ food very often - maybe once or twice a month in summer. I don't drink fruit juice and don't like marmalade. I probably do eat tomatoes a fair bit, but that doesn't change, and I have gone months without any cysts, so I struggle to blame a particular food as I feel (perhaps wrongly) that I would have constant issues and more than just a single spot at a time.

I did do a food diary for the last 6 weeks - the only thing I could see really was the increase in skin issues around 10 days into my cycle. I have just looked again and the days I have noted a cyst forming, the previous days before I have had things like cornflakes (dry, I don't like milk) 1 coffee, a slice or two of homemade sourdough and alcohol. Most of those days I have not had any tomatoes, the only fruit has been strawberries/raspberries. The other notable thing is that I have had alcohol the night (or two nights) before, although I stopped drinking altogether for a month a while ago to see if it made and difference and I didn't notice that it did :/

I will have a look into those oils, thanks!

You're welcome I notice my skin changes (reddens and spots) if I eat wholemeal bread ( I don't eat it usually so I'm aware).

I haven't cut gluten/wheat out before to be fair, although again I am sceptical about food suddenly causing acne, particularly if it is just one spot and only part of the month. I think these days a lot of people rush to cut out food or blame certain food groups for everything (my mother is a great example of this) when actually it is nothing to do with food! I don't eat a lot of dairy so that was easy to eliminate for a bit. I could cut out all of the other things individually again but to be honest I eat small amounts of them as I am pretty healthy and try to have a balanced diet. Plus I ate the same way when I was completely acne free, before all of this started. :/

I know what you mean but food does have a lot to do with our health ! Our bodies change with age too!

Hi OP :) as you sound really low.

No my acne has never come back (thankfully), I do get small red pimples occasionally but never the multi-headed chin cysts. I noticed the isotrexin had stopped working because my skin was less "refined" (I am v. vain, and now I've had that perfectly smooth skin I want it back!).

I totally understand you don't want to go on the pill or antibiotics. To be honest it doesn't sound like you need them, as your spots come and go. I just needed mine gone and that 4-pronged approach worked well (and I had been on Dianette before and knew it worked for me). My GP only let me stay on it for 6 months though because of the DVT risk. That was ok though, didn't need it anymore. I wouldn't go back on antibiotics now either because I got all sorts of side effects being on them for 4 months.

Maybe ask your derm why it might be that you keep trying things and they stop working? Next time you go I would ask for Duac (am) and Isotrex/Isotrexin (pm) as a last ditch attempt before wedding & then TTC (you can't use them during). Retinoids are a miracle for acne and they will fade your red marks too in a matter of weeks. I feel like you just need something to give you a bit of confidence that you CAN sort it, and then you will break out of this worry cycle, which can only help.

If that doesn't work, it sounds like it's really affecting your life, so I agree maybe try Accutane if the derm will give it to you in future? If you were near London I'd tell you to see my derm, she'd sort you out!

Biscay Oh ok. Good luck with TTC and fingers crossed it sorts out your skin :)

bananafish I did not get on with skinoren or treclin at all! It's funny how different things work for different people. (Slight thread hijack... did you get your Burberry trench yet?!)

Interestingly Skinoren is the only thing I know of (currently) that you can use during TTC/pregnancy/bf'ing.

I've had cystic acne for years, definitely hormone related.

It gets worse with dairy.

I currently have clear skin and have had one cystic zit this year. I've had a couple of 'rumbles' where I've felt like a couple are coming but have not broken through. I stopped listening to the dermatologist who basically just cost lots of money on their time and products.

Now I cleanse every morning with simply St Ives very abrasive scrub. Probably bad for my skin overall as should be a 2-3 times a week thing, however I've stopped using other things apart from that, and a decent soap at night. No moisturiser, no nothing. Skin probably isn't in good shape (I can't see anything wrong with it to be honest though), but I'm not getting my big mingy embarrassing zits. I can even go makeup free these days.

Talking about the oils, there is a book by Liz Earle about them called New Vital Oils. It's fascinating.

Thanks @BlairWaldorfLovesShopping - yes, very low, bordering on depressed with it actually, and exhausted of the constant worrying and constant disappointment. I should be in my prime, late 20s and about to get married, and instead I feel utterly miserable.

I have just handed in my prescription from the hospital for Lymecyline and differin, but in two minds whether I should bother. My digestion is very good and I really don't want to mess it up with antibiotics that are unlikely to work long term. I wonder whether I should use the differin and either wait/see/pray or make a private derm app to get started on Accutane. I have wedding in 7 weeks and scared Accutane will make things worse before better, that my hair might be wrecked and how it would affect my honeymoon and holidays in the sun. On the other hand, it might clear me up immediately and mean I don't ever have to worry about this horrendous spots ever again.

What do you all think?

@MardAsSnails I have also quit moisturiser as my skin doesn't need it, and instead using Cetaphil cleanser morning and night and that is it. If I wear make up (only a handful of times per month) I will also use micellar to remove it, then cleanse. Only other thing is epiduo every evening though I don't think it is very effective anymore

I have finally worked out how to add photos so have attached one so you can all see what I am dealing with :(

A gentle steam will help alleviate those big trapped below the surface spots.

I've had success with facial steaming followed by cleansing my face with waterless anti bacterial gel that is meant for cleaning hands on the go! Followed by a light moisfuriser that is patted on.

Hi I just wanted to tell you about my experience with lovely great spots like this. I have had them since I was 15! I am now 45. My lovely Dr put me on Dianette when I was 16 and my skin cleared within 6 months. I came off the pill at 25 and got pregnant with my son within 2 months. I breastfeed for 18 months the spots came back and I looked awful (but he was worth it!). I went back on Dianette when he stopped feeding and stayed on until I was 33 when I had my daughter, same again terrible skin until 14 months when I stopped feeding. I have been on Dianette since then until now. Over the years when I neared 40 various Drs said I needed to change pill (most will give you acne on top of your acne!) Then suddenly a cheaper brand of pill which is the same as Dianette, Co-Cyprindiol was suddenly brought out and not one Dr has said I need to come off of it! It does the exact same thing as Dianette, clears your skin and gives you really short periods (2 - 3 days). So I would suggest you try it maybe especially before your wedding to keep your skin clear. Then come off of it when you wish to conceive. On another note you are quite lucky my poor daughter has inherited my skin her face is covered in spots like yours but all over, and the doctors have tried all the skin creams and anti-biotics since she was 11, she is now only 12 and they are recommending accutance, but it can stunt growth and cause hair loss.

She has terrible skin and low self confidence because of this and she cant go on the pill yet because she hasn't yet started her periods but has had the spots since 9. Our only saving grace is when she starts she will be able to take the pill.