PCOS acne. Roaccutane didn’t work. Ideas?

[minipie]

I’ve had acne since my early teens. I’m now 40 and beyond fed up of it. Tried over the years:

Zineryt
Duac / Epiduo
Laser
Roaccutane - twice (via private dermatologist)
Dianette
Yasmin
DIM supplement
Spironolactone
Probably some other stuff I’ve forgotten

Some had no noticeable effect. Others - Duac, Roaccutane, Dianette, Spironolactone, DIM maybe - produce an improvement, but never fully clear.

Do any fellow sufferers (or ex sufferers!) have ideas on where to go from here? I can throw money at it if needed. If suggesting a dermatologist - any specific names would be most welcome.

Thank you ....

@minipie I do! My skin was never absolutely terrible but Marvelon has made it flawless with a very lazy and sporadic actual routine.

Yes, I have PCOS (or perhaps 'had', now I'm post menopause - I'm not exactly sure). I wasn't diagnosed until I was TTC, my only symptoms before that were acne and very irregular periods. For sure different pills make a difference. Dianette did work for the acne but made me depressed, which was when the GP recommended Marvelon. Before that I'd been on microgynon which was ok, but at one time I tried one of the other types (with progesterone) and that was bloody awful for the acne.

Differin is a type of retinoid, I think Tretinoin is more effective though it can at least help fade old scars faster and help even out skin tone if you have areas of redness.
I think it's worth having a strong retinoid and zinc sunscreen even if it's not a cure (although for some it is because it reduces oil production) but I know you've learned to manage your expectations so any reduction in active spots would just be a bonus for you rather than expected.
BTW Differin (adapalene) did nothing for me but Tretinion is giving my complexion some brightness all retinoids are not equal.

Thanks @minipie think I’m just feeling a bit down about it today (maybe my mood has been affected more than I thought 😂)
And @Fluffycloudland77 that does make sense, thank you.

I’ve not been taking my 60mg with food, have been doing it about 11pm when I remember before going to bed so maybe I should take with dinner instead.

You really need to take it with food each evening.

I do understand. I completed a course of Roaccutance 3 months ago and it hasn’t worked.

Ok so I haven’t tried Differin but did try Epiduo (mix of benzoyl peroxide and adapalene... I think?) However I wasn’t on that for long as I got pregnant

Marvelon sounds worth a try, I’ve never been on that one as I recall

Tretinoin I had thought was just another name for retinoid but maybe not!! I am guessing that requires a dermatologist prescription does it @Anotheruser02?

also Anotheruser02 sunscreen is something I’ve never really used except on holiday because it makes it worse. Can you recommend any specific ones to try?

Some people get a prescription for tretinoin (from Skin + me or Dermatica) some people buy from abroad (like Pharmacy Geoff website) if you self prescribe from abroad start with 0.025% before moving up a stage to 0.05% then 0.1%. I'd try this Ren sunscreen I also really rate Eclat mineral sunscreen which is also zinc oxide but I've struggled to buy that this year it used to be on amazon.
Adapalene is slightly less effective than tretinoin but less irritating, from what you have said though you probably wouldn't find it very irritating!

@minipie

also Anotheruser02 sunscreen is something I’ve never really used except on holiday because it makes it worse. Can you recommend any specific ones to try?

I'm pretty good about using sunscreen nowadays because I've got quite fair skin and sun is really bad for rosacea. At the moment I'm using a Boots Protect&Perfect one - it's a bit tinted, factor 50. If I need a waterproof one we all use an Avene one recommended for DD when we used to do watersports in Greece. Very good protection but gentle.

www.avene.co.uk/suncare/sunscreens/sunscreens-sensitive-skins/lotion-for-children-spf-50

In the past I used a Clinique one, I think it was called something like City Block.

My gynaecologist put me on Microgynon for my PCOS and it also helped my acne. I certainly noticed a difference (not a good one!) when I stopped Microgynon (my GP refused to prescribe it for NHS cost reasons - prior to that I'd paid for it privately).

