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........

Well, I thought I'd start a "post-accutane" log, chronicling my sporadic use of retin-a and minor panic attacks whenever a zit pops up on my face. I guess it's been four-ish months since I stopped accutane. My face isn't red anymore, although I still have a mess of marks (pretty sure it's scarring, HAVE TO DO SOMETHING ABOUT IT).
For a while, I had no zits whatsoever, then slowly began getting little ones at my hairline and in my eyebrows (those aren't so bad, as they go away on their own in a day or two). I've been trying to ramp up the amount of retin-a I use on my face to every night, but it always seems to irritate the area around my nose and make it worse, so instead I've been putting it on my cheeks, where the worst of my acne scarring is, as it supposedly is supposed to fade the marks.
At the beginning of January, all my blackheads came back and I started getting zits around my mouth and nostrils, where the majority of my zits were before starting accutane. When they didn't go away, I tried eating better, which didn't do much, then stopped using sunscreen. I think it was an ingredient in the sunscreen that was doing it, since my face is clear right now (knock on wood) and some of the blackheads have vanished.
This is probably going to be most boring log ever, but I'll try to spice it up with awkward stories of my everyday life.

History: 28 y/o female, total hysterectomy at age 23. Started hormone replacement therapy directly after surgery. Most "successful" HRT was estratest which contains some small amount of testosterone. Very healthy, clean diet. Exercise 6 days a week. Military career requiring long work hours, high stress load (12 hr shifts, minimum 60 hr weeks, day and night shifts). Had some acne ever since puberty, but comes and goes unpredictably and has never been that bad. Some cystic acne also. Approximately 6 weeks ago, all hell broke loose - literally - on my face. Started with one, then two, then last week I had 12 cysts, no apparent reason! I saw my gynecologist because I suspected HRT had failed. Other symptoms included more sweating than normal (for those who have been through menopause, the "regular" sweating is enough! but more?!), sleep disruptions or insomnia, high stress load, some mood swings. I tried all the OTC options I could find. All I succeeded in doing was drying my skin out to the point where it was flaking off nonstop, but the acne kept coming. Very embarassing! I am normally a very confident woman but find myself avoiding going anywhere if I'm off duty. If I had a choice about it, I'd call in sick a few times!

5 days ago:

Doc switched my hormone to Ogen, or Estradiol, 1 mg tablet daily (all estragen, no testosterone). She also gave me Retin-A cream .05%. She didn't feel comfortable giving my antibiotics. Can't see a derm as it takes forever for referral approval, then waiting on an appt, and I am headed overseas in 2 months for a 13 month assignment.
I switched my daily multi-vitamin to a menopausal daily vitamin pack including evening primrose oil. Have been only washing my face, gently, when I wake up (very oily t-zone - you cannot NOT wash it!), after workouts when I shower, and before bed. Apply small amount of Retin-A at bedtime, wait 10 min or so before applying Cetaphil moisturizer to seal in. Also moisturizing in morning. I got a cucumber cream face wash at GNC that is working pretty well so far (I also have Cetaphil face wash). Both are noncomdeginic and moisturizing. I bought all new makeup in case I had some sort of bacteria that was attached to the old (yes, I know, probably paranoia). I always drink TONS of water, eat very healthy, avoid extra sugar or sugar substitutes. I am in excellent physical shape, but my face is apparently not! I also bought zinc yesterday afternoon, 100 mg tablets. I have Vitamin A and E on hand, but I think that is overkill with the Retin-A and multi-vitamin packs. I was going to buy the no-flush niacin but they were sold out so I will try again this week.

Results to date:

Seeing some improvement today. The Retin-A certainly has a drying potential, but with my oily skin and regular use of cetaphil moisturizer I am holding that at bay pretty well. The cysts and pimples are definitely "softer" and going away faster than ever, also easier to cover with a bit of concealer when I have to go to work. The redness of the acne is more vivid though. I suspect it will take a long time to get that all to fade away. I have never had a problem so severe as this before and I am scared to death I'll never go back to being "me" again! Will try to maintain a log here to see how I do. I am dreading the IB, but then again, can't imagine it being much worse than what I've been going through lately!

