Cystic acne-please help

[Shinyandnew1]

My poor DD is really suffering at the moment -she’s late teens now and has had poor skin since 15. We went to the doctors years ago and she has been back and forth for years…went through the usual Duac cream, lymcycline antibiotics which cleared it up until the course ended, then the pill which didn’t work to begin with. They then gave her Dianette which cured it completely within about 3 weeks. They have now stopped her taking this as it’s apparently dangerous and her skin has really flared up again-she’s back on Lymecycline, a different topical cream and Yasmin pill, but it seems to be actually looking worse after just two weeks.

She’s asked about a referral to the dermatologist which they said they might do if this doesn’t work. She is so unhappy-crying all the time, talking about dropping out of university. I don’t think she’s ‘depressed’ and needing anti depressants -she’s just understandably unhappy about her skin and would be happy if it all cleared up.

I’m presuming they will never let her have Dianette again, even though it cured it when nothing else works?! Would a private dermatologist appointment suggest anything different and how much would that cost?

I would push for a dermatology appointment. My DS had cystic acne and was miserable. GPs do not really understand skin further than prescribing different anti-biotics which in my sons case made things worse. It look 6-12 months but the acne was cured and hasn't returned.

Yes, I think she really needs to push for this. Can I ask what cured his acne in the end-was it Roaccutane?

This was me through my 20s and 30s. Eventually, 4 years ago, I saw a private Dermatologist and was prescribed Roaccutane.

I have a history of depression and was concerned they wouldn't prescribe it but my Derm's response was if my skin cleared up my mood would undoubtably improve - she felt it was a risk worth taking but I'm not sure if it would be as easy to get prescribed for a teenager who has depression so worth bearing that in mind.

Anyway, I took a low dose for a year and I haven't had a cyst since. I didn't ever have them all over my face but would get one or two enormous ones each month that would take up to 6 weeks to clear and were unbelievably painful. I was left with pitted scarring too even though I didn't touch the spots as, anyone who has experienced them knows, they are impossible to squeeze!
My skin was very oily too which completely went away although has returned, sadly but still no cysts.

Anyway, it cost me about £350 for initial blood tests (they have to keep an eye on your liver function during treatment) but I think you could try and ask for these to be done at your GP. Each appointment was £125 but I only saw her 3-monthly. Each private prescription was for a month and was the same price as a standard prescription so just under £10 back then.

I had no risk of pregnancy as I was single but that would be a concern with your DD potentially. Also my Derm was happy to give me 3 months worth at a time as I am a HCP so knew what to look out for.

I had very dry skin and terrible aches in my joints but I'd do it all again in a heartbeat.

Please take your daughter to see somebody, I was able to self refer to Spire and was seen very quickly. It will change her life. If any of my children end up taking after me I wouldn't hesitate to do the same for them.

Another vote for roaccutane. I had cystic acne in my teens and I took it for I think 6 months (although it was back in 1988 so can't remember if it was longer or not).

It was life changing. Not an easy drug to take but my god it works

I'm not sure if it would be as easy to get prescribed for a teenager who has depression so worth bearing that in mind.

I don’t think she has depression, to be fair-she is down and unhappy because of her acne-she’s not on any anti-depression medication-it’s just her skin is really getting her down :(

Sorry, I didn't word that very well. I meant just be aware that depression can be a side effect with taking Roaccutane so as long as your daughter is prepared that they will ask her about this then there shouldn't be any problems with prescribing it 😊

My teen had bad acne. We were just about to go down the dr’s for medication route when she saw on TikTok of all places about cutting out dairy.

i was sceptical but she gave it a try and there was an obvious difference within a week.

does she have any other issues? In hindsight DD’s “fussy” eating, constant snacking, bouts of constipation, diarrhoea, wind, and S&P bugs which no one else got were all signs as well. It was all very vague until the dairy was removed and it cleared up.

she’s been off dairy a year now and her skin has cleared to the normal teenage spot now and again. That was from being covered over her back and shoulders, forehead, cheeks and chin.

As a 40 year old who’s always suffered with bad skin, also look into a lumispa for thorough cleansing of your skin and light therapy as an alternative (I believe the light kills bacteria in the skin) if you were looking at a softer option than roaccutane.

dianette is great but I think you can only take for 2 years. My friend took it for longer and got a blood clot on her brain 😢

My dd responded very badly to having acne
I mean suicidal thoughts
the NICE guidelines for acne direct doctors to assess people’s mental health when they have acne and to factor that into their treatment plans
by this I mean let her GP know the psychological impact of her acne and push for specialist referral asap

I would suggest contacting gp and asking directly for dermatology referral. Cystic acne needs to be taken seriously to prevent scarring.

In the meantime they could try a different pill for her as Yasmin doesn’t agree with everyone. The absolute risk of dianette causing blood clots is very low, however most GPs are nervous about it and it might be a hard one to argue your case. carry on with antibiotic and topical such as Adapalene ideally until her appointment.

there is very little evidence for the role of diet in acne. There is a suggestion that whole milk is better than semi skimmed but in the context of severe acne it is not going to make enough of a difference.

I have been treated for acne since I was about 25, antibiotics, topical treatments and Roaccutane and they worked whilst I was taking them but soon as I stopped it all came back. In fact the Roaccutane did not make much of a difference to my skin but it did my mood. I never had it again.
25 years later and I started treatment for rosacea and it has made such a difference. No more constant pustules and swelling in my chin area and all the redness has reduced. I would also ask about rosacea as they always said mine was acne.

