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 :)

Hi OP, just saw your post from yesterday. I have only ever used Duac in the morning and Isotrexin in the evening - both every day (after working up to that of course). You aren't meant to use retinoids in the morning.

Thanks @BlairWaldorfLovesShopping

I am starting Lymecycline today. Will continue using the epiduo for now but have appointment next week to ask for Duac and Isotrexin instead, so will hopefully starting integrating those next week :)

I will keep you all posted on how I get on!

ppeatfruit Did you eat a sanctimonious person with no understanding of acne?

Yes she was delicious thank you alpaca . Hormones are also affected by what we eat. If you read the op's reply you would've read that she has been badly affected by food , so have I, it was acne that wouldn't clear up for ages. Only cleared by me taking Evening Primrose Oil and using Weleda cream . I opened my mouth and took the EPO . Funny that.

There are also many doctors and medics who are saying that too people are taking antibiotics for too long. Trying to find other ways of combating problems is the way out. Like looking at our foods.

I could eat anything or nothing, and it wouldn't make a jot of difference to the fact that five days before my period I get a break out along my jawline (unless I take something hormonal to counter it)

I think that is probably the same for me @OlennasWimple (although mine seems to be earlier in my cycle - my skin is usually good the week before and during period). I have tried cutting out the obvious like dairy (although I don't really like yoghurt, never drink milk as I hate it and might have cheese, cream or ice-cream twice a month max) and alcohol. I cut out caffeine for a couple of weeks which was painful and made no difference (I only drink one cup per day).

I feel my diet is pretty balanced - I don't have a lot of anything other than vegetables, everything else I have in moderation, so have always been doubtful that it could be caused by diet.

I am hoping the antibiotics give my body some time to sort out the bacteria and give me a mini reset, and hopefully when I come out the other side with my topicals, I will be able to control it. If not, will resort to accutane :)

Hi again,

Differin didn't seem to do much but Epiduo did for a while.

Thanks for the other suggestions, will look up the toner. I have read acne.org obsessively for 4 years, it is my bible! I have tried using GA but haven't found it helps much. I suppose the main issue is that I was a permanent cure/prevention rather than treatment.

I can get isotrex from Pharmacy privately so I might do that. Day 3 of antibiotics - no nasty side effects yet, hopefully will stay that way!

Hi user,

Hi user, I haven't read the whole thread and don't know much about acne but my daughters friend has had terrible acne and she has just brought an aloe vera plant which she has been using directly on her skin and says it has had very impressive results.

Hi everyone,

Quick update. Been on the antibiotics for about 12 days now. No side effects so far. Skin definitely doing a bit better - I had some little clogged pores before taking the antibiotics and it was just a matter of time before they got inflamed and became massive, but instead they have got slightly inflamed and then cleared within a day which is not how my skin normally works! Will update again in a couple of weeks. Praying for clear skin for my wedding in 5 weeks!

Hi all,

Quick update - now in my third packet and the difference to my skin is already huge, and thus the impact on my social life, confidence etc. I have felt really relaxed and happy this last week or so and it has made me realise the enormous negative impact my skin had been having on me. I haven't spent all day worrying about my skin, trying to hide or avoiding social occasions and for the first time in a long time, I have felt conformable with my other half (would usually avoid him all night, take long baths and wait until it was dark to be around him).

On a more negative note, I have been having a few digestive side effects, but nothing too bad. I have started a probiotic supplement yesterday which I probably should have done from the start but I usually tolerate antibiotics quite well so wasn't sure if I would need one.

I haven't started using the isotrex gel yet, mainly because I wanted to see what impact the lymecycline would have and also because I am away on holiday a fair bit over the next couple of months and concerned about sun damage with using a retinoid. I will probably start using it in September once holidays are out of the way.

I will keep updating as someone else might be having similar problems and my experience might help :)

Have you tried probiotics? Made a big difference to my skin. Can recommend Prescript Assist, Jarrod Ideal Bowel Dormula, VSL#3 and S.Boullardi.

Did you have a bout of food poisoning anytime close to the onset? I did, and I developed really bad intolerance to dairy (lactose) and also certain other sugars (fructose in particular as well as polyols). The illness led to gut dysbiosis.

For the first three years of being no dairy, any trace of dairy and a huge cyst or two (or more) would erupt. So I would say no dairy is safer than low dairy. Now, five years on, with help of the probiotics, I can have a little bit of (high fat) dairy now and then, but only in the 3 days or so before my period. And I take a full sachet of VSL#3 right after.