Well Iam starting this log at week 5.. After reading thought it would be a good idea for people doing Ziana to read and for myself to look at my progress( well I hope )..
SO Dec. 1 I started Ziana and Doxy antibotics.. I had whitehead bumps on my cheeks and got cystic acne..
So on week 5 my patients are running pretty low.. It wouldnt be so bad but my breakouts are sooooo red, when I dont have makeup on I look pretty sad. I have about 10 red spots. 2 cystic spots. Which I know it gets worse before better so thats the only thing thats keeping me going. I will at least give it a try and see if this does help and then I know.. Besides its winter, we dont do much in winter LOL
From the info I have gathered it takes between 8-10wks b4 I should see something or notice any sort of difference.. Ugh at least 4 more weeks thats scary..
Luckily alot of my previous red marks are fading out, so I hope these bright red ones on my face do.. And I pray that by March my face will be clear as I am standing up in a huge wedding. My face, besides my red spots looks pretty good, I can say that.
I dont get that oily from the ziana anymore. My face doesnt peel..that only happened the first week.
I wash my face with PCA from my esthetician, which I see once a month..I wash morning and night.
I did go to esthetician b4 I went to the Derm but it was taking to long and costing alot. Right now I am kinda regretting going to the derm as my face is worse, but I know its for the best.. All I want is clear skin, I mean am I asking that much .. LOL I am in my early 30s I should have to deal with this crap..
Ok I will write again soon.. Please post anything you want if your using ziana

well i guess im making this into a log like all the other ones ive seen on this board. if your using adapalene too please comment on how your doing too!

Okay so first id like to say im a 15 year old male, and ive had acne since i was about 11 or twelve. I have moderate acne, no cysts or anything, just a tonna clogged pores and a few pimples always seem to be scattered over my face. Not the worst but enough to keep my head turned to the side when talking to someone so they dont see my new zit. Ive tried almost everything: salicylic acid, tea tree oil, scrubs, benzoyl peroxide. And ive tried all those systems: nuetrogena, acnefree, proactiv, and clearasil.
But they didnt work and i settled for my own system- a gentle wash every morning and night followed by a 10% bp creme (which by the way does wonders, is cheap, and in my opinion is the best over the counter solution money can buy)

I finally went to a derm and he gave me free samples of all this stuff like Duac and Ziana and Differin but i didnt know what to use. I looked them up and this is what i found
Duac- 1% clindamycin/ 5% bp
Ziana- 1.2% clindamycin/ .025% tretinoin
Differin- .3% adapalene

well i knew duac and ziana were out of the question, because i deal with mostly closed comedomes and i dont want to be using any antibiotic like clindamycin in my system. the doctor did say differin is a little strong, but since i use 10% bp every morning and night it shouldnt be that bad

so far, after two nights of applying it all over my face after using a gentle soap free nuetrogena wash, nothing has changed. no difference in acne, no redness, no peeling or flaking. and no initial breakout (yet)

i guess ill keep you guys posted and try to contribute as much as i can, feel free to do the same

If you're American and you're uninsured, or if, like me, you have an insurance company which won't cover Retin-A Micro, this message is for you.

I went to a couple of pharmacies in my town (in North Carolina) when I was looking to have my prescription filled. The first one offered to sell me a 20 gram tube of 0.1% for $98, and the second sold me the same for $92 (or $4.60 a gram).

When I began to run low on Retin-A Micro, I started to look for pharmacies online which could fill my prescription legally* and for a lower price, and I found one in Ontario which looked promising. I printed out the form for my dermatologist to fill out and fax, and I went to his office to ask him to send my prescription to Canada (I must admit that I was a bit nervous because I thought he might not believe that it was legal, or that, even if he didn't doubt its legality, he would still be suspicious enough of the Canadian pharmacy to refuse my request).