I suffered with cystic acne mostly on my chin for years. Eventually a GP prescribed me a topical antibiotic called Zineryt and it worked wonders for me. It started to heal immediately and I didn't get any new breakouts. If I stopped using it though it would come back but not as severely. Everyone is different though and different treatments have different effects.

I started getting cystic acne in my early twenties. It coincided with stopping birth control.

I had it most of my life until I hit the menopause. Now I have permanently clear skin, lined and wrinkled but clear.

I tried the doctor a few times but nothing really worked. Don’t be me and give up. Go straight to an expert dermatologist.

Can you pay for a private Derm appt?

I would do all possible to make that happen. The NHS waiting list is very very long

I don’t think she’s ‘depressed’ and needing anti depressants -she’s just understandably unhappy about her skin and would be happy if it all cleared up.

Yes but she's depressed at the moment and her skin might not clear up for the foreseeable future. Maybe not anti depressants for a teenager (unless 100% needed) as they have more risks than for older people. But a counsellor to talk to about it? You should let her GP know how she's feeling so they can decide what's best for her.

I had a friend who had a breakdown or something in her teens which partly involved staring at her spots in the mirror and crying. She ended up in hospital with it.

Dianette- you could beg them again, if she's in this much distress, depending what the danger of it is. I had a very bad reaction to it (benign intercranial hypotension, which mimics a brain tumour.)

When I had cystic acne it was caused by a med I was on for something else. When I stopped that med it cleared up.

Oats are also good for anything to do with skin (can't really do any harm anyway.) Let some oats brew in some water and once it looks nice and cloudy, apply it to the skin. Also eat porridge (again, can't hurt.)

Definitely look at her diet and cut down on the dairy and sugar. Push for a dermatology referral. I didn't need roaccutane but I had quite bad acne. Wish I'd sort help sooner.

This was exactly me and it was horrendous - I feel for your DD so much.

I loved dianette but my Bp got very high - there's a reason it is banned in France and other places. Roaccutane was the cure for me. It isn't a nice drug to take (cracked lips, peeling skin, light sensitivity etc) and I avoided it as long as possible, but now wish I had used roaccutane earlier. I had a course in my mid twenties and it genuinely changed my life. It's only for a short period of time and really turned my skin around. Now almost a decade later, I only rarely have spots, no cysts, often go without makeup and hardly give my skin a second thought. I still hardly believe it!

Good luck!

The anti-androgen effects of the diuretic Spironolactone cleared up my cystic acne in about 4 weeks. Never had a breakout the entire time I took the medication; my skin looked amazing! I did not experience any side effects.

Accutane was only minimally effective for me and I had just about all the listed side effects unfortunately. It also left me with permanently high cholesterol due to the effect it had on my liver. This was a low-dose, 16 week course. Plenty of people use it without incident but it's a serious medication that can have permanent side effects.

It depends on how much it is, tbh. If it’s £100-200, then yes. If it’s £250+ per appointment, then I’m not sure I can. Two at university at the moment are bleeding us dry…

I had cystic acne twice (mid teens and early 30s). Roaccutane was the only that cleared it up. It was a genuine lifesaver as I don't know how long I could have managed with my face looking like it did.

Please push for a referral for a dermatologist with your gp - don't let them fob you off. Good luck to your dd - there honestly is life after acne (so long as you can get the right treatment sorted)

Here's an article on cystic acne and Spironolactone:

https://www.healthline.com/health/spironolactone-acne-i-tried-it#Other-pros-and-cons-of-taking-spironolactone

That’s really interesting-I hasn’t heard of spironolactone so did a bit of googling. Is it the case that it’s not licensed in the UK but can be prescribed privately?

That’s really interesting-I hasn’t heard of spironolactone so did a bit of googling. Is it the case that it’s not licensed in the UK but can be prescribed privately?

I'm not in the UK, but found this from the British Association of Dermatologists:

https://www.bad.org.uk/pils/spironolactone/

So they do appear to prescribe it for hormonal acne.

I suffered with cystic acne to varying degrees for decades. Spironolactone was an absolute miracle worker for me. It was surreal going from wanting to hide my face during a breakout to getting compliments on my complexion!

I think it's worth a try. Cystic acne leaves scars and can really crush your self-esteem, particularly when you're young. I have immense sympathy for your daughter.

Definitely dermatologist - private if you can stretch to that but I had erythromycin which had no mental health side effects I had a poorly tummy with it tbh but it worked brilliantly. Best wishes to your daughter it's horribly painful along with everything else.

I developed cystic acne at 24 when my dad died very suddenly. It was all round my jaw/chin and just awful. I had everything the GP could give, and was referred to dermatology where I was offered Roaccutane but was too nervous about the mental side effects (previous history of depression).

What worked for me in the end after years of different prescription meds - and sorry if this sounds woo - was a supplement called chlorella which a consultant on the Liz Earle counter recommended. I figured it couldn’t hurt so trotted off to the health food shop to get some, and within weeks my acne had cleared. I still get hormonal spots, and my skin is quite reactive (I don’t tend to chop and change skincare, for example) but absolutely nothing like before.