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 feel like a just discovered something major...All this time Ive been making my skin worse by picking at my acne!! It never occurred to me until now that it has contributed largely to my acne!! Go to stoppickingonme.com....It will change everything!!! I now realize that my skin picking is a result of psychological issues. So I will attempt (keyword: attempt) to stop this horrible habit. I will also try to stop over-scrubbing my skin with harsh cleansers chock full of acids, as well as globbing on the Differin (pea-sized?!? I would use that amount on one cheek) Updates soon on my progress!!!!

Hey Y'all--

I'm excited to share my progress, as I've been working all year at eliminating my acne and stopping my compulsive skin picking habit. I'm FINALLY making some great progress. I told myself last month that with only a little over two months left to go in the year, I was closing in on my self-imposed "deadline" and had to get serious about healing. I'm including the following picture to give an idea of what I would do to my skin when I picked at it. At the time this photo was taken, I was not using any prescription medications for my acne either. I have now been using differin and ortho tri-cyclen for about three months.

I'm also attaching a photo of how my skin looks today. I have not been picking for at least two weeks.


Hope to share more soon!

I suffer from moderate acne, mostly due to football from all the rubbing with the helmet on my face, but I'm starting my new regimen today...

AM:
plexion cleansing cloths
duac topical gel


PM:
plexion cleansing cloths
retin a micro

I also use Liquid Neutrogena face wash before and neutrogena oil free moisturizer applying the products....Hoping to see some results



Let me know what you think

skin biography: 22 years old, have struggled with acne since i was 12. went from teenage hormonal acne to female adult hormonal acne (cysts on the lower part of my face). after your standard try-everything-at-the-drugstore-plus-proactiv-and-rx-antibiotics-and-creams, i went on birth control for the past two years. pretty much totally cleared my skin, but didn't want to be on artificial hormones for the rest of my life. stopped taking bcp in april of 2008. cysts are back, blackheads that never went away are more pronounced, and my skin is overall SUPER congested. i tried mama lotion but that made me break out even worse, so i've decided to give green cream a try.

received two samples (level 3 and level 6) yesterday. my skin is not sensitive, so i've decided to try level 3 every night. if my skin starts getting irritated i'll just scale it back. will then move on to level 6 two or three times a week.

day 1:
i applied level 3 for the first time last night, and with zero reaction after 24-hrs, i decided to go ahead an order the full bottle of level 6 because i know samples won't give me an accurate picture of long-term results. barring some really terrible reaction *knock on wood* i plan on trying green cream for at least 6 months. haha that is quite a commitment coming from this skincare product junkie.

otherwise, i'm using the clarisonic facial brush, mario badescu botanical facial gel and mario badescu oil-free moisturizer with spf 17. i also have a little mario badescu buffering lotion and desert essence blemish stick left. as soon as these products run out i'm going with elta MD for a gentler cleanser and a moisturizer with spf 40, since i'm currently living in hawaii and i know green cream will make me sensitive to sunlight. until i can get a new sunscreen i'll just wear a hat.

whew. this is quite long for a first post. i suppose i'm keeping a log for my own benefit, but i hope as time goes on my experience can be helpful to others.

cheers,
sushi

Hello, I am new here and this last week I started using Retin-A and BenzaClin (a mix of benzoyl peroxide and a topical antibiotic). I would like to be able to use this webpage/board as a resource, as well as a log for my improvement.

In this first week, my skin is drying out like mad. I imagine due to the Retin-A. My face is extremely flaky in the mornings and I end up gently buffing with a damp towel. I must say though, my acne has already started to improve. I don't have it terrible, but I have a lot of little breakouts on my forehead, chin, and temples, that give me a very uneven texture. As of today, my skin is very smooth, but I have a lot of redness and redmarks. Then since I am still flaking, makeup to cover the redness is out of the question.

I am hoping to be brave enough to start a gallery so I can watch the progress too. I am happy so far. Hoping for the best.

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 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!

Hm...I decided to start a log so I can keep track of my progress. Maybe this will help destress too? Personal log/blog! Woo. So here's my story I started breaking out since I was 11 when I was under an immense amount of stress. Now I'm 19 and I think my acne has calmed down a lot. Currently in college doing the whole adult thing: new apartment, new car, best friend for a roomie, new diets, new situations. I've concluded that alcohol is bad for my liver therefore is bad for my skin. My only problem areas are my Tzone. I only break out in my Tzone.

Here's what's in my medicine cabinet

Dermalogica Anti-bac Skin Wash
Cetaphil Gentle Skin Cleanser
Neutrogena Deep Clean Gentle Scrub
Neutrogena One Step Gentle Cleanser (Complete makeup remover)


Neutrogena Alcohol Free Toner
Clinique Take the Day off makeup Remover

GM Collin Acne Complex (liquid for spot treatment)
GM Collin Gel Puracne Gel oxygen (moisturizer)
GM Collin Gel Purifant (face wash)

Olay Sensitive
Olay sensitive SPF 15
Cetaphil Moisturizing Cream

Makeup
Clinique Perfectly Real Make up
Everyday Minerals

Diet
Lactose intolerant >>kicked in when I started college freshmen year =(
Green Tea

I am currently on Retin-a micro and I use the Clarisonic Skin Care Brush. I don't use all of those products just some of them depending on how my skin feels. =)

I JUST purchased my Clarisonic Skin Care Brush and received it 10-1-08 so we'll see how that goes.

