The information below is taken from a thread in the Acne Research forum.

Here is my question to LabGirl:

LabGirl ... could you please explain, in your usual awesome level of detail, what goes on with people's skin during the initial 3 months on retinoids?

There has been quite a bit of discussion about this lately ... someone actually went so far as to call the initial breakout a myth. She basically said that any pimples that show up during that time were going to show up anyway. Do you think that is true?

Also, do you think the severity of the IB (assuming it isn't a myth) correlates to the severity of the acne someone had going into the treatment?


And here is her awesome answer:

This is a really good question since many scientists still don't know exactly how retinoids work. Dr. Albert Kligman is the original patent holder on using topical retinoic acid to treat acne (he has done tons of research on this topic, and has 40 years of studies on acne, sebaceous gland function and retinoids).

Anyway. A retinoid is any molecule capable of binding to and activating a retinoid receptor. There are many types of retinoid receptors, RAR-alpha, RAR-gamma, RXR (retinoid-X receptor), and their activation does all different things (cis-13 retinoic acne or Isotretonin acts on the retinoid-X receptor, and can inhibit cellular proliferation....especially of the sebocytes, whereas trans-retinoid acid stimulates the other retinoid receptors...as well as the RXR and increases the proliferation of keratinocytes.)....it's not really that simple and the retinoid receptors actually interact with eachother and form heterodimers that control various types of cellular proliferation in epithelial tissue and also in other types of tissue.........

Okay so in the first few weeks of treatment with topical retinoic acid (or other topical retinoid), the skin cells begin to proliferate rapidly. This really only takes a few days to have an effect, but you don't see the effects instantly (although you may feel them). As you already know a retinoid makes skin cells proliferate and desquamate in only 5-6 days (it usually takes a month). This may be why.......but we don't know for sure ....

Physiological and retinoid-induced proliferations of epidermis basal keratinocytes are differently controlled

Within a couple weeks the epidermis thins out. This is when you begin to see the derided initial breakout. Is it really an initial breakout? Is the skin actually purging itself???.....well yes and no.....

You may see after about 2-3 weeks of treatment a bunch of tiny bumps (whiteheads, comedoes, clogged pores, etc). As the skin cells rapidly proliferate inside the pore ducts the microcomedo swells up. At the same time the stratum corneum is becoming thinner. It's usually 8-9 cell layers thick, but by using a topical retinoid it becomes only 4-5 cell layers thick. This happens to the entire epidermis. The granular layer is also smaller and the granules contain less keratin. The proliferating skin cells don't have the chance to become hyperkeratinized as they loose their nuclei and cytoplasm, flatten out and become enclosed in the cell envelope of the corneocyte.

Since the epidermis is thinner the comedoes (which actually form in the dermis), become visible through the thin epidermis.......this also makes you more sensitive to UV radiation.....so wear a good sunscreen...

So what about the inflammatory initial breakout? Some of the comedoes may become inflamed.....if you are prone to inflammatory acne. Retinoids do cause a bit of irritation, and this can induce inflammation. Sometimes the pores are so blocked up that it takes weeks to resolve the comedo, and the bacteria and sebum trapped inside, and the irritation from the retinoid make it a perfect opportunity for a pimple to form. The reason it seems like an initial breakout is because it speeds up the rate of cellular proliferation. Those may or may not have become pimples without the retinoid. But in the worse case scenario you will get about 15 months of pimples in only 3 months.

I have another theory about the initial breakout phenenmon. Since the retinoids thin out the epidermis they cause increased transepidermal water loss. Water in the skin is important to normal desquamation. Water is necessary for the destruction of the desmosomes and tonofilaments that hold the cells of the stratum corneum together. If there isn't enough water present in the skin, the cells don't desquamate properly.....this is why you get flakes .......the cells are stuck together in clumps.......this is bad if it happens inside the pores.......Dry skin is bad for acne, since abnormal desquamation inside pore ducts can cause the formation of comedoes.

