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 ....

It's used off license for PCOS as it is, but I don't know. Does the PCOS affect you in other ways? I feel so much better in myself since taking the met, it has done more than just sort my skin. My baby is six months old and no one has stopped my prescription yet. I will beg them not to if anyone suggests it!

If you do decide to take Metformin it’s worth googling the side effects. It can cause upset stomachs and reduces your appetite. I had to stop taking it I felt awful. Don’t want to put you off, but it’s worth knowing.

@JMAngel1

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.

Yes I do - my coffee habit has crept up and up ... sigh, another thing to give up!

Hmm ok, I’m not sure about metformin in that case twinkle and Anotherducker. I don’t really have any PCOS symptoms other than the acne and there were cysts on my ovaries so that was enough for diagnosis. But periods are fairly regular, not hairy, no weight issues, and it didn’t cause fertility issues (once I got onto thyroid medication.). So maybe not worth the side effects just for the off chance it would help. And they may refuse it anyway.

I’m considering trying Dermatica or Skin+Me , partly because they have a big team and I feel like it’s less dependent on one person’s ideas iyswim? Also because otherwise there are so many things to try and I think I’ll just lose track!

The only thing that works for me is the Philosophy Purity cleanser. No idea why, its not marketed as an acne cleanser but Its an absolute miracle worker. I started using it over a decade ago, and never had anymore painful acne since. I hope its never discontinued. I would definitely recommend it!

Did not want to read and run.

I am 30 and when not on the pill always used to have at least four spots at a time, all the time. I know it may sound minor to some but I found it so embarrassing. As soon as they had healed up, more appeared and caused dark spots for ages. I used to get cystic spots on my chin which took ages to go away and heal.

Since July I have been using acnecide which is benzyoyl peroxide at 5% and you can get it without prescription. It totally changed my skin. I just get the occasional tiny spot now, which resolved quickly and they hardly ever scar. No cystic acne - EVER. I rarely wear makeup. It has given me so much confidence in my 'natural beauty'.

The formula kills bacteria causing acne, is keratolytic (a natural exfoliater) and absorbs oil

I get it here: www.chemist-4-u.com/lp/acnecide-benzoyl-peroxide?campaign=C4U-AW-Mixed-pharmacy-skin%20care&adgroup=acnecide-benzoyl%20peroxide-Mixed-acnecide&gclid=EAIaIQobChMIwPXQ47DL7gIVROvtCh1YRAjDEAAYASAAEgIu9vD_BwE

Hi blanco90 I have it in my drawer! I do use it but sporadically - I did use it every day in my 20s and it did help but only a bit.
Should probably try again...

I use Dermatica, but a lot of people who have tried both on here rate Skin + me as better, less gentle and progress faster. If I had your skin that reacts to nothing I would go for them, also they are likely to chuck in an antibiotic and niacinamide alongside tretinoin because most people get three active ingredients for their designated problem.

Someone posted a code on another skin thread for two months free of Skin + me yesterday.

Oh thanks! Will have a look for that. Yup, elephant hide here.

I totally appreciate things don’t work for everyone! The NHS website says it can take a few months to see the full effects. For me, it calmed down any spots I already had, and now it prevents them. I really hope you find something!

I keep my routine simple: gentle face wash, exfoliate with a flannel, then apply acne code. Only if my skin is v dry do I moisturise, as moisturiser can trap dead skin cells which worsens acne!

*acnecide rather...