Fortunately for me, though, my dermatologist's office contacted me later to let me know that they were going to fax the prescription. The 20 gram tube of 0.1% goes for $28.79 ($1.43 a gram) at the Canadian pharmacy, and the 45 gram tube goes for $45.94 ($1.02 a gram). My dermatologist wrote a new prescription for me so that I could order the larger tube. The shipping and handling charge is about $17 per order (not per item). 6 days after placing my order (I was told that the first order would take 10-15 days to arrive), I received my Retin-A Micro gel from Ontario! For the 45 gram tube of gel, I paid $63.07 (and that's including the shipping and handling charge). Plus, the customer service was wonderful.

So remember that it's possible to save some money by ordering meds from a good pharmacy in Canada. Obviously, though, if you want to order a prescription medication from any other country, you should exercise caution and do some research beforehand to make sure that it's legal and that the pharmacy is reputable.

Best of luck to you all.



*Yes, you can obtain some prescription medications from another country legally. You can't order certain drugs, like Valium, but you can order Retin-A!

[attachment=22581:ram1.JPG] [attachment=22582:ram2.JPG]

Just wondering, does anyone else have weird side effects from this stuff? My skin has yet to get worse, actually has only gotten better as far as breakouts go, but now my skin is OILIER that when I first started? Only a slight peeling/redness/itchiness around my nose, but that's my fault 'cause I've been applying it there when I was advised not to!

Also, my skin is peeling weird - like when you pull dry glue off your hand... it's gluey! And even though I use a gentle face brush almost every night, the texture of my skin never feels smooth! Just wondering if this is normal, 'cause I haven't been able to visit my dermatologist due to a lapse in health insurance (which sucks, btw) so I figured I'd ask here...

Thanks!!

For a bit of background im 20 years old with no history of acne, however i think this was due to the fact that ive swam since i was 12 and being in the pool constantly exfoliated my skin. ive recently stopped swimming because of CALIFORNIA STATE BUDGET CUTS (grrrrr) and im convinced that my skin has no idea how to exfoliate properly.

i am plagued with tonnssss of whiteheads which occasionally become inflamed and full of gunk. gross. unfortunately i scar easily as well so any pimple leaves its mark for at least 2 months . . .if im lucky. . . . im hoping that retin a micro helps because im tired of gross bumpy looking skin and scars (the bane of my existance!!!). Also when i do get those pussfilleddisgusting zits they last FOREVER i mean they dont heal like a normal person (i.e a couple days) they slowllllyyy deflate then leave a circle of discoloration that has to peel off.



for the past week ive been:
AM
SA facewash

PM
SA facewash
RAM .04
topical erythromycin when i think something feels inflamed

should i be using the topical before or after the RAM? ive been using it after . . .


DAYS 1-6
New whiteheads popped up on my cheeks and a slight pink flush. on a side note my skin is super resiliant and can withstand just about any acne treatment (i supposed this is from constant immersion in chlorine water?) AHA/BP/SA never sting/burn even at the highest consentrations. so far ive had some slight flaking, but no burning, scaling, or stinging. the new whiteheads are super tempting to pop, but ive learned the hard way that popping a whitehead almost always becomes infected.

DAY 8
whiteheads seem to be growing in size/going to make their presence known soon . . .ugh that means NOTICABLE ZITS more of that pink flush, its not too pink its looks like i just got back from the gym or running. i had some dying zits on the left and right cheeks which definitely seem to be peeling off, this is good.

Hello!

I am a 16 year old female, and I've had acne since I was 11. The severity has always been changing, but I never get cysts, blackheads, or nodules. I have mild to moderate acne usually in the papule or pustule stage, with a couple of whiteheads or milia thrown in (can't really tell). My skin was best one month when I was on homeopathic medicine, but took a nosedive once I learned that it was just the placebo effect. I am allergic to benzoyl peroxide, so the acne.org regimen is kind of out for me. Anyway, this is my log on Retin-A 0.05% and Clindamycin phosphate 1%.

Hi all,

I'm a 24-year-old female, living and going to law school in New York City. I developed acne around the age of 21, and it was mostly small and comedonal. After staying completely clear for 2 years with ProActiv, I began breaking out last October with very large, very painful pustules on my outer cheeks, which left me with bad PIH. This would usually be post-menstrual, and the ability to predict when I was going to break out with these horrible buggers became maddening.

