I think I'm having a cystic acne relapse after Roac

[ouch321]

Suffered from horrid cyst lumps under the skin in the chin area for years. GP prescribed 6 month Lymecycline which worked great after a month. Course ended and lumps returned. Referred to dermatologist. One more course of the antibiotics and she put me on Roaccutane. Was 20mg and supposed to be 1 year. Started v early Jan 2019. However 4 month in and they kept pushing my monthly appt back as the clinic so busy and when I saw her she said as you've been without pills for a few weeks no point carrying on. My skin was clear after going on Roac straight away so I wasnt worried.

It is a year now and I've had no cysts until now. Until last night when I felt that familiar tender lump under the skin. So so gutted and think it means it is going to start again.

Anyone experienced this and what did you do?

I am wondering if I should ask my GP to keep me permanently on the Lymecyline.

I had roaccutane and my acne returned. I now take Dianette which is really effective for me, and I use Differin or Retin A also. I've heard Spironolactone is a good option but I've never taken it myself.
Did you actually only take one month of Roaccutane in the end? Would you not try again with a full course? It worked for me for quite a long time (maybe 3 or 4 years) but my skin went to pot again when I started having children. I've taken quite a few different antibiotics of which Minocin was the most effective, but as you've found too the spots often return once the pills stop.

I had 4 months. Jan-April. Of pills.
Roac is a pain with monthly trips to hospital so days off work. Blood tests. Urine tests every month.
At least with the antibiotics you can get 6 months in a pack.
I really thought Roac would get rid once and for all. I don't know whether it's the short course or it would have come back anyway.

Hi both, can I just ask your advice about acne. I have been struggling for a few years and wondering what is wrong with my skin. It's more like lumps under the skin, no heads as such. Just wondering if I should push at the GP after the lockdown?

From what I’ve read, the lower dose prolonged course of treatment does mean a higher chance of recurring cystic acne.

Then again, I’ve had 3 courses of highest dose - 1st at 14 years, 2nd at 23 and 3rd in my thirties. None of these in UK and my perception is that here in UK there is a reluctance to prescribe higher doses due to side effects.

I do think that, for some, the higher the dose (but shorter length of treatment, mine were 3 months each) the longer your skin will be clear. When you get another appointment perhaps you could discuss this with your doctor.

I had a 6 month course I think. This was 16 years ago roughly, so it was the 'original' high dosage one rather than a long low dose one. I was told that roaccutane is great for cystic type acne but less effective long term for smaller spots, which is what I am left with. The large sore ones that sit under the skin and last ages and never come to a head are pretty much resolved for me - I do get the odd one but I'm not covered in them like I used to be.

Hello, I had roaccutane and dianette pill when I was much younger too, for acne. Many years later I still get spots in the chin area, but the only thing I've found to work is Roche-Posay Effaclar Duo+ everyday. Good luck!

Russell- yes sounds like cystic acne. They don't come to the surface. If you squeeze they will be full of sebum and maybe a tiny bit of pus but they are too deep normally to access as it were. They can stay for 2 weeks.

@ouch321 it probably would have sorted it once and for all if you had finished your course. You need to reach a cumulative dose which is around 120-150mg of accutane per kg your weight to ensure that it remains effective long term. Personally I don't see the appeal of ruining your stomach by constantly taking antibiotics. If you went back to the derm you could discuss taking a higher dosage (like 40-60mg) over a shorter period. 20mg is a very low dose imo but maybe you are very lightweight?

@edgehorn

Haha I wish!

No, I'm a little plump.

Dermatologist told me that these days there is a preference for a lower dose over longer time.

Sorry why did you say I would ruin my stomach?

I tried everything including being on Disnette from age 15 (which helped alot). I was referred to a dermatologist and took roaccutane for 6 months. My skin was beautifully clear. I then went back on Disnette. I had my last child in 2018 and that seriously messed my skin up. Doctor won't prescribe Dianette because of my age and blood lot risk. I've been referred back to a dermatologist. Its awful to have have worse skin the the students I teach. I wear heavy makeup each day which hides the redness (phoera foundation) but have oily skin so my face always has a mild greasy sheen and my pores are massive. It's awful; I'd have a pretty face otherwise, and this wrecks my confidence.

That’s a low dose. I had 40mg a day for 4 months.

Did they say you could go back if you relapsed?.

Lymecycline meant to be 4 months max unless under a consultant. Honestly I’d ring your dr, they can px lymecycline again while waiting for dermatology.

In the nhs the squeaky gate gets the oil. It’s very poor caseload management to put more people on isotretonoin than you can accommodate in clinic.

Hopefully your next consultant will be better at managing their caseload.

@MrsPworkingmummy have you looked into spironolactone? I've seen it mentioned on here a few times for chronic acne. I've not taken it myself tho. I was initially refused Dianette on the basis that I had a cool, but saw a different doctor the next appointment and got Dianette despite being 40 by pointing out that I dont have any of the other risk factors for blood clots - not overweight, never smoked, low blood pressure. The GP didn't prescribe it straight away but asked for an opportunity to look into it first, then later that day he called to confirm that he would prescribe.

Last year I had bad acne plus perioral dermatitis and my skin was so awful I just wanted to hide. It destroys your self esteem. I felt dirty and disgusting and didn't want anyone to look at me. It's so much better now but I do have scars and redness and I look hideous without foundation. I dream of being one of those women who can breeze around makeup free or with a smidge of tinted moisturiser, but pretty sure I will never get there.

Had a coil not a cool

@ouch321 I have heard that prolonged use of antibiotics can cause an upset tummy

My gp refused spiro on the grounds she couldn’t prescribe off-licence. This was Oct 2018.

@emsyj37. Have you tried retinol at night and vit c am for the scars? It’s fading mine. Plus I wear spf 50 daily even if I’m not going out.

Might be worth asking again @Fluffycloudland77 - take a look at the threads on here where it has been discussed as a treatment for acne?

I do use either Retin A or Differin at night yes, but I use Niacinamide in the mornings rather than vit c. I have heard vitamin c can be very irritating on the skin and I'm keen to avoid another lengthy bout of perioral dermatitis so I have avoided it up to now.

I don’t get acne anymore, the isotretonoin really helped.

My son had to have two courses of roacutane as the acne came back about a year later