@minipie I haven't read all the comments so apologies if I'm repeating anyone. I'm 36 and have suffered my whole adult life except for 2yrs after my first lot of accutane. Firstly, your dose doesn't sound that high. I was only on it 6months but I was on 80mg for much of that - I weigh 9stone. If the dose doesn't go high enough then I've heard that can be a reason for it not working.
As I said though, mine came back eventually. The single biggest effect on my skin is carbs and sugar. Have you tried doing a keto diet? If not I highly recommend it. I don't do full keto - I still eat lots of veggies but avoid starchy ones like potatoes, butternut squash, sweet pot etc. So it's more low carb than no carb. I do still have dairy which I find is ok as long as carbs are low but you've gotta make sure you're having the full fat stuff. Also try and eat regularly, don't skip meals and snack on nuts to keep your blood sugar level even all day.
In addition to this, go really gentle with your skin care regime because the more you do to the skin, the weaker the barrier. I use these products:

Evening toutine

• to remove make up: https://www.boots.com/garnier-micellar-cleansing-water-400ml-10169115?cmmmc=bmm-buk-google-ppccPLAsAs--(GB:Whoop!)+Garnier---(GB:Whoop!)+Boots+Shopping+-+Category+-+Beauty+-+Mobile&gclid=Cj0KCQiA0-6ABhDMARIsAFVdQv-x1qBnS4NduqBv95Rp0BnHtnWOw85kcRjJzlAPeNi7QbhbgStdshsaAisYEALw_wcB&gclsrc=aw.ds

• then I double cleanse with vanicream facial cleansing bar. https://www.amazon.co.uk/dp/B00E4MRMVK?ref=ppxpoppmobappshare

• apply vitamin c serum (has a tiny amount of retinol so best avoid if ttc) https://www.amazon.co.uk/dp/B07P5TMHD9?ref=ppxpoppmobappshare

• moisturise with vanicream lite https://www.amazon.co.uk/dp/B000TCWX68?ref=ppxpoppmobappshare

• apply azelaic acid to my jawline and neck where I'm most prone to cystic acne. I get my azeliac acid from the doctor as they can prescribe a 20% version but you can also get a 10% version through the ordinary.

In the morning I just wash and moisturise with vanicream. Perhaps use vit c serum too if skin feeling in need.

I have very sensitive, very oily and dry skin that is prone to cystic acne along jaw and neck. This routine has improved my breakouts HUGELY. Hope it helps xx

I have PCOS. Yasmin previously kept my acne at bay for years, though I was never without some kind of blemish, so might not be as bad as yours. I have found Dermatica has cleared my skin completely for the first time in 25 years.

Another coming on to suggest Keto, you can then have full fat dairy and the salami/cheese/avo etc that you said you enjoy.

Thank you BubsNumber2.

That’s interesting about the Roaccutane dose. I didn’t get much in the way of side effects so perhaps the dose was too low. Very frustrating if so as I was on it for ages (and self paid 😱).

Yes low carb would definitely be good for me I suspect. Certainly weight wise, possibly skin wise. I’m going to give it a go once the kids are back in school as can’t face making myself different meals along with all the other cooking at the moment!

I'm a dietitian specialising in women's health, and also a PCOS acne sufferer (or ex sufferer) between the ages of 13 and 29. Like you OP, I tried every prescription medication under the sun, including two courses of Roaccutane.

In a nutshell here's what I advise for my clients (and do myself). It's all evidence based:

myo-Inositol 200mg-4000mg per day - improves hormone levels by reducing insulin resistance. My acne (and anxiety) significantly improved with this. I take about 800mg/day.

Omega 3s - anti inflammatory. Aim for 500mg EPA/DHA per day. This is the equivalent to 2 portions a week of salmon/mackerel/sardines. If you don't like fish take a supplement daily.

Vitamin D - 1000IU/25ug per day

Trial of removing gluten/dairy for a few months. Before removing gluten it's advisable to get tested for coeliac disease by your GP. If removing dairy, you can use plant milks, yogurts etc for missed nutrients.
Gluten, but not dairy is a trigger for me.

Manage stress/anxiety

Don't over exercise with very high intensity training: this can increase the body's stress hormones provoking acne and worsening other PCOS symptoms.

Generally follow a Mediterranean type diet. People with lean PCOS tend to need more carbs than overweight PCOS (who do better with reducing carbs).

Hope that helps!

Sarsums thank you, very interesting indeed