I've been (happily) on OrthoTriCyclen for about 6 years, and use Purpose Moisturizer, which I love.

My derm prescribed the following regimen for me:

Morning:
Wash with Neutrogena Fresh Foaming Facial Cleanser
Apply Clindamycin lotion
Spot treat with Duac if needed
Moisturize

Evening:
Wash with Neutrogene Fresh Foaming Facial Cleanser
Apply Epiduo
Spot treat with Duac if needed
Moisturize

I'm starting this log a little late, but there's no better time like the present. I've never used a retinoid (or clindamycin) before, but obviously through ProActiv I'm very familiar with BP. I'm mid-way through my 5th week on this regimen, and thus far I am loving it. I haven't had any of the huge, painful zits since I started. A few comedones came to a head, and I easily extracted them (I have one of those blemish extractors from Sephora. Try not to use it too often, but I go to class and have a boyfriend, and I'm not going to walk around with a giant white zit on my cheek).

Last week was my period; typically on the following week, I would develop some of those paaaaainful zits that would turn the entire area around them red - thus making me look like I was punched in the face. I am happy to report that I've had none so far. I keep waking up in the morning and rushing to the mirror, only to sigh happily in relief. This also means that I haven't had to use my Duac in a few weeks!

I haven't had any irritation with the Epiduo. I'm careful to only use a pea-sized amount, and although it feels weird going on, I haven't turned red or anything. I also like how smoothly the Clindamycin goes on. I do get a little greasy later on in the day, but it almost looks more like a healthy glow.

Right now I have a few scattered comedones in my T-zone, but nothing red, and nothing that isn't easily concealed with light foundation. I even started wearing blush again recently, whereas before I was hesitant to put any makeup on my acne-prone areas.

Hope this provides ample background. I'll update this as my condition changes!

I finished my course of accutane last july and since my skin has been okay. Oilyness returned two weeks after my course ended. Skin has been doing okay. My primary derm said to just wash whenever you feel oily and that's about it.

I went to another derm and he said I should wash with pan oxyl and prescribed me retin a and said okay I'll see you in a month. My appointment lasted a whole two minutes if I am lucky. I don't think he spent enough time to diagnose me or even ask me questions.

So now I don't know what to do should I go on retin a or should I get another opinion. I don't want to go through another breakout period and such from the retin a. My main concern is oily skin.

Please help thanks.

I am moving my log from the retinoid section, as I am no longer using Differin. Differin did not work out well for me at all (I used it for 8 wks). It made my chin break out horribly and left my forehead bumpy. I think my skin just didn't care for the stuff!

As of now, I have congested skin on my forehead, temple, nose/under eyes. No obvious acne and no inflammation, just general bumpiness and a few small whiteheads. This has been my ongoing problem since January or so. My chin has a little bit of active acne left, along with some bumps and spots that are healing, along with a few marks. All of that was due to using the Differin. I had no active acne there when I started! This is the area I really want to improve the most.

So here is the new plan:

I am being treated by an esthetician who specializes in acne treatment. I went in for a consultation yesterday. She tested my skin using 15% mandelic acid and 20% glycolic acid - neither of which caused any stinging. So, she says this indicates I do not have sensitive skin. She looked at my forehead (where I have been using the Differin) and said that it almost looks like an allergic reaction.

She set up a very specific routine using some high potency products, but ones that based on my skin sensitivity test, won't be too strong for it. Some of the products are only used every other night at first, others are only left on for 20 min at first, and then you gradually leave it on longer. All old products are gone, and I have a bunch of new ones as part of this regimen. I also go in for bimonthly facials to help the process along. I know this will all be $$$, but I think it will be worth it. Oh, and I am also taking doxycycline to help prevent inflamation.

Here is the routine for weeks 1 and 2:

A.M.