One if the issues with sunscreen breaking people out is that you need to treat it like make up when you cleanse, if your cleanser wouldn't melt a lasting foundation then it wont dissolve a sunscreen.
I agree that overly complicated routines aren't always useful but when it comes to cleansing the balm type cleansers will really break down make up and sunscreens, and obviously you don't want to leave them on an oily skin type so that's why a double cleanse is good just for the evening, first cleanse with a balm to properly melt away products, second cleanse with a wash more suitable for your skin type to take regular sweat, sebum, and any remainder of the first balm.

A low carb diet always clears my skin. By cutting out sugar/flour/dairy I can reduce 90% of my acne. Glycolic acid toner and Salicylic acid serum every night also helps, but what I eat is more important. (I’ve suffered with acne since I was a teen, PCOS, gestational diabetes, I’m a similar age to you).

Anotherducker I have a suspicion you’re right. Generally my body is happier without sugar and flour. Shame they taste so damn good!

Not sure I can cope with cutting out dairy as well as sugar and wheat though! I’d rather have acne

Have you tried Inofolic?

Nope - what’s that Orange?

Ahhh you have my sympathies. I am on roacctane for a third time (in my 40s). Previously it gave me clear skin for 3-4 years so hoping this may be the last time. Mine is totally hormonal, I get the worst cyst acne.

I love Dr Basarab at Wimbledon Parksise hospital. She is also at a couple of other places if you google her.

Thank you, I’ll look her up

I have Endometriosis in my late 30s and have been really struggling with my acne. The mini pill is the only thing that controls the Endo pain, but acne is a side effect (although mine was bad anyway). I'm currently on day 31 of the acne.org regime and have seen a really good improvement. Is it just on your face or is it body too? I have it all over my back, chest, stomach (yuck) and neck. But this is the first time in ages that something has shifted it. It's bloody time-consuming tho. I've also gone low dairy too....

2 rounds of roaccutane for me too - didn't work. Had acne from 13 now 48.
2 years ago, found DIM - 3 weeks in and all acne gone. Still taking it.
How about combining all of it - so low carb, no sugar, no dairy with DIM and a topical vit A derivative. And drink spearmint tea. Also take a look at Ashwagandha supplement - reduces cortisol which can reduce workstations effect on sebaceous gland and follicles.
I also use Soolantra as have concurrent rosacea - could that be you? Google demodex theory.
Don't bother with Caroline Hirons - this suit is beyond her - it's not a Skin issue, it's endocrinology.

Workstations?? Aldosterone!

I got put on Metformin to help me conceive as I have PCOS but my acne is sooooo much better on it

JMAngel1 which DIM do you take, and how much? Sadly it’s not had the same effect for me.

Must admit I can’t quite bear the idea of going sugar wheat and dairy free especially when I’m catering twice a day for the whole family. Might be able to try it once kids go back to school.

I don’t know if I’d be prescribed Metformin just for acne (not weight loss or TTC) anyone know?

within Until my late 20s it was on my chest and a little on my back too but since then it’s been mainly face with the odd neck/chest spot. And bum!! What’s that all about..

I am making a little list of things to try (one at a time for scientific rigour); so far I have:

• Ask GP about Metformin for acne
• Try Marvelon (currently on Yasmin which is doing sweet FA)
• Tretinoin/Differin
• Low carb, low dairy - wait till dc in school
• Duac or maybe Epiduo (benzoyl & adapalene)

Wondering if it’s worth going to a dermatologist or Skin+Me type place; or do I try these things myself/via GP?

I have to admit I’m slightly disillusioned by my previous derm (who has a good reputation for this) who didn’t really know where to go when Roaccutane didn’t work..

I take smoky mountain brand.
Do you also drink caffeine - coffee, tea, coke?
If so, try stopping - got to do every thing you can to calm your adrenal glands down.