An initial breakout can be controlled by using a topical or oral antibiotic in the first 12 weeks of treatment. After that you shouln't need as much bacterial control, since the pores aren't easily blocked and most of the comedoes will have resolved themselves. BP just irritates the skin and increases barrier damage. Moisturizing is crucial on a retinoid, since the epidermal barrier is compromised due to the thinning of the epidermis. A good moisturizer is one that contains about 3-5% glycerin. Glycerin is a great ingredient and really improves the barrier function of the skin, by filling in the extra-cellular matrix between the corneocytes ....and it promotes healthy desquamation of skin cells by drawing water into the skin from deeper dermal tissue and it is known to activate certain genes in the keratinocytes (just don't tell the FDA).

Okay when I get to work I'll look up some more stuff.........

I didn't even mention the effects topical retinoids have on the dermis........they reduce shallow scarring and wrinkles by stimulating the fibroblasts in the dermis to produce Collagen I and III.....which fills in shallow scars and plumps up wrinkles........another reason to stick with it even if the initial breakout makes you think that "this can't be good for my skin".....eventually it will be........

I posted on this message board a few years ago, singing praises of the Clear Skin Regimen, but it stopped working for me (See my signature for more details.). I started on YAZ a few months ago to combat my ever-worsening moderate acne, but it hasn't seemed to do much, except lessen the frequency of breakouts but not the INTENSITY of them. So I decided to try Differin, and it seems to actually be working!!! I will keep this thread updated as I see changes, but what I'm really hoping for is to forget about this website, like I did before when my skin cleared, and I didn't even have THINK about acne anymore. Comments are welcome! Thanks!

P.S. The first picture is from 6/18/09 (6 days after starting the Differin), and the second picture is from today, 6/24/09.

Hi, so I'm new to the site but I check here all the time so I thought I might as well add something.

I have been using duac for more than a year now, with pretty good success. The problem is it does nothing for my blackheads which are horrible, deep and everywhere. So even though duac keeps my face mostly clear of pimples I have to do something new. I just started using Differin last night and have decided to alternate between the Duac and the differin each night.



So this is my routine

Morning
wash with spectro jel
apply moisturizer, or not if I feel its not too flaky (really oily skin)

Night
wash with spectro jel
wait 30 mins... apply Differin 0.1% cream or Duac. (the first one night then the other the next)
*should I moisturize?

* I am not sure if I should be using moisturizer after differin? And if anyone else with really oily skin reads this, how do I get around the fact that putting moisterizer on in the morning makes me even more oily all day? (I use complex 10 non greasy, non comedogenic)

* Also does anyone know whats good to use on the sensitive skin of the chest? I have been using bp but it irritates and bleaches everything...

In the evenings: The Dermatologist has me washing with Brevoxyl Wash-4, Applying Differin 0.1% Gel, and Applying Tazorac 0.05% Cream for Spot Treatments. Does this seem like too much? By the way in the Mornings, I use Finacea Gel. Has any one everyone ever used 2 retinoids?

if there is anybody who was extra duac or doesnt want it anymore...please let me know. i need it desperately but cant afford it.

My insurance will only pay for the generic. Does it work the same?

hi everyone!

thought i'd keep a log of my progress because other people's logs helped me out a ton in figuring out my next steps to clearer skin

i was on differin .01% cream from march 08 until dec 09. when i realized it wasn't working as well, my doctor bumped me up to the .03% gel. that worked for a little while, but again, my skin is progressively getting worse. (i was completely clear all last summer until about december)

so today i picked up my prescription of clindamycin topical solution (which i've used before) and my retin-a micro .1%...

i'm a LITTLE worried about another initial breakout from the retin-a micro, but am hoping since i used differin in the past, it wont be as bad... any insight/experience with this, anyone?!