-Wash with Silica Facial Scrub
-Ice skin for a few min
-Apply Salicylic toner
-Apply Glycolic 10% serum every other day
-Apply oil free sunblock (also functions as moisturizer I think)


P.M.

-Wash with Silica Facial Scrub
-Ice skin for a few min
-Apply 10% BP - leave on for 15 min (Days 1-3), then wash off. I guess you gradually build up to leaving it on all night
-Apply Vivant Mandelic 15%
-Apply moisture balancing cream (first 2 wks only)

Whew!! And this plan changes on a daily basis!! I think she may add a Vitamin A product later on. I am going to put my trust in her knowledge and stick to this routine. She said I have noninflamatory acne and that she thinks she can get me clear quickly. Her treatment guide says 6-12 weeks - so hopefully since she said "quickly", that means I'll be on the lower end of that time frame! She also gave me a list of do's/don'ts - including not using fabric softener, what foods to avoid (sushi, salted foods, peanut butter, dairy - and some others).

Today is my offical Day 1. I'll update this evening after the PM product routine. Wish me luck!

Okay so, as bad as I may be at keeping these things up, I tried keeping ajournal of this stuff and I think this might be easier for me. Also looking for some support and ideas here.

So far on:
Benzaclin topical spot treatment
Benzoyl peroxide wash 10% EDIT: once every few days
doxycycline (100 mg) twice a day
Eucerin + Spf 30/Aveeno Sensitive skin + Spf 15 redness calming moisturizer

Just added:
Hibiclens wash EDIT: once every few days
Retin-A Micro .4% EDIT: twice every three days
Nature Made Garlic Supplement EDIT: once every other day or so
EDIT: probiotics (acidophillus) as often as i can, up to twice a day, plus yogurts with live cultures
head n shoulders (as a body wash every now and then and as shampoo)

May soon add:
EDIT: bcp
more supplementation


first of all, some background info-
i first got acne in the 5th/6th grade: nothing too bad, jsut the normal pre-teenage spots and blackheads
by 7th grade: my acne was getting worse, with some strange bumps on my neck, chest, and back
by 8th grade: full blown-bacne, but my face stayed pretty much the same. the bacne compeltely destoryed my confidence at this crucial time in my life. i refused to wear anything that showed any part of my upper body, and gained weight due to depression. i wouldnt even go for boys becuase i was afraid of what they might say about my condition. i also started seeing a dermatologist.
by 9th grade: did a course of doxy, also tried tazorac and nicotinamide. the tazorac ruined my skin and made me embarassed to show my face even to my closest friends. it also made my back flare up all red and itchy for weeks at a time. the nicotinamide also did nothing.
10th grade: back and chest acne even worse, it had gotten ridiculous. kept up with the tazorac even though it sucked in hopes that it would someday produce the desired results. it didn't. my skin was super sensitive all the time. Also-red bumps appeared down the hairline on my stomach, breast, and all voer my legs. I'd spend weekend covered in cream to get rid of them, and still do. wondering if they migth be folliculitis?
11th grade: my current situation- switched dermatologists (this ones way better) tried sea salt baths, to no avail. switched from tazorac to retin-a, which is way better. back on the doxy for like 2+ months now, and using benzaclin, which seems to work really well for not-too-bad zits

right now: chest has cleared quite a bit, some nodules on back, face, comedomes on neck. plenty of bumps that just won't go away on my legs and stomach.

Hey everyone.

I've been on retin-a micro (.1 and .04) for six weeks as well as using finacea and taking two antibiotics. I saw some results, but this weekend my skin started looking much worse. I'm getting so tired of it. I'm 18 years old, and I just want to enjoy my senior year. My skin basically has many whiteheads and about to emerge whiteheads mostly on my cheeks and chin. I'd say it's light-moderate. I can cover it all with makeup, but you can see all the raised bumps :/ Plus, I would love to not have to put makeup on everyday and worry about my face. So, I'm thinking about going on accutane to stop it for good. I'm just trying to decide...any advice about retin-a and accutane would be awesome.

Hey y'all =)

Hypothetical question!

