Acne - Mirena plus Dianette??

[emsyj37]

I suppose this should be in Health but it's not very busy on there so I'm hoping a doctor or someone with experience of this might be more likely to see my thread on here.
I've suffered with acne since I was about 13 (I will be 40 soon). I have had every treatment there is (including Roaccutane) and it always comes back. I've had a few longish periods of clear skin, most notably whilst taking a combination of Minocin and Dianette. It's been a while since I've taken medication for my skin as I have been pregnant or breastfeeding for the majority of the last decade, but my face is really really awful and so recently I visited the GP who prescribed Minocin but said I could only take antibiotics for a max of 6 months. I know the spots will return when I stop, and I know Roaccutane works better on cystic acne than my type (lots of little spots) so I asked about taking Dianette but was told I can't take it whilst I have a coil. I had a Mirena coil fitted last December and it was a traumatic affair involving anaesthetic being injected into my cervix, so I don't want to have it removed - plus I like having no periods!!!!
I found a US website that suggests you can take Dianette whilst having a Mirena - is it possible? The GP said not but experience tells me GPs aren't always very knowledgeable about combinations of medication etc so I want to find out more and see if it actually might be possible to take Dianette for my skin but keep my coil in. Any knowledge or experience gratefully received.

Dianette has a considerable risk of deep vein thrombosis so may not be suitable given you are nearly 40. I would look into alternatives. (Sexual health clinician)

Dianette has a significant thrombosis risk. Your background risk of thrombosis risk also increases with age. Dianette is now rarely prescribed due to the degree of this risk and when it is issued it's no longer a long term medication. Usually 6-12m max. If oral antibiotic courses or topical treatments are not helping it's time for a dermatology referral.

I've never considered the DVT risk - it was never mentioned when I took Dianette previously but I was in my 20s then I suppose. I have never smoked, I'm not overweight and I'm reasonably active (I run probably 20k a week). The only thing a derm can prescribe that the GP can't is Roaccutane- I guess that might have to be the route, but I don't have much faith that it will cure the problem.

I think you need a referral to a dermatologist too. Yes, the only thing your GP can’t prescribe is Roaccutane but you’re not necessarily getting a derm opinion for that. They can do lots more, various combinations etc. While your GP might be great with skin, derms have have expertise that a GP cannot have, and you’ve already had various treatments from your GP. Don’t put up with acne, it’s miserable. Give a derm a go.
As an aside, if/when you do visit a derm, they might encourage you to get the Mirena removed - any progesterone-only contraceptive is awful for acne prone skin.

As previous poster said a derm would be able to set up appropriate treatment plan. If it is hormone related you could ask a derm about spironolactone which is another androgen blocker but without the high levels of estrogen found in dianette.

Have you ever tried Yasmin combined pill? It has an androgen blocker in that and GPS may be willing to prescribe that? Although probably not in conjunction with mirena.

Progesterone only bc makes my acne awful which is why I opted for copper iud.

I’m assuming you’ve tried topical meds such as differin?

I don't think the Mirena has made any difference to my skin to be honest- I know some people find it exacerbates their acne but I haven't seen mine worsen and I've had a Mirena before (between baby 2 and baby 3) with no issues.
I've never heard of spiranolactone mintbiscuit - possibly there are lots of options I've not heard of as it's been 14 years since I last saw a dermatologist. Interesting to think there may be other options.
I do use Differin daily and it's the best topical treatment I've tried, but not enough on its own to control my acne unfortunately.

I don’t think a gp will give you dianette now op, my gp took me off it years ago because of the DVT risk and refused to reconsider. Which I’m pleased about now I’m older and wiser

Agree with previous about dianette being too risky over 40.
If you haven't tried anything for a while, you probably haven't had Treclin gel. It's topical roaccutane plus antibiotic. Loads of my patients love it and the ones who can't tolerate roaccutane are still getting clearance on it. Your GP can prescribe it.
Minocycline should be stopped, firstly because you shouldn't have topical and oral antibiotics at the same time, and secondly because it has been largely withdrawn due to side effects of abnormal pigmentation that can be permanent.
(Doctor currently working in Dermatology)

I've not tried Treclin, does it have any similarities to Retin A? I can't tolerate Retin A unfortunately, but I'm interested in the idea of topical antibiotic. I've used Zineryt which did absolutely nothing though.

Did you use Adapalene before? That's the retinoid one. It has similar side effects of mainly drying the skin and making skin more sensitive in the sun. Would be worth a try.

If you have a lot of little spots are they sure it’s acne and not rosacea? Probably a basic question but worth asking.

emsy. This was me - dreadful acne, 2 courses of roaccutane, spirokonokactone, upmpteen courses of antibiotics - acne woukd always come back.
I'm 47 and finally cured my acne last year for good - it had been getting progressively worse with perimenopause.
What worked for me
No dairy
No sugar including high glycaemic carbs
DIM supplement - this is key - google Eric Berg Oestrogen Dominance on YT - lifechanging.
African Black soap Pranaturals brand
No heavy creams/oils - just a light hyaluronic acid serum - Hado Labo etc
Get off all hormones - remove Mirena - your hormones are already unbalanced without adding exogenous ones into the mix.

Good luck. acne is heartbreaking but you can beat it but the power is in your own hands - steer clear of GP and dermatologists - they don't fix anything, just stick band aids on problems for a short time.

Differin is the brand name for adapalene Hiphopotamous so yes I've been using it for a while. Years in fact.
It's never been suggested that I have rosacea but that doesn't mean it's impossible. I've never looked into it really- maybe that's something to explore.
That regime sounds extreme Angel - I already avoid dairy because of my skin and I don't eat much sugar but I don't want to give up everything!! I also don't want to remove the coil unless I have to as I don't want my periods back with associated mood swings and bloating etc if it can be avoided. Obviously if removal was a guaranteed cure then I'd do it but I'm not convinced it's made any difference to my skin really.

I hear you emsy. it does seem daunting all written down but if you take the DIM supplement it will stop bloating and mood swings too - it's all about oestrogen dominance. Watch the Eric Berg YT video he explains the symptoms of oestrogen dominance really well and how a few lifechanges can help all sorts of symptoms that you never thought of as being related before. I had to change my mindset to what constitutes a treat - sugar is my enemy and is not a "treat" - if I have it, I need "treatment" to cure the problems it causes so it's the opposite of a treat iyswim.

DD had lots of little spots- described as sandpaper acne by her dermatologist. He specifically prescribed roaccutane because of this pattern. Apparently it is more resistant to antibiotics and other treatments.

It took two courses but her skin is clear now. He said he's known patients need three courses, or long and low treatment though, so worth considering another term appt.

@emsyj37, I’ve recently started Adapalene for my adult acne, having also had roaccutane in my youth. I was just wondering, how have you found it when you’ve gone abroad and have been exposed to the sun? I’m due to go on holiday in 2 weeks and I’m a bit worried about burning or pigmentation problems.

I hope you find a solution for your acne- it’s miserable!
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