last night was my first night applying retin-a micro ... i was expecting it to be worse than what it was, for some reason. i was also expecting to wake up this morning with a red face... but not yet... *fingers crossed* ... no peeling, irritation, or redness!

i'm also not going to ease into it like some people have... i feel like i've been on differin for so long that i'm sort of past that stage.

here is my regimen:

- wash with Dove Beauty Bar for Sensitive skin
- apply clindamycin solution
- wait about 20 minutes, then apply retin-a micro .01% (not sure if i have to wait or not, just out of habit from using differin.)
- still trying to decide if i should moisturize after, but when i do, i've always used Olay Hydrating Fluid for Sensitive Skin.

pretty simple. wish me luck, guys!

so tomorrow night is going to be the end of my third week. I put that stuff on almost every night (skipped two days, once because I completely forgot and the other cuz I was too lazy). I kept on having regular inflammed white heads but when I look at the mirror I noticed my left cheek was one color ... Or maybe it was just the bad lighting.

Starting the 3rd week of treatment, I started having those hard bumbs... Right now i have 2 bigs ones lurking on my right cheek and above my left eyebrow. I keep picking, hoping that the gunk inside would spill out... which is probably making it worst. I'm noticing blackheads around my nose (didnt use to get them there...) and some between my eyes. Is that the initial break out? I really hope so... cause i don't want it to get worst than that.

I have tons of red marks on my face from the pimples i got ever since i started using Retin a micro. I sure hope it fades away fast. I heard that RAM helps with that as well? Peeling-wise, i think I have shed the whole top layer of my face and then some. And I keep looking at the mirror, twizzer in hand, ready to pluck away the dead skin. Thats bad also eh?

(I just got cetaphil moisturizer... and I am NOT happy with it. makes my face sooo greasy... and sticky. I hope I can return it. )

Hi everyone,

I wanted to start this regimen log, specifically because there isn't a lot of info out there now about personal experiences with Aczone. It's pretty new, so I thought hearing someone's experience with this topicla might be helpful to some of you.

I've had acne since I was 11. And hellaciously oily skin. Not just a little shine. We're talking oily eyelids. My entire face. I did retin-a and antibiotics in high school, with some success. Around my early 20s, my acne turned cystic, and my derm and I tried Azelex, more antibiotics, Differin, Cleocin-T, Benzaclin, etc. etc., with no success. Finally, after I appeared in her office in tears, she prescribed Accutane for me. I had crappy health insurance at the time, and so she gave me the entire prescription in samples. I still had to sign the papers and get blood work, but my experience with Accutane cost me nothing except the co-pay for the visits.

Accutane kept me clear for about 3 years, until my husband and I conceived our first child. After I gave birth, I had to steer clear of anything systemic due to breastfeeding, so I tried Pro-Activ. It worked astoundingly well, and it essentially kept me clear until I got pregnant again 20 months later. Still, though, my acne wasn't serious, just more of a nuisance. After my second daughter was born, I got fed up with the Pro-Activ and came here. I tried Dan's BP Gel and had pretty good luck with it, but it didn't help as much with the hormonal acne. After getting a couple of bad cysts on my chin, I decided to try the Philosophy Acne kit.

Um....that was a huge mistake. 4 months later, my skin was worse than ever. I was getting 5-6 new pimples a night. Depressed and miserable, I turned to a dermatologist. (Well, actually, she's a physician's assistant).

She prescribed Doryx, Aczone and Ziana for me.

I didn't fill the Doryx, because it will give me a yeast infection and I just cannot tolerate that.

It's been 8 whole days on the system with these two new topicals, and I couldn't be happier.

I know it's too soon to tell whether or not I'll have an IB, but I've had maybe 3 new pimples in these entire 8 days, and the Aczone has made quick work of them.

My skin feels very smooth, and one again, with makeup, it looks like I'm clear. The red marks from the old pimples are pretty bad, though.