My skin before Retin-A had big pores, scars (mild rolling and ice pick) and was dull and oily.

Suppose Retin-A gets rid of the large pores (or at least minimizes them) over months, heals my scars and makes my skin glow and non-oily and reduces fine lines.

Will I really keep this skin for the rest of my life or what should I do to maintain the effects of Retin-A?

I believe my skin is improving, but I don't want it to degenerate instantly once I get off Retin-A, though I know I could stay on it for the rest of my life.

Thanks for your help!

Well its not as great as i was hoping for to be honest yes my mild acne has somewhat decreased as in the spots don't form like they use to but there still there under my skin casuein red marks and blotcheyness which is very frustrating as i was hopeing my complection would be alot more even after 6 months of retin a.

So all in all im very dissapointed with Retin A as yet again i find myself extremely frustrated knowing ive just had another 6 months of false Hope!

Think i'll through in the towel with topicals as none of them really seem to help and try to get my hands on Roactane.
(The crap you have to put in your body for a clear complection for fucks sake)

From what I've been told -- you don't need as high of a % in the gel as you do the cream. Apparently the gel absorbs more than the cream.

Highest I've seen the gel available is .025%
That is, unless you get Retin-A Micro, then .04% and .1% are available.

Now, I'm currently on .025% and I don't think it's purging well enough. If I were to get on one of the higher percentage Micro, is that really even higher strength?

I wonder since, from what I gather, the micro kind of sits on your face, it doesn't absorb as much as regular gel in an effort to lessen irritation.

I can't do the cream, too greasy for me. What do you guys think I should do. I will ask my derm, but just wanted advice here first.

ok so let me tell you about my acne story .. it started in like 7th grade until high school , then around 9th grade i tired proactiv and it did wonders for about two years . Then i dont know what happen it stopped working , so i tried many other things ..then around 12grade i came across yaz birth contol and heard it would help my acne . so i tried it and went bac to proactv and it did woners the combination of yaz and proactiv made my face clear after about 5 monthes. Then i had to get off the birth control because it was too expensive .. so i was just using proactiv and it did nothing ( my face got soo bad after the birth control) .. so i went to the demotogist and he gave me duac . I tired that for about a month and NOTHING .. i kept it but i was not using it . After about 4 months of using nothing . I went to the store brought cetaphil (cause a friend told me about it ) , i started using that and started using the duac again, i figure i would give it another shot (in the morning) then my friend told me about clearasil 10%benzoyl peroxide .. i started using that at night .. and within 2 weeks my face was CLEAR.. let me say that again CLEAR completely CLEAR ... this combination has done wonders for me .

My routine
Morning
Wash- cetaphil ( using something gentle)
tone- Proactiv toner ( it's gentle )
duac (Clindamycin 1% /Benzoyl peroxide 5% gel)
then i put on lotion

night
wash - St ives gentle scrub
tone- proactiv
clearasil -10% benzoyl peroxide acne treatment


I hope this helps someone like it helped me

Here's the deal. I have a lot of scarring and red marks that I want to diminish and I have a tube of .025% Retin-A. I also have some active acne right now but am afraid that using Retin-A will make me breakout worse.

Should I start it right away?

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.

So I've had what they'd call severe to moderate acne so my derm put me on benzaclin, differin 0.3% and a clindamycin phosphate about 9 months ago. I did get a short IB but after about 2 weeks my skin was already looking so much better. And it lasted for a long time up until NOW! About 2 weeks ago I had the worst breakout I have had in a long time. I figured it was hormonal, and that it would go away after some time. But up until this point the breakouts keep coming! Breakout after breakout...just as some go away, more suddenly arise! I have not changed my ritual and I was my face twice a day religiously. Is it possible that these topicals just aren't working for me anymore? I'm so incredibly frustrated and nearly on the verge of tears every time I was my face and see the damage my acne is causing. It's affecting my social life too. I don't want to be seen like this \
So, has this happened to anyone else? Should i switch to other topicals? I wish I knew what was causing these horrible breakouts so I could get them to stop. They are literally ruining me. Help! Anyone!

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%.

