Benzoyl peroxide for acne. Does it get worse before it gets better? What foundation/moisturiser is best?

[Sunbeckons]

DD has started using benzoyl peroxide for her mild-moderate acne. She has moved onto this after using Differin for 3 months and it not appearing to have much impact. I'm not sure if she should have tried it longer. Her skin seemed to purge and then stayed the same for 6 weeks. Not as bad as when it purged but worse than when she started.

Anyway, she's started benzoyl peroxide having never tried it before. It's made her face very angry within a few days. will her skin purge already on this or is it just red and angry? How long might she need to put up with this? What can she use to soothe her face? Is there any make-up she can use? She has a front of house part time job and would ideally prefer to wear some make-up to cover up the redness.

Any advice very welcome. She's 18 and had mild acne since she was 11 - mostly bumps under the skin on her forehead. It's only in the past year it's got red and lumpier and spread.

Thank you for your post. I have seen the Bath prescribing guidelines before and forgot about them. Hmmm, I am now wondering if she ought to have moved on to one of these combinations as she did initially respond to the retinoid but it was retinoid alone (Differin) and maybe needed something else to clear the bacteria?

1. Topical benzoyl peroxide and adapalene (prescribe as Epiduo® gel (2.5% BPO + adapalene 0.1%) or separately if different strength of BPO needed) OR
2. Topical retinoid plus topical antibiotic e.g. Treclin® (clindamycin 1% + tretinoin 0.025%)

We didn't go back to the GP - because - well, you know, short of time, other health issues presiding within the family, difficult to get an appointment, in the past only 'seen' a nurse prescriber (phone appointment and photos!) Picking up Acnecide from Boots was the easier next option.

Thank you. We've been through salicylic Acid in the early days. Also Zineryt. They did not work for long.

DD uses a 2% salicylic acid toner (Paula’s Choice) 2/3 times a week as well as Clinisept spray daily + after exercise on her dermatologist’s recommendation. We keep her face wash and moisturisers very gentle + non irritating, the Ren Evercalm range has been fabulous for this. The Clinisept is particularly fantastic - it’s both antibacterial and antifungal without the stripping properties of benzoyl peroxide. No bleached towels either!

This routine works really well for her

What is the strength of formula she's using?

2.5% is best for the face. 5% and 10% are very harsh.

2.5% BP with Eucerin or Olay plus spf moisturisers applied both day and night work well.

If the acne persists, though, get her to a doctor and put her on roaccutane.

Acne can do immense damage to self esteem. It can cause deep emotional and psychological side effects.

I need to choose my words carefully here, because your tone - both flippant and judgemental - has actually made me quite angry.

In brief - if you know nothing about a topic (and clearly you know nothing about acne) it's best to preface your remarks with, "I know nothing about acne, but..." That way, people who do know something might be able to give you a little grace.

Jumping in as you did with phrases like "It's not...something to be embarrassed about - basic gentle hygiene is probably sufficient...Besides, at 18 she's likely to find it diminishes and disappears o er the next couple of years..." is an astonishing example of blithe ignorance.

@Sunbeckons

Another route is the pill - it is commonly prescribed for acne that resists topical treatment in girls and women.

Do you know if it's possible to get 2.5% over the counter in the UK? Or can gp prescribe it?

I will push with the GP if it's not clearing up and gets worse. I won't hang about given my experiences. It's relatively recent that it's advanced from under skin forehead spots to red spots on her cheeks.

Hi again OP. If it is worsening, and you have tried both Differin/adapalene and benzo, I would suggest you give the other treatment pathway recommended on the Bath/NICE guidelines a try, which incorporates the topical antibiotic alongside the retinol ie. Treclin gel. The double-pronged approach - antibiotics tackles the P acnes bacteria, retinol encourages cell turnover and unclogs the sticky sebum which attracts the bacteria and becomes inflamed - can be very helpful.

Thank you. I think that is what we need to do.

@Sunbeckons have you had a look at skin and me? You send them a photo, and they tailor a regimen for you. I use their products (more for anti ageing haha!) and my skin is definitely improving. I do have oily skin though and get the odd spot at age 38 (!) so they took this into account too.
I would definitely give it a look. I'm sure I've got a discount code somewhere if you end up being interested.

I would stop with all the over the counter and GP prescribed treatments (having tried this with my own daughter). In my experience GP's don't understand skin. Get a referral to a dermatologist. Until then avoid all these products that simply burn the skin.

What did the dermatologist do for your daughter? Did you pay to go private? The waiting list for a dermatologist appointment is about 10 months where I am. I don't think I'd get a GP referral until they had gone through the whole prescribing pathway. I wouldn't hesitate to pay if it doesn't improve. But, we're at the beginning stages of it getting worse and it might still respond to BP.

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I've pm'd you, I go dermatologist privately and I'm on epiduo forte 2.5% and 0.3% if you have any questions feel free to ask but as its my prescription I shared it privately the products I've been told to use. It may be worth asking your derm if its okay to use the products I do.

I've stuck with it 3 months and will be a further 6 months as I have other things that need addressing health wise first. My face visibly looks better but the first 2 months were a horror. I had a skin beard every morning and towards the evening. My face was red, angry and cracking. Now it's tolerating the epiduo with very minimal issues.

Worth trying an activated charcoal and bentonite clay cream that's helps me. Or even vitamin b5. Also spearmint tea.

My DD uses Kanzen. The have a returns offer.

Around here you would find that the same protocol is followed NHS and private so the only benefit to paying would be more by of a hand hold and if it comes that you need referral to consider roaccutane the appointment would be quicker.

Well for the purposes of anyone else who finds this thread in future, DD's spots have cleared up for now. The red angriness died down when she used less product and did not use it every day. In the end she used an Avene soothing moisturiser and also a cerave facial moisturiser with bult in SPF 30.

thanks for the update as I was checking this thread

I always go balls deep with products and then break out. I’m learning now I’m 47 🤦🏻‍♀️

Thats fine

Is she using BP cream with Differin? That's too much. She should use a BP wash - only once a day, leave on for one minute and then wash off. Then Differin. Both are very strong medications.