Anyway, I'll update as frequently as I can. I hope to help other folks out there who are trying Aczone, or who are considering it. Thus far, I'm very pleased with it, and the Ziana as well.

I'll also get around to posting a before picture with some progress shots.

This will be for my personal regimen Log as well as the community to see as well.

--Was Given Aczone (dapsone gel 5%) from my Derm.

--Also was Given Ovace Plus daily face wash.

I was on The Daniel Kern Regimen(acne.org) for 3 months with little to no success. So i decided to try the Derms. scripts/advice. When i was a Teen I was on everything, Antibiotics,Differin, Retin-a, washes which was little to no success. I then was prescribed Accutane when I was 17 years old which cleared me up to perfection, I'm now 25 and have had a slight comeback of my acne(within the past 4 months). My acne was diagnosed as very very mild, but to me its bad.

Im hoping this new product will be the cure to get me clear again.

I haven't been shaving recently due to the aggravation it causes to my acne.

Can someone help me, I'm having a very difficult time trying to get the pics to work on this site, there hosted at photobucket.com

Day 1
[IMG]http://img.photobucket.com/albums/v687/vdubguy97/DSCN0329.jpg[/IMG]
[IMG]http://img.photobucket.com/albums/v687/vdubguy97/DSCN0330.jpg[/IMG]
[IMG]http://img.photobucket.com/albums/v687/vdubguy97/DSCN0331.jpg[/IMG]

Hi guys,

My dermatologist has prescribed me a new combination topical which consists of Adapalene 0.1% mixed with a 2.5% BP solution. The product has been named Epiduo and is being marketed by Galderma.
I use it only at night which is the recommended frequency. Been using the product for a good 3 weeks now, and am very happy about the results.

About me:
33 year old F with recurring t-zone acne and bacne, as well as chest breakouts. I guess my acne is mild to moderate (no cysts). I was on Diane and then Yaz for 12 years but had to stop because of increasing hormonal discolorings in the face.

I also use Murad's Acne Body Wash each morning which I find to a great supplement to the Epiduo. For the face I use a mild cleanser and skin tonic and oil-free moisturizer. I also have to moisturize the chest area, since the Epiduo/Acne body wash combination is proving a little harsh for my skin.

My aim is to get 100% acne/bacne free and this log will document if and how I will succeed.

At the moment, my chest is already 90% clear, back is 70% clear and face 50%.

Well, finally got Retin-A 0.25% today Along with Bactrim DS. Well, I got the generic brand but there the same thing right? Anyways, I'll be keeping a log and post a few pics up later.

To start off, according to my doctor my acne is "moderate" It may look worse to me but its moderate.(compliment I guess?) Anyways, he prescribed me Retin-A and Bactrim DS for twice a day for the first week and once a day after the first week. My blogs or "posts" will be every Friday since it seems like it would be a good idea to post once a week instead of everyday


Week 1:

I just got it, my face looks like crap to me. Not much else I can say.

probably bad place to ask as im guessing no one ever comes on this site once their acne is all cleared up

but i was wondering whether anyone has or knows of anyone who have been completely cleared or near enough (say a few zits a month) with topical retinoids

yeah they might work but the ib and irritation are pretty rough and results ive had and ive seen other people had are always patchy,

differin for me worked quite well - definately pleased with results and people made comments about how my skin had cleared up - but i never had a completely clear face always something never felt comfortable without make up (right now i don't feel comfortable with make up on due to ib on isotrexin - at the 3 week mark so at its worst hopefully) has anyone got to a stage where they have perfect skin?

i was just wonderng because it seems like too much to expect.

I'm 27 and I finally decided to visit a dermatologist for the first time in my life about 3 weeks ago. Best thing I ever did.

I've been on the birth control Yaz for about 4 months and although it did get rid of my hormonal acne, I got a sudden outbreak of clogged pores (little zits) everywhere on my face about a month ago. I think the combination of oily skin and humidity just drove my skin nuts. Like hundreds of little zits everywhere, which I had never had before. I've always had mild acne but this was crazy. My face felt like sandpaper and I looked like a red mess.