Yeah I'm Ben 23 from the UK. This log is gonna show how I face life with acne etc. A very brief history of my acne is below:

My acne started when I was about 14/15 and it was pretty annoying. I didn't really do anything about it til I was 16 and my parents more or less kept shouting at me til I went to the doctors. The dr gave me benzamycin gel and for a few weeks my acne, which was moderate at this point, seemed to subside, but it was only a mild improvement. I kept on using the benzamycin though, but although acne pissed me off at this point, it didn't ruin my life. When I was 17 I went back to the Dr's because my acne was still pretty bad. He added 100mg of doxycycline per day to my prescription. This made little difference. Round about june 2000 I stopped the Benzamycin and the doxycycline as they didn't seem to be doing anything for me. Over the next coupla months my acne went very quiet and I got barely any outbreaks which made me feel a bit more confident. Then after the summer my acne came back and really exploded. I was getting huge papules, pustules and possibly nodules. I was not a pretty sight. In early 2001 I went back on benzamycin and doxycycline, but again it didnt do much. In about may 2001 my doxycycline got increased to 200mg per day. After a week I looked in the mirror and a helluva lot of my acne had just gone. I was pretty shocked at the improvement and my acne gradually disappeared. After about 6 weeks I was more or less 100% clear. My life turned fucking great! Girls were suddenly interested in me and lots of other things in my life just seemed to come into place! I got a GF and for the next year or so, things were great. I would get maybe 1 whitehead a month and the occasional papule. Every 3 or 4 months I would have a breakout of 5 or 6 spots, but they cleared up pretty quick. I must add that my skin has been oily all throughout this story. After about 15 months, production of benzamycin stopped in the uk. I got put on to zineryt and it broke me out like crazy. I was really upset that I had finally got clear and then my skin fucked up again overnight. I went back to the doctors and they put me on isotrexin which gave no improvement. Then followed about 6 months of hell with my skin. I suffered a few scars in that time, nothing major, but noticeable. My personality also changed. No longer did I wanna go out about 3x a week. I avoided my friends as well. It certainly affected my relationship with my GF, I just wasn't the person she'd met when we first started going out. But I was too embarrased to tell her what was making me feel like this. around xmas 2002 I went on 5%BP and erythromycin. It got a little bit better, but nothing major. In spring 2003 benzamycin was available again, I went back on it but it didnt seem to work as well as it had previously, maybe it was because I was on erythromycin tablets now instead of doxycycline. Then a new dr at my surgery whose speciality was dermatology took me off the erythromycin tablets as I'd been on them for several months. My acne got worse again! I went back on the erythromycin and over the next 6 months, i got fairly clear and got a lot of confidence back. Then after 6 months I again got taken off the oral antibiotics and just had benzamycin to play with. I thought that my skin would fuck up again, but I actually stayed pretty damn clear for about 3 1/2 months, but then one day my skin started breaking out again. I saw a derm a couple of times but didnt get on roaccutane. I got put on differin and some oral antibiotics which did little good. I felt really shit in this time. I was exceptionally close to getting on roaccutane in the past summer, but high liver enzymes meant I never got to go on it. I did get put on differin and benzamycin though, which I'm still on 5 months later and its got me pretty clear. I still get 3-5 spots a week, but no more pustules and only 1 or two whiteheads a month. I dont look great though, no matter how much mild acne I have, it still looks bad. My oily skin makes it all look worse too

Well thats a not so brief history of my acne hell! I thought the new year was a good time to start a blog up, so here it is! At the minute I'm on differin in the morning and benzamycin at night. I've also just changed my cleanser from clean and clear oil free to cetaphil cleanser, hopefully this will help with the redness that my face seems to have. I'm also using lukewarm water to wash my face with instead of cold water, I read that cold water can help to irritate your face and that makes sense to me.

