PCOS hormonal acne - any skincare advice

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I’ve had acne since my teens. Diagnosed with PCOS in my 30s. I’m now pushing 40 and still have acne. I’ve tried all the medications (Dianette, topical antibiotics, benzoyl peroxide, Roaccutane, Spironolactone, also a period of dairy free) Some have had some effect but then plateaued, none cleared it up totally.

Due to the acne and being overwhelmed I’ve shied away from most skincare. I currently use almost nothing. But I’d like to try a different approach. I’m worried though about anything that will make the acne worse. Serums and heavy moisturisers seem likely to clog my skin - I think?

I do need a decent cleanser though (currently using wipes ) and perhaps retinol? My skin seems pretty tough and doesn’t react.

Any recommendations, specifically for people with acne? Most people seem to have dry sensitive skin - that’s not me!

No, my acne didn't get worse in those first 3 weeks, just that it took 3 weeks to work and then no new spots and the recent ones cleared quickly.

Thanks - I might try it from tonight since I already have it!

Need to try to work out whether it’s ok to take it alongside Spironolactone...

I've had hormonal acne all through my twenties and thirties. Of course everyone's skin is so different, but this is what has worked for me:

Less is more with skin care, after some rather 'elaborate' regimes in the past I generally now just use a cleanser, a serum and an SPF, alongside some meds I get from the doctor, and my skin seems much happier for it. In the mornings I use Duac from the doctors just on the areas I get hormonal acne, in the evening I use Differin in the same areas (also from the doctors) and I go through spells of using Spironlactone when my skin is bad, although I try not to use it all the time. For me the Spironlactone dose was quite tricky to get right, it only seemed to really start working once they put me on a dose of 125mg, which took them about 9 months of trial and error to work out. When my skin is bad I also try to use the Neutrogena red light mask every day. Its a complete pain in the a**e to be honest! But it only really seems to kick the acne into touch if I use it every day. I don't think its ever one thing that gets rid of acne TBH, its getting the right cocktail of things that your skin responds to, but there's lots of good suggestions here :)

Oh, one more thing! I think the cleanser you use can make quite a difference as well. In my experience oils and balms that I wash off with a face cloth have worked better for me, rather than specific acne cleansers. I was told that acne prone skin is often actually quite delicate and dehydrated, so stripping it with harsh cleansers just puts your skin out of balance and your face will produce more oil to try and compensate. Again, everyone is different, but the Neal's Yard Wild Rose Balm, The White Company Super Balm Cleanser (actually made by the people that make the very fancy NIOD skincare range) and True Skincare Safflower & Geranium cleansing oil have worked well for me. Just remember to be religious about using a new face cloth every day or two! I very occasionally use something very gentle with a bit of salicylic or glycolic acid in it if my acne prone areas are feeling a bit 'clogged' but I try not to do so too often.

You won't need the spiro anymore and you can just stop taking it but obviously speak to your GP first. There would be no problem taking them together just make sure you drink at least 2 litres of water a day.

I'm currently taking Millinette (about the tenth pill I've tried, and the only one other than Diannette that's worked for me) and Lymecycline (antibiotics). GP and dermatologist have both said I can take these indefinitely, which I plan to do, as usually I try to wean myself off treatment only to have a horrific break out! Accutane worked for me but my skin got worse again after a year or so. I was offered another course but didn't fancy the dry skin side effects, which I think also aged me really badly (could just be getting old, but I'll blame accutane!)

Thanks everyone

So, I have started taking DIM. Going to keep on the Spiro for now and see if the DIM helps, if so I can wean off the spiro.

I have also bought a cleansing oil (a vit c one) and gentle face wash (cetaphil) plus a once a week glycolic exfoliator to replace my current routine of soap&water in the morning and face wipe in the evening.

And I’ve switched from my nivea BB cream to the La Roche Posay tinted Effaclar moisturiser. Looks much better actually, I really like this.

Let’s see...

I just see from one of your posts that you didn't get dry lips from the Roaccutane you took in your 30s. theis means it's highly likely you weren't absorbing the Roaccutane, as @Fluffycloudland77 said. Dry lips are pretty much a universal side effect.

I think your best best is to return to your derm, esp since your acne is so resistant.

Thanks @championquartz I missed that from fluffycloudland. Yes, they were slightly dry but nothing like as dry as they were in my teens. So why would I not absorb Roaccutane and what could I do to ensure absorption...?

I’m reluctant to return to the same dermatologist for more Roaccutane as she was private and so expensive (plus it’s just nasty stuff all round)! I don’t know if an NHS derm would give me Roaccutane given the spiro works 75% - I have spots but not nearly so many as without it - and given Roaccutane didn’t work for me before?

It’s worth a try, the idea is you don’t wake up and check gor new spots every day.

Vitamin a is fat based so gets absorbed better when there’s fat in the meal hence I took it with dinner.

Ok it’s not a fun drug to take but it’s highly effective where other treatments fail.