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.

Sooo I have found that giving up sugar and wine made a world of difference. I still drink coffee and other alcoholic Drinks and don’t seem to have any skin reaction.

I’ve tried lots of gentle retinol but the one that has been very effective is the 2% retinol by the ordinary. It’s the one that isn’t in squaline. Maybe look
At what Caroline Hirons recommends? She takes a gentle approach. Find that when Im harsh with my skin it doesn’t really help.
All the best xx

Have had acne on and off for 30 years... have had roaccutane in the past twice and it’s always come back...but...
Things which help:

Double cleansing my skin at night with any oil based cleanser and then cerave hydrate cleanser - using muslin cloths to make sure everything is off.

Cleansing once in the morning with the cerave cleanser

Using La Roche-Posay Effaclar Duo+ (Twice a day as first skincare step

Cerave moisturiser

It’s worked for the last 6 months which is almost miraculous...

That said - they are my must-do’s but there is definite trial and error in terms of finding your own way but do not underestimate the role of cleansing...if I wear make up I sometimes triple cleanse.

Good luck - you’ll get there - it’s trial and error, hormones and age

Desogestorol (Cerazette) worked for me.

I know you're not keen on altering your diet but it might be worth a try. My dp had horrific cystic acne all his adult life. He'd tried all manner of medicines and creams, including roaccutane, and had spent years on minocycline until he developed gram negative folliculitis. His skin had never been so bad and I don't think I've ever seen anyone with acne so extreme. When he was 40 he went low carb, so no sugar or starch, and it cleared up within 3 weeks.

Obviously everyone is different and eliminating one food can be effective for one person and not another, but the main culprits seem to be sugar and white carbs, dairy, or caffeine.

Have you tried honey and Turmeric powder.

Mix 1 tablespoon raw honey with
1 teaspoon of turmeric powder
A few drops of lemon juice optional
1 teaspoon of milk

Method

Mix into a thick paste and apply to face avoiding the eye area wash off with warm water after 10 to 15 minutes .
Two or three times a week

Hope this helps hun.

Dalacin T topical lotion worked wonders for me. But I’m unsure if my acne was different to cystic acne. Mine was hormone related I have PCOS

I developed acne at 17 after going on the pill. It turned to cystic Acne 3 year later. I must of spent thousands on facials, pills, lotions and potions. In the end a course of roccutane cleared it up completely, 40 now do still get spots but never as bad. I used to have microdermabrasion facials with laser, that did help a lot with scarring, but is expensive. My daughter started getting spots at 8, she 13 now and has acne, again I’m spending fortune on all different treatments, work to start with then stop, we’re now trying zinc tablets, I remember I used to take them and reviews seem to be good. She cut out dairy, won’t eat chocolate, sweets etc.. breakout still there everyday. It really effects self esteem but I remember how horrible it was when I was growing up. Some people used to be so mean and used to say stupid things like urgh look at your face you need to stop eating chocolate!! So does annoy me when people say change diet. A lot of people have great diets and still get spots. It’s such a horrible, distressing thing to live with, I hope you find something that works for you

My mother has had difficult skin, she has oilier skin at 80 than I did at 40. She tried everything in the end a dermotologist prescribed a really strong antibiotic for people with sepsis, she was on it for awhile and has never had another spot, this was when she was in her sixties. She is now lucky enough to have no wrinkles but an eating disorder wrecked her bones.

As others have suggested I’d try the ordinarys niacinamide and zinc and retinol. I apply a thick layer over night. Make sure you give your face a good scrub in the morning though to get any residue off and any dirt that could have clogged up pores over night.

@Lau52 Why don’t you take her to the gp?.

Hi OP. Have you had your hormones checked (I know you are a doctor so feel silly asking). Do you eat a lot of fibre e.g.weetabix, wholemeal soda bread etc?

I suggest another approach, do a food sensitivity test, check for food intolerance, CRP levels (not normal range but the realistic ones) you will be surprised.
Change completely your diet, start from cutting processed sugar and milk.
Also cut processed food, cook from raw, cut more open less :-)
Good luck
ps. sounds simple but it is hard and very effective!

My friend went vegan and there has been a significant change in her skin. That was years ago and and her acne has been much better ever since

Just want to pop into this thread as I have the same issue, acne since aged 11 and the only real fix for me is the combined pill. I have now been diagnosed with idiopathic intracranial hypertension so can’t take the pill anymore tried roaccutane as a teen and while it did clear my skin for about a year, it gave me quite severe depression too. I’ve tried light therapy, basically every drug and cream under the sun with no lasting results. It’s really hard.

I feel your pain. I had it really badly for at least 20 years. The only thing that seemed like a magic cure was Acnecide. I had roaccutane (did nothing at all) and every antibiotic pill and potion in the known universe.
I read about acnecide, was really annoyed that something so widely available sorted it out and I'd not known it existed. Just make sure you don't use it every day and don't be too precious about your towels.
Good luck. I know it totally sucks and it feels like the rest of the world has airbrushed faces. x

So I'm going to chuck this out there as no-one else has mentioned it and it totally sorted mine out. I got big shoulder & face flares ups in my late 20s and again after pregnancy in late 30s and has sorted both times, as well as helping if I ever get flare up from too much sunscreen or poor diet every now and again.

Linseeds. Cheap, whole ones (gold or brown, but not ready milled). Stick a tablespoon in a spice mill/grinder attachment of a stick blender. Whizz until the seed cases are broken properly and its a kind of dusty powder - they're hard cases so you need a decent small mill for this, anything that will do coffee beans should work.