Okay, guys. I really really need some advice. My derm put me on .1% taz and I've been using it everyday since oct. I'm past the IB point (it was pretty bad) but I no longer break out from the topical I do however, get a few red patches here and there. Since then, I've had two salicylic acid peels done and those worked wonders. But today, as I was getting ready for work, as I applied a little concealer and powder my face just looked like it was peeling. I don't know is this normal? Should I think about applying the taz at night every other night? Or every two nights? I'm thinking since I'm past the IB that I won't break out like I did, even if I apply it every other night.

Here Is my Routine.

Morning: wash with Cerave hydrating cleanser (use baby brush for 5 secs on t zone)
30 mins later apply clindamycin phosphate topical gel and or BP to the necessary hot zones (areas that i see a pimple)
1 hr later apply Cerave moisturizer


Night: Wash with Neostrata (use baby brush for 10 secs on t zone)
30 mins later taz
2 hr later Neutorigina anti blemish anti wrinkle moisturizer



If anybody has any thoughts I seriously would so apperciate it. Thanks guys soooo much

So I started using taz in november of 07 and i stopped putting it on my entire face this past summer because it was making my skin super sensitive and red.my main problems are blackheads on my nose and cheeks,and boy do i have a boatload of them.so since about spring/summer ive been using paulaus choice products and now ive kinda settled on washing with olay for sensitive skin and then i use bha 1% gel then lotion then i spot treat with the taz.i also have the 2% bha liquid and use that every few days or so becuase its so drying.and i do realize that blackheads arent just magically going to go away.so now that thats out of the way i have a few questions...

1.i know on the tazorac site they say to apply lotion before using taz but i know that using lotion no matter what kind it is will clog blackheads even more so ive always wondered isnt that kind of like counter productive when thats what im trying to do is get rid of my blackheads?i usually just apply it without using lotion but it makes my skin super dry with these flakes of skin that wont go away.so should i use lotion or not?any suggestions?

2.ive always had an acne problem and for a while i just used the whole proactiv line which was definitely one of the biggest mistakes of my life (and trust me ive had quite a few).but up until i started using taz my skin was never oily at all.i know because of all the BP in the proactiv stuff definitely dried out my skin but even when i wasnt using that stuff i never had oily skin really.then when i started using taz on my cheeks and nose area have been oil producing machines and when i blot my face with oil sheets like every hour it looks like i was using it on a pizza or something lol.has anyone else had this problem?

3.this one is related to #2 becuase i stopped putting it on my cheek area back in the spring and my cheeks still get oily it sucks bad especially bcause i never had oily skin prior to the taz.anyways i noticed after about 4 months after i started to use taz i got these bumps that protrude out of my skin right down the insides of my cheeks like if you were to put your finger on the inner part of your eye and run your finger down the noseline or whatever thats where they appeared.i never had these before and im thinking that the taz caused them to show up (damn i wish i never started using it).and i already asked my derm if it was pityrosporum or however you spell it but he said no its not.of course he didnt give me a solution to the problem because hes a total jackass but thats a whole different story.so im wondering if i should continue to dab some taz on these spots to get them to go away or just stop using it and hope the bha wil help it go away?im just paranoid if i keep using taz on them that it wil just make it worse.

4.i also have some mandelic acid from garden of wisdom (no seaweed and i think its 5%).i havent used it in a while but thinking about using it again.does anyone know if it would be safe to apply some MA then wait about 30 min then use some taz on my nose?i just dont want to make anything worse or if the two dont work well in combonation with each other.

well thats it i know i messed up a lot of spelling etc. sorry about that but im kind of in a hurry here.i really really really appreciate anyone that has taken the time to read this and try to help me out.i hope to hear back from some of you thaks so much!!!!!

my dermatologist prescribed me this a couple of months ago, and he told me to apply it to the affected area (with acne) only instead of my whole face. ive actually stuck with it but later i stopped. im starting to use it again and so far its been a week and im at the initial breakout phase. was wondering if i should try applying little amount all over my face? ive always applied topical retinoids only on affected areas.. not sure if applying to the whole face would be better?

thanks for any advice

I am going to start using Retin-A tonight. If I want to use it with a moisturizer, should I mix it together or should I apply the Retin-A first then wait 20-30 min and apply moisturizer?

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!