I also found that fructose/polyols had a big influence on my skin. So I eat low fructose and polyol too. This means eliminating certain types of fruits (tree and stone fruits mostly, so apples, pears, peaches) and just eating others (most berries, citrus, pineapples, papayas all ok for example).

The reason it isn't always clear that a particular food causes skin trouble is down to it being about reaching a threshold. Imagine there is a bucket in your tummy, one that holds certain types of sugars. As long as the sugar stays contained in the bucket, everything is fine. But when the bucket overflows, you get skin problems.

The thing is, different types of sugar fill the same bucket. So you can eat a little bit of dairy (lactose) one time and be fine. But another time you break out, and it's because on that occasion you'd also eaten some fruit high in fructose earlier in the day, so the bucket overflows.

The idea is that when you eat certain sugars, certain bacteria in your stomach feed on them, this throws your tummy out of balance bacteria wise, and when this happens it affects your hormone balance.

I found it simplest at first just to go really low sugar. Then over time I researched levels of different sugars in different foods. I used this to work out my threshold and which fruits etc are safe for me. This database is really useful.

In effect, I avoid some fruits and vegetables totally, only eat high fat dairy in the run up to my period and eat other fruits sparingly (never two days in a row).

I know it sounds complicated, but it's really worth it. It helps with weight management too. And I don't need to be on any medication that could affect my ability to conceive or carry a child healthily.

Sorry, see you are taking probiotics- didn't see your last post before I started my epic one!

It's Jarrow Ideal Bowel Formula.

I've struggled with cystic acne for most of my adult life. Stumbled on a magic cure thats cleared out my skin 100% with no medicines, creams or topical treatments. SUGAR!

I've eliminated all sugar, grains, carbs (as much as possible) and within 10 days all my acne, spots, bloating has disappeared. My skin is completely clear and tight (revered about 5 years of aging).

Nothing has ever worked for me beyond a few weeks or months. Am never going back to sugar!!

I must add that it's been 6 months now and not a single spot or acne has appeared. Not even the one that definitely comes prior to my period. It's a miracle!!!

Hi user, so glad to read your last update, I had been thinking of you! Onwards and upwards. Hope your stomach settles down soon, I had lots of issues like that with the lymecycline and thrush, yuck.

How long til the wedding? :)

Hi all,

Thanks for all your comments and suggestions. I am not totally ruling out the possibility that food contributes, but the fact I only get one or two spots every month and the rest of the time I am clear (and also ONLY get them on my chin) makes me think it is hormonal rather than food. I cut dairy out for about 6 weeks (not difficult as I don't consume milk anyway, have butter maximum twice per month, don't eat cream, don't really like desserts so will only have ice cream a few times per year) and it made no difference. Also tried cutting out coffee and alcohol, again no difference. Never had food poisoning and generally have very good digestion. I suppose the other, perhaps lazy (but honest) point is that I do not want to spend my life never eating sugar, dairy, carbs etc. That to me is worse than 6 months of accutane. Constantly worrying about what I am eating, whether it will trigger a breakout and having to live like that forever seems totally miserable, even though I appreciate this does work for some people. I am already very healthy, make everything from scratch, don't eat processed foods, barely eat bread, no dairy, very little sugar (handful of maltesers or alike here and there). I don't really eat crisps, I don't like cake or biscuits. I eat organic meat and get at least 7 portions of fruit and veg (mainly veg/salad) every day. I am also very slim (BMI 18.5), walk miles with my dog every day and go to the gym a couple of times per week to do cardio.

This all started when my periods became regular and my PCOS magically disappeared. Before then, when periods irregular and had PCOS, I had perfect skin. So I do think mine is linked to hormones and ovulation, which I didn't do before.

Stomach seems a bit better since I introduced probiotic and swapped the time I take my antibiotic to lunch time, with food. Hopefully will keep that way.

I am really concerned about the problems returning when I get off the antibiotics, as basically every review on the internet says acne returns. I am also conscious of not being on the antibiotics for too long, so I am only planning to stay on until end of Sep after wedding and honeymoon (will have been on them approx 3 months then).

