Can someone help my spotty face?

[taybert]

I have acne. I’ve basically had it since I was 11 (37 now). I’ve had times when it’s been better (on the pill, various medications) and worse (pregnancy). I’ve had 2 course of roaccutane as an adult, the last one finished about a year ago. I’ve been on Epiduo (benzoyl peroxide and adapalene) with spironolactone for maintenance since but for about the last month, it’s back. My head is an oil slick, I get rid of the breakout I have and another one pops up. It’s a familiar tale and I know I’m probably heading for the return of painful cystic spots soon.

I’m a doctor so I know all about the different meds and I’ve either had them and they haven’t worked or or I can’t have them now (eg OCP). I don’t have the strength to do another 6 months of roaccutane for the sake of a year off spots.

So please wise women help me! Having spent thousands on miracle cures for acne over the years I’ve pretty much given up on complicated skincare regimes beyond cleansing and an oil free moisturiser in the morning. But there are so many more products around now with active ingredients and I wonder if there’s something that could help a bit. Even just to reduce the oil.

Ideas very much appreciated! Thank you.

@user1486723488 no but interestingly amazon keeps trying to sell it to me!

I had awful spots from 14 and then late 30s i got horrible cystic spots along my jaw. I saw the GP and a derm and tried various lotions and tablets (not roaccutane). Three years ago i started using Paula's Choice products, the most important for me being the BHA 2% lotion. I now get one small spot about every 6-9 months. It's been amazing for me, not having to think about my skin. May be worth a go for you.

I have had breakouts for years and the only thing which has helped significantly is retinol/antibiotic combination from my doctor

@Fluffycloudland77 and @taybert well that sounds significantly off-putting!

It’s not that bad. I don’t get spots now unless I wear a visor at work & I get one on my forehead but that’s just while the pandemics here.

I would have taken capsules of dog shit if that’s what she’d prescribed 😂.

10/10 would do it again if I need to.

Have you tried oxytetracycline? I have taken that on and off over the years inbetween my 4 (!) courses of isotretinoin. Also have had success with minocycline.

Currently taking isotretinoin again, another long and low course, works wonders for me but only for the year or so I'm on it. But for me it is worth that year for my skin to repair itself.

My acne abated a bit in my 30s but got bad again after I had dc at 36.

You should try drinking plain kefir. And making sure you're eating a range of nutrients. No need to cut out food groups. You need to rebalance your microbiome. I suffer from hormonal acne, ezcema and psoriasis. I was on medication ranging from antibiotics to dianette for years with varied side effects. This year I decided to stop all medication and focus on natural remedies and it has worked. My skin isn't perfect but so much better. Read up about goat's milk kefir.
Topically I'd recommend niacinamide which will balance the oil but not cause dryness. Also green clay masks and pink clay masks. The pure stuff you buy in powder form and add water to make a paste.
I find French pharmacy brands best for acne and comprehensive skincare. I've had great results from the SVR sebiaclear range. Also the vitamin c booster from superdrug has really helped clear my skin as well as helping scarring.

I developed cystic acne as a result of menopause. The only thing that helped was La Rochay Possay effaclar duo +, I'm not sure it would work for you but worth a try, perhaps?

It’s really depressing when you read through all the ideas and you’ve tried most of them. Still, there’s a few new ones to try which should keep me busy unti I decide I’d be better giving the money to the dermatologist again! Hey ho.

I would say if you’ve tried all the medication then you should get light/laser therapy. I’m not sure what it’s called but you’ve have to get it done professionally and it’s pricy.

I’m currently using zineryt and it seems to be working. Not sure if you’ve tried it but you probably have already.

Im sorry that really sucks. I know how you feel. I did roaccutane 6 times in total, the last time I did 1.5mg/kg (in the US). Even that didn't fix it, it just held it at bay for a while. Sucks about the migraines and diannette because that eventually kind of worked for me, alongside low GI diet because it was PCOS that was the ultimate cause (I think). The thing that worked when I was off the pill was Isotrex gel (topical roaccutane) it is also supposed to be good for wrinkles but I didn't get that benefit. Hard to get in the U.K. because of shortages, but see if you can get through an online doc if you live remotely? Last thing I'd say is that none of the fancy moisturisers etc can touch my face without a breakout - it's bucket o' Nivea and simple soap. I'm sure it's nothing new to you and you've probably been through all of these, but I want to say that I feel your pain!!

I really feel your pain op. I'm 40 now and have had acne on and off since I was 12. Dianette was the only thing that properly worked but my GP refused to put me back on it after dd2 was born 10 years ago. I use effaclar duo which seems to stop the spots hanging around as long as they usually would, although doesn't stop them appearing in the first place. Nip and fab products are also quite good. Unfortunately giving up alcohol seems to help but I just can't do that long term! I want to try giving up dairy but can't find a non dairy milk that's acceptable in a cuppa. Plus cheese 😩

I wouldn’t hang your hopes on dairy anyway @tiredanddangerous, I’m full on allergic since I was 27 and it never made a scrap of difference.