The dermatologist prescribed me generic retin a cream (.025%) and duac. It cost me $20 total since I have insurance. I've been using retin a about 2-3 times per week at night and duac on alternate nights about 2-3 times per week. In just 3 weeks, I have cleared up tremendously (50-75%). I really doubted my dermatologist when she prescribed retin a and duac because I've never used anything other than benzoyl peroxide face wash (which used to work but wasn't enough at this point).

The only downside is that retin a makes me peel but there is no way around it since that is how it works. You skin peels so that you are revealing new skin while at the same time, washing away clogged pores. I still have some red marks on my face.. mostly on my chin from past hormonal breakouts so let's see how I do. I am supposed to see the dermatologist in about 3 more weeks as a follow-up.

Well, I'm starting this log so that I can track my progress through the weeks/months. I'm writing this as I start week 7 of nightly application. I started using taz during the last week of July/beginning of August. Wow has it been a rough ride. I'm used to purging and breaking out since my 16 months of spironolactone was constant breakouts, but after waiting for my skin to clear up, and after a really horrible breakout during my vacation, I decided to quit. I was also getting two periods a month and that was a killer.

I've tried tazorac in the past but always quit because I would reach the point of the initial breakout. This time I am sticking with it this time for a good six months because I honestly don't have any other options. I am sick of antibiotics and have already done four courses of accutane over 8 years (I'm 33. My first accutane course was when I was 17. My last course was when I was 25.). Because of accutane I am left with really bad joint pain in my hip that on bad days is debilitating, and permanent decreased night vision. I am also wanting to start a family in the next two years and will not take it.

With all this history aside, I started the dreaded initial breakout at about week 3 and it's been continuous ever since. I had a really awful breakout on August 23/24 and wanted to hide the entire weekend, but couldn't because of plans. The breakouts range from bad to really bad and every time I think that it may be getting better, I break out again. My skin has also been peeling for a few weeks despite using moisturizer. Maybe I need to apply more.

My routine is: wash with Aveeno ultra calming face wash in the morning. Moisturize and protect with Aveeno ultra calming SPF 15. Apply make-up. At night I remove my make-up with cetaphil gentle cleanser (wipe it off) and wash with Avveno. Apply Aveeno ultra calming night time moisurizer. Wait 20-30 mins and then apply a small amount of tazorac.

I've also been taking Vitex the past two months to help regulate my periods after stopping sprio. I'm wondering if that is increasing my breakouts as it helps to balance hormones by boosting progesterone. I think I'm going to stop taking vitex since my periods are now regular and see if it makes a difference.

Other than that, I eat a semi-clean diet with lots of veggies, fish, chicken and fruit. I drink wine and like the odd dessert. I also take greens plus multi, fish oil, probiotics, vitamin B, C, D and calcium/magnesium.

Right now my skin is a terrible mess. I'm recovering from a breakout around my nose, so I have 4-5 there as well as a couple on my chin. In just the past couple of days I'm now getting one on my forehead, three on my chin, one on my jawline, one above my lip and a new one on my cheek. Nice. Thankfully, only the one on my forehead is a big one. The rest are small pustules. I really hope that in the next week or two or three the breakouts will start to subside. I'll post pictures in the next day or two so I can keep a visual log as well. Some good news, the areas that aren't breaking out look really good and my melasma is starting to fade.

Feel free to vent along with me, offer some encouragement, or just stop by to say hello.

I thought i'd write a log now since I'm clearer than i've ever been.

First I'm 23, I started dealing with acne when I was 17. It showed up out of no where. Instead of listing all the things I've tried that didn't work I'm gonna list the things that did

Bactrum & Retin A & Clindamycin & AHA

I took 3 months worth of Bactrum with Retin-A every night and was completely clear back in October of '07. I slacked on my regimen and my acne came. Being that Bactrum is so potent my derm. declined when I asked for another 3 months prescription.