So Ive had acne since I turned 13. It completely flared up when I first turned that age, then died down and was very mild for years up until this point!! Now that I turned 18 it has gotten out of control!! I had a bad breakout on my forehead and on my cheeks. Before this my face was pretty much clear!! So I was prescribed Differin at night, Clindamycin in the morning, and 2x a day Doryx antibiotics. Its been a month, and being on this medication is like a roller coaster!! It clears somewhat, then flares up. Then it clears, and then it flares up again!! Im so devastated...Its been a month now and Im wondering if it will ever clear. Im also taking Ortho-tri-cyclen lo birth control for PCOS. Please help!!

My regimen:
Morning: Wash with Shiseido White lucent cleanser
Tone with Kose Sekkisei lotion
Apply Clindamycin gel/ take Doryx 100 mg
Put Neutrogena daily moisturizer spf 45

Night: Remove makeup with Ponds cold cream
Use Neutrogena oil free acne wash, diluted with Shiseido White lucent
Apply Differin, .1%, take Doryx 100 mg
Wait 30 minutes, apply Kose sekkisei cream

Week 5: I think this is like the 2nd biggest breakout with Differin. BIGGEST breakout was my 2nd week. I have acne all over my face now. FAIL. HAH. But, I still stick to it. I believe in Differin. BTW, I'm using .3%

I'll be updating each week.

I need some questions to be answered:
1. How long is the initial breakout period?
2. Any signs that show that your acne is about to start clearing up? Or like a week that it would start working?
3. I have a pimple full of blood. What should I do with it? Hot compress?
4. If Differin doesn't work, and I need to use Accutane, will I have to go through the IB AGAIN?!
5. Differin swelled up my cheeks. How should I remove it?
Please answer my questions.



OH my routine:
Morning:
Shower
Wash face with Cetaphil Gentle Face wash
Moisturize w/ Cetaphil Moisturizing Lotion w/ SPF 15


Night:
Wash face with the Cetaphil Wash.
Differin
(I don't apply moisturizer because I only have the Cetaphil Moisturizing Cream. Also, I want differin to work and not want a moisturizer to negate some of it's effects. But, when I don't use moisturizer, my skin feels just a little tight.)

^My routine good?

Any suggestions or questions? Feel free to reply.
Thanks guys.
Please encourage me to stay confident and not quit on the Differin journey.

hi im ashley, i used to have moderate acne. about four years ago my dermatologist put me on benzoyl peroxide and clindamycin and it pretty much cleared up my skin. i would say my skin got to about 75% clear. i still had tons of blackheads on my nose and chin and i would get about two big pimples (cysts) a month and five small ones a month. it was a great improvment but a few weeks ago i decided i wasnt satisfied. i went back to my dermatologist for the blackheads and she perscribed differin 0.3%.

WEEK 1: i washed my face with benzoyl peroxide and used clindamycin every morning and differin every night. my face got more oily at first and then really dry and red on my cheecks

WEEK 2: wash my face with benzoyl peroxide every morning and alternate nights with clindamycin and differin. my face just got way too dry and would sting like crazy when i put the clindamycin on. so now my skin is a little less dry, but still flakey on my chin and sides of my nose. i hope this doesnt jinx it but i havent had a pimple since starting differin. my blackheads have been a bit easier to pop, i dont know if thats in my head or due to the new process. i havent had an IB yet, im hoping its bc my skin was pretty much under control to start, but its still early so i guess ill have to keep my figners crossed!

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

May soon add:
EDIT: bcp
head n shoulders (as a body wash)
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.

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.

So, from the title you can gather that I'm a 26 year old woman. Well, almost 27....in 3 months. I've decided enough is enough. My battle began in my late teens and has kept coming full force. By the time I reached 23-24 I was dealing with severe acne. I should have gone on Accutane at that point but decided against the side effects and leapt head first into Blu-U with Levulan and Smoothbeam treatments. 2 years later I'm happy with the results because it decreased my acne considerably and now I would say I have mild to moderate with an occasional cyst. So the bottom line is, I'm still breaking out. My list of previously tried products include:

SA
BP
Apple Cider Vinegar (Internally & Externally)
Diet changes
Vitamins (Zinc, B, etc)
Proactiv
Murad Acne Complex
Various combinations of OTC products
Clindamycin
Erythomycin
Duac
Tazorac
Blu-U w/Levulan
Smoothbeam

And probably numerous others I can't even remember right now. So, with the new year and everything and still dealing with breakouts I finally made an appointment with my doctor. I decided to start with my PCP and if things don't improve, then I can be referred to a dermatologist. My doctor told me (after telling her everything I've tried) that the next course of action would/should be Accutane, but that my kind of acne is not necessarily "bad" enough to use it. Not her exact words, but I knew that anyway. So she prescribed Retin-A Micro 0.04%. My routine is as follows:

Morning:
Wash with Aveeno Ultra Calming Foamer Cleanser
Apply