@taybert, would you consider a TCA peel?.

Is a TCA peel useful for active acne? I guess it works on a similar principle to a lot of the topical products. Might be worth a try.

Apparently on mild to moderate.

Not as much downtime as a phenolic acid peel.

Have you considered a prescribed topical tretinoin? I use Dermatica and they prescribed me 0.05% tretinoin with niacinamide. No side effects as long as you build it up slowly.

It’s £23ish including delivery and a tube lasts me about two months so it works out pretty cost effective.

I got pregnancy acne which didn't stop after the pregnancy. I had a great result from Roaccutane but still got bad monthly cystic acne (Roaccutane doesn't necessarily stop hormonal breakouts i was told by hospital) I've been using Paula's Choice BHA 2% as has my sister who has had acne since she was a teen and our skins have really cleared up. I also use that Sand and Sky pink clay mask which has faded marks on my face and seems to soak up the oil. I also use The Ordinary Niacinamide each morning followed by their hyaleronic acid then moisturiser. Retinal or glycolic acid alternately and rosehip oil each night. This was recommended on here. It's been getting better every month and this month I got one small bump instead of all across my neck and jaw.

I really feel for you as i have had the same since i was 13 now early 40's. I have very oil skin and have tried all the products, changed diet etc. The last 18 months my skin has been clear with only the odd outbreak and is nowhere near as greasy. I got the tip off here, what has worked is the ordinary niacinamide and zinc 10%. I only cleanse morning and night and then put a thin layer off this on top. I'm not exaggerating when i say its life changing as i know how much skin can really affect your confidence and make you feel down. It took about 2 months for me to really stop breaking out but it controlled the oil after a couple of uses. Well worth a try.

I had cystic acne and Roaccutane didn't work for me. The only thing which has helped is my dermatologist's routine (I get the odd tiny bump now but otherwise my skin is clear and healthy and glowing and I actually get compliments on it from strangers!)

AM

Cerave hydrating wash
Obagi Vit C serum
Skinoren (azelaic acid)
Avene moisturising cream

PM
Cerave
Prescription retinoid cream
Avene moisturising cream

Plus some treatments to deal with rolling scars - but the above is what sorted the live acne out!

Have you looked into cycle syncing and hormone balancing? I'm seeing a function medicine specialist soon about mine as I get terrible hormonal acne at 38, which has got progressively worse with age. My understanding is that antibiotics etc don't help long term because they don't address the cause and then can even make it worse as they mess with your gut flora and exacerbate the problem.

I think acne is a result of your liver not working at it's optimum and could do with some support.

I had menopausal acne, massive cysts on my chin , neck and jaw line. I was prescribed Differin and it's really helped clear my skin. Good luck x

Are you me? Seriously I have the same and I completely sympathise, it's awful. I have tried almost everything apart from Roaccutane and sadly that looks like my next step. Stress is not making it any better either.

Sorry to hear this OP, must feel desperate. I know it feels like you've tried everything but have you tried a kinesiologist? My whole extended family, one after another, have been to see this chap in Sussex who I swear is a miracle worker who has been doing it for 40 years. He basically just works out, using muscle testing, once and for all what things your body can digest and process and what things it can't. And it's incredibly specific. So forget, let's say, citrus fruit. He will tell you that it is, let's say, only grapefruit that is the problem. My sister had all kinds of medical diagnoses and was taking various meds that weren't helping at all. She'd had 'acid stomach' and headaches for as long as I can remember but After a consultation with him and cutting various, seemingly healthy things from her diet, she's never had a headache or 'acid stomach' again. My brother in law went to see him. He was beta blockers, statins, the whole works, had been told by his doctor that he'd have to be on them for the rest of his life. A few appoitnments with this guy and he's off all meds and is healthier than ever. My son had awful spots on his upper arms. One appointment to sort out what he wasn't digesting effectively and hey presto, they were gone within a few weeks. Sorry to go on, I just believe so passionately in this guy. Don't ask me how it works, but it just does, though you have to follow advice religiously and check and double check all labels etc. Good luck for the future, I hope something works for you.

Roaccutane isnt that bad @Boobsarenotloadbearing, a lot of the negative press comes from people who haven’t even had acne. Usually with a list of top tips like don’t pick them and cleanse twice a day 🤨

No one cleanses more thoroughly than an adult with pus coming out of their faces.

That’s miserable OP, what a lousy problem. I’ve had cystic acne all my life and Roaccutane was skin and life transforming. I had a long and low course and I was sorry to stop it! That was 10 years ago or so. I see my skin becoming congested again, although I have no spots (yet). I know I’ll have to go back on Roaccutane at some point but I’m considering long term Roaccutane- something like 10mg twice a week. I don’t think the derm is keen but I find it hard to find a reason not to. Severe acne is miserable.