Will start using the isotrex in September and perhaps that will help reduce chances of problems when I do come off antibiotics. But to be honest, the freedom I have felt and the confidence/happiness the last week or so has made me realise I am totally willing to take accutane if I need to in order to have a happy life. I can't believe how totally miserable I have been the last 4 years because of my skin and I can't face feeling like that for the next 50 years of my life.

Thanks again for responding and for your suggestions, I really do appreciate them!

My skin is not perfect but it's a lot clearer than it was a year ago. Things that helped get rid of the persistant cystic acne on chin:

A short course of diamond wand microdermabrasion
** Stop switching and trying skin care products, stick to one cream/exfoliator/mask
Stop using heavy creams
Stop using foundation, heavy concealers
** Very basic cleansing / washing routine (leave skin alone most of the time)
Stop touching / picking skin during the day
Went on the pill
** Reduced stress levels drastically (ditched ex, increased exercise!)
** Eat less cheese and sugar
** Take Magnesium and B12 tablets

I believe the items marked ** helped the most!

Hi all - another update. So far, so good - no cystic spots since I started treatment. Side effects manageable - stomach issues settled once I swapped to taking antibiotic at night after meal. Have had a few minor thrush type symptoms but things keep settling down themselves without further medication. Been taking for a month next week - have another month to go at least. Derm originally said to take for about 4 months and then extend a further 6 months, but I would prefer no to be on antibiotics for 10 months. Hoping that can be reduced since I had positive effect immediately.

Hi all,

Probably my last update. My skin was clear for my wedding day - hurray! I had the most amazing day. However, the antibiotics were only partially successful. After my last update I got a breakout around my period. Not cystic thankfully, but deep white heads that appear as a red mark/bump first and you just know they are going to be big and horrible. I had 2 or 3 but they came to a head and cleared within 5 days, although left marks as usual.

After that break out I decided I had nothing to lose by trying the isotrex retinoid. I have been using that daily ever since and think it has had a dramatic effect on my skin. I have had a few bumps since, but much smaller, come to a head quickly and/or dry out and disappear. I have also had a dermaplaning facial and incorporated azelaic acid this last week and this has improved the texture of my skin and helped with hyperpigmentation.

As it stands, I have only had problems with my skin around my period, for the last 10 weeks which is an improvement as I was previously getting issues around ovulation too. The pimples have been smaller, although deep, come to a head within a day or so and disappeared after 5 days. So all in all, this is a good step forward. I am hopeful with continued isotrex and azelaic acid use, things will continue to improve.

I stopped the Lymecycline after 8 weeks, just before my wedding. The side effects became unbearable, including thrush and stomach problems, and I hadn't seen enough improvement from them in the 8 weeks to believe they were going to 'cure' me. They may have helped, but I am hopeful that the other topicals have been the main contributor.

Thanks again for all of your advice and suggestions.

You have my every sympathy. I had the same from the age of 27 to 45. Appeared overnight and also went overnight. Totally hormone related and anyone who ever blithely suggested it was linked to my diet got very short shift! I tried everything and antibiotics helped for the 4 years I was on them. Blue/red light therapy helped massively and is clinically proven and recommended by derms. You can either buy an at home device or go to salons for treatment. I'm pretty sure the one I bought has a money back guarantee too.

I generally have clearish skin except these chin monsters that appear from time to time. So disgusting. I was put on Lymeccyline for 6 months and had great skin but at the end of the course they eventually started appearing again. Gutted.
The doc has suggested Roaccutane but I am a tad wary as it's harsh stuff.

Hi . On another thread on here folks were recommending hibiscrub /hibiclens (UK/US) for cystic breakouts. It's just a strong anti-bacterial wash, not specifically for acne. I have cyclical breakouts with cysts in one place on my forehead so have been trying it twice a day and I do think it's making a diffeeence (no new ones). Very cheap and straightforward so worth a shot?

Hi again everyone,

I have had some success with a mixture of isotrex and azelaic acid. I am still getting the odd small blackhead or pimple here and there but have largely controlled my chin with these two products. Although I get the telltale small red mark/bump on my chin that would usually be the start of a cyst, I have found that using these products daily means they don't materialise (touch wood!) and instead just go away after a day or two without ever having properly come up or formed. I am only using the product on my chin, hence still get the odd small pimple elsewhere, but overall I am pleased with this. I should say that I only really have a problem around ovulation and then my period week, but this is controlling it by and large. Thanks for the suggestions, will incorporate some other products as suggested by other people as and when these stop working or I need an alternative.