So, right now my regimen is:

A.M.
NATURE'S PLUS NATURAL BEAUTY CLEANSING BAR(main ingredient Olive Oil which helps with old acne marks)
3+ drops of Jojoba Oil
Dan's 10% AHA
Clinque Super-Defense Moist. w/ 25spf

Makeup:
Estee Lauder Double-Wear foundation
COASTAL CLASSIC CREATIONS 'SAND DUNES' BLUSH (PEACH) 100% organic
Physician's formula loose power

P.M.
Clinque Wash Away Gel (makeup remover)
NATURE'S PLUS NATURAL BEAUTY CLEANSING BAR
Retin A .1%
Wait 30 mins to an hour then apply 3+ drops of jojoba oil.

Using Retin-A and clindamycin constantly has cleared my skin up significantly, added 10% AHA has just pushed it to the next level. I'm still looking to find an all natural make-up remover and sunscreen. Hopefully replacing those two products will get my skin from mostly clear to perfect!

Starting Duac tomorrow. I have had the prescription sitting in my wallet for several months. I hate topicals because I already have dry sensitive skin and don't want to irritate it more. But after locking myself in my apartment for the past 3 days because of a bad breakout I realized I can't take it anymore and am going to just spend the $250 (my stupid insurance won't cover it...booo) and fill the prescription. I just want to know (other than dryness and irritation) what others experiences are with using JUST Duac gel (not in combination with other topicals)? Was there an inital breakout? I have heard that Duac doesn't really have an initial breakout and if it does than it is minimal. I usually don't or haven't experienced an initial breakout with most treatments, but I shouldn't be surprised if I do this time. Please any help is genuinely appreciated.

hi everyone,

i'm a 25/f and have suffered from acne for years! i tend to get the inflamed / cystic kind on my cheeks which is the worrrrst... it's relentless & tough to conceal. i was on accutane 2x. the first time, it worked amazingly well for 7-8 years. the next time, it only kept me clear for 2 years then my inflamed acne came back. it's been increasingly worse this past year to the point where i was very seriously considering going back on accutane for a <gasp> third time. the only thing that stops me is that the last time i had a terrrrrible initial breakout that kept me holed up in my basement refusing to see people for at least 1 month. it was awful. i will probably do it again if things dont improve by december.

i have tried everything under the sun to try & get rid of my acne. proactiv actually worked for like 5 months last year but then suddenly stopped working. currently, i am using duac, retin-a, and aczone (just added this) on my face and taking an antibiotic 1x a day. i have also given up dairy and have been on yaz birth control for the past 1 1/2 months. a note about the dairy: i dont think it's making much of a difference except that i lost a few pounds. i think i will continue with the reduced dairy diet but not cut it out completely. as for the yaz, i actually think ortho tricyclen lo was better for my skin.

after expirementing with all the medications out there, i have concluded that, short of accutane, the 3 things that have helped me the most are: 1) regular chemical exfoliation to keep my pores clean and dead skin cells off 2) daily use of antibiotic/benzoyl peroxide to keep bacteria at bay 3) keeping inflammation at bay to prevent massive pimples on my face.

1) i say chemical exfoliation and not just exfoliation bc i think physical exfoliation with scrubs can sometimes make things worse. plus it doesnt always get all the gunk off your skin. that's why i now use the retin-a every day. i use it during the day but most people use it at night. i also do glycolic peels and get a facial 1x a month. my facialist does the best glycolic peels, but since it's expensive i've been experimenting with a glycolic peel i bought from makeup artists choice and use it 2-3x a week.