I find the most tolerable way to eat it is to mix in with museli or porridge, (add it after cooking so the seed oils aren't ruined by heating them). But you can also add it to salad, or drink with water or apple juice (it gets really slimey if you leave it too long, a bit like fibrogel - don't spin it out!).

There is some science to it...the omega oils in the seeds help balance out skins overproduction of sebum somehow. Once your pores aren't clogged, no more acne.

You need to stick with it for at least 5 weeks to see a difference, so you've done a whole cycle of hormones. Then keep going if you see an improvement.

My diet overall is much better now, so I rarely need to supplement with linseed now, but interestingly, I never found that eliminating anything (dairy, caffeine etc) made a difference.

Having it fresh from seed source is somehow much more effective than an omega oil tablet. It is also very high fibre, so it should help bulk out your 'motions' and help with general gut health too.

Might not work for everybody, but it was like a miracle for me, and like many of you I'd been on the whole medication/pill options without ever properly sorting it out.

I have some scarring still across my upper back, but skin is clear....got to be worth a couple of months of slightly odd breakfasts to give it a shot eh? Nothing cheaper in the market, I guarantee it! About 2 quid for 2 months worth here: www.buywholefoodsonline.co.uk/brown-linseeds-1kg.html?gclid=EAIaIQobChMI7IOE2tPm6gIVied3Ch2OEQnyEAQYAiABEgKjm_D_BwE

Since you're a doctor, OP, you might be able to make head or tail of what the link is here, it's mostly gobbledygook to me ;) But basically the alpha linoleic acid in linseeds affects sebum production, so no more clogged up hair follicles, no more acne: www.ncbi.nlm.nih.gov/pmc/articles/PMC5821166/

Try the freederm range. It's the only thing that's worked for us. The face wash, moisturiser, serum and spot cream all work!

I think you need to take a multitude of different routes to tackling this. Like you I have ups and downs with my acne, the below helps my flare ups:
Minimum of 8hrs sleep
Clean cotton pillowcase, change every 2 days
Cut down on dairy
Lots of veg and fruit
Showering twice a day
Using natural products such as Ren/Drunk Elephant
Having a day or two of no make up a week
Get a tailored facial once a month with a dermatologist
2litres of water a day
Easy on the sugar and caffeine, this puts pressure on your adrenal glands
Take Probiotics
Selenium
Vitamin E

Finally get your hormones checked fully and thoroughly. If it isn't gut that's causing it, it is hormones.

Also I hate benzoyl peroxide it is a free radical and ages the skin.

I could have written this too! Stopping dairy really worked for me - I had to do so to feed DD - even though I really doubted it would. Also had two courses of roaccutane in teenhood, tried dianette but now get migraines. I have horrendous joint pain - abnormal for my age (I’m 32) and I do wonder if the roaccutane is why.

I’ve just decided to be spotty until I’m barren now to be honest.

Thanks everyone. Lots to think about here. I eat dairy but my diet is good- lots of veg, fruit, lowish carb. Do like cake but don’t have it even very week, I like tea and coffee and cheese and wine (but don’t drink to excess). I fast, I run, I drink water. I’m stressed (who isn’t?) I have a healthy weight. I don’t have PCOS or a diagnosable metabolic problem. I dunno, that feels pretty balanced to me.

I’m pretty sure I’ve tried every prescribed product or one in each class at least. That said some of them were 20 years ago so could be revisited. Everything I practise with regards antibiotic prescribing tells me it’s not good to be on them for months on end, and they’ve never really worked anyway. It doesn’t feel like it’s worth the risks.

Some of the regimes posted look like I could try them with just a few tweaks to my current one. They seem like a good place to start. Interestingly the in vitro effects of CBD oil look really promising, though there’s no evidence currently of it being effective for acne in practice (but that’s a lack of evidence, not necessarily a lack of effect) so could be one to keep an eye on.

I also realised whilst sweating away in my PPE today that facemasks probably aren’t helping, so maybe clear skin is another thing to look forward to”when all this is over”!

Lymecycline here too. It’s the only medication that works for me. I use Emma Hardie cleansing balm and le roche posay. I’m 51 and still have the meds on repeat for flare ups.

Thank you @Fluffycloudland77 its really helpful to hear from someone who has had it and that reassures me :) my docs were waiting till after lockdown to start so it can be monitored properly.

I use silver serum from the skin shop and actually swear by it. Its pretty gentle and the have a whole range.

I have seen adverts for a new night extreme pad from nip + tuck ( I think that's the name). Its in a tub and is fairly expensive in the shops, but the company has a direct deal on line. Hope it helps x

Feeling your pain! I had cystic acne in my teens, most of my 20s and even a couple of outbreaks in my 30s. In my case it seemed to be very much a hormonal thing and Dianette was what helped me most. Benzoyl peroxide did absolutely zilch and minocycline wasn't much help either.

I did actually have a course of Roaccutane, it was fairly effective, and I was lucky not to have the side-effects as badly as many people do. (That said, I feel I experienced some permanent thinning of the skin whilst on it, so I'm glad i wasn't on it very long.)

I also had some sort of paste at one time (forgotten the name) that had to be kept in the fridge and painted on to the skin, and that helped a bit. But on balance I'd say Dianette was what helped me the most. It's a pain that you're not able to be on a combined pill, as you said being on the pill had helped you - I'm wondering if your acne is primarily hormonal in cause like mine was.

Hope you get the right treatment and hope it improves soon. I know how much this sucks!