2) as i thought back to what tends to help the most, i realized that my forehead and chin are usually clear bc i put on globs of benzoyl peroxide at night. i was also using duac only on those areas for awhile and using the stronger retin-a on my cheeks (biggest problem area). then i realized that while proactiv was working, i had put the stuff all over my cheeks too.. and it had helped! why not use my prescription stuff on my cheeks? (duh). anyway, i just started using the duac all over my face once a day.. i do it at night, most people do it during the day. i realllly think it's helping. we shall see! i will keep you posted. in addition to the duac, i put on clean & clear's 10% benzoyl peroxide on any pimples to sort of seal in the duac & bp. not sure if it helps, but i like to think it does.

3) keeping inflammation at bay... ok this part is tough for me bc as i mentioned, when i get pimples, they like to explode into huge volcanoes. as a preventative measure, i take my antibiotic (doryx) daily. i also supplement with vitamins but i'm not sure how much they really help the acne. i also keep my sugar intake low bc that just feeds inflammation, same thing for spicy food.. the less, the better. i'm working on trying to improve my digestion bc i'm pretty sure that if i remove toxins from my body quickly then i'll improve my skin. ok. that said, when i see a pimple forming i do one of two things. if it is clearly going to turn into a whitehead, i put duac on it bc the duac tends to draw the whitehead out. if it is underground and red, i use the zeno on it and then put duac on it to help draw it to a head. since i've gotten the aczone, i alternate applications of the duac and aczone on the underground ones or use duac 1x a day on it and aczone 2x a day for spot treating. aczone has, in my experience, helped keep pimples from exploding a lot of the time but not all of the time. if it touches benzoyl peroxide it turns orange/red but the color wipes off easily with water. if used by itself, can dry clear or white on your skin. it's a great help but not a miracle cure. for the zeno, i've noticed that if it doesn't work within the first 4 uses, you should stop using it on that pimple bc it can make it worse / angrier / bigger etc. it rarely makes my pimples disappear, however, it does help them come to a head faster or reduce the inflammation. also, if i happen to pop a zit, i use the zeno right after doing so to bring down the inflammation.

ok. hope this is helpful! i will keep you posted on how i'm doing now that i'm using the retin-a / duac / aczone regularly and in combination with each other. i won't post every day but i'll check in about once a week.

good luck!

Hello everyone

I'm a 20 y/o male suffering from mild/moderate acne on my face. I just got put on new regimen so I'm here to talk about it and get some advice!

AM

Wash / cleanse with Pracsion FC Cleansing Cloths
Apply thin layer of Duac gel

PM
150 MG Doryx
Wash / cleanse with Pracsion FC Cleansing Cloths
Apply thin layer of Epiduo gel



I'm on day 6 so far. I've seen a small improvement, still have a few bigger pimples on my right cheek that's bothering me. I think cleansing twice a day with the cloths have caused a little irritation so I'm switching to once a day at night to see how that feels. If anyone has any advice let me know!

Well i just got back from the Derm. I actually had a positive experience this time.

I started getting mild acne at age 12, wasnt so bad but went to the derm at age 17. I was on Retin-A last year, but i wasn't following it properly for a while due to clear skin, so i started to get breakouts. I figured i needed more and jumped straight from .05% to .1% which was too harsh at the time, and not even using moisturizer. Then it all went downhill from there. I started breaking out and couldnt figure out why, i then found acne.org and was inspired to try Dan's regimen. I used this for about 2 months, ending with the most severe breakout of my life. Theres a chance if i woulda hung on longer i woulda been clear for good but i quit and regretted it but i'm not going back to that.

After i quit the DKR and found the "Caveman" regimen i was convinced i never had acne in the first place ( i was wrong). This worked for a month or so while but just gradually has been getting worse, due to the increase of uninflammed acne that eventually turns into inflammed acne. I was gonna just ride acne out til adulthood, but my father is 52 and still has pretty bad uninflammed acne, so im not going to just do nothing about it anymore. I am a believer that acne can be cured by diet alone, but i am a college student and really don't have a huge say in what i can eat without getting too underweight.

I am following this current Regimen:
Morning
-Clenia wash (Sulfur)
-Cetaphil Moisturizer
Doxycycline 100mg

Evening
Retin-a .05% (Every other night, replace with suflur soap on other nights)
Cetaphil Moisturizer
Doxycycline 100mg

This was my picture last year while on retin-a (no clenia wash or doxy)
http://img21.imageshack.us/my.php?image=dan3g.png
almost perfect.
This is my face today
http://img23.imageshack.us/my.php?image=may11.jpg
Mild inflammation (having a good day, haha) but since i dont have a digital cam atm
you cant see the tons of comedones i have.

I'm pretty scared of a bad breakout from this but it cant get much worse than how its been the past few weeks, and im sure the anti-biotic will do the trick.

Im going to apply the Retin-a every other night for a little while, ill keep you guys posted on my progress.

Thanks for reading!

P.S. Should i stop taking zinc? I heard this isnt safe to take with doxy.

Two years ago, my derm put me on Differin 0.3% gel. For the next year and a half or so, I was the clearest I've been in years (I was also taking Bactrim during this time). However, earlier this year I experienced the worst breakout I've had in years. I thought I would do a few chemical peels to clear the damage, so I stopped using the Differin. I continued to take the Bactrim. I've had more breakouts recently. They aren't TOO severe, but they are fairly persistant with some leaving red marks. It's still better overall than when I was first prescribed the Differin though. (This also makes me think maybe the Bactrim isn't working anymore, and or the Differin is what was keeping me clear). I haven't used the Differin in about 6 months.

Now I'm wondering if I should use it again (the 0.3% gel). I'm really afraid of going through the initial breakout because I have a lot of stuff coming up and I don't want to ruin my face because it's at least "decent". Still, I want to feel and look like I did last year. But would it even work again if I went back on it? I'm just not sure what to do...

So my doctor gave me some differin 0.1 cream to use a few days ago. Tonight will be my second night.

My face looks really nasty right now. Like worse than when I began. A few more pimples, but the skin just looks red and gross. It's expected....right? (i have broken capillaries on my cheeks and it looks like they spread or something...maybe its just blotchy redness)


ill try to update. i love feedback.

I am a 30 yr old F whose acne seems to have gotten way more problemmatic in the last few months. Since I've been a teenager, I've always had a few zits every month, often hormonal, but I've never felt like I needed to do anything about it until now. Somehow in the last four months I've gotten a number of cysts that take forever to come and go. Maybe 2 at a time or so, but since they stick around for so long, my face hasn't really been clear in this time period -- mostly in my T-zone, also by my ears. I also have generally large pores and blackheads on my nose, and light scarring from old acne. Not too much though. I'm also starting to get some wrinkles.

I asked my doctor about what could be done, and she prescribed clyndamycin swabs, which did help make my good skin look smoother, but I was still getting cysts. I saw another doctor (for something else, but I mentioned the acne), and, since I had two cysts developing on my forehead, she prescribed Retin-A micro 0.04%, and told me to start at once every three nights.

I used it the first night I had it, and then read a million RAM horror stories on the web, and hesitated for a week or so. In fact, I even started with the DK Regimen and my face looks pretty decent. But I am getting greedy and would love for some marks to go away and for my face to look great, including maybe even wrinkles going away a bit.

So, tonight I'm starting again with RAM. I of course am fearing the dreaded initial breakout, especially as I have professional activities in the fall during which I really cannot have horrible cysts on my face. (Note: the past four months of bad skin, I have really only gotten cysts -- no other kinds of zits.) But we'll see. I can always stop, right? Though I know that you have to keep going to see results.

I have a question. For some reason the spots I use tazorac on ends up red instead of tanning. Is this supposed to happen? And I do use sunscreen lotion. How can I get a tan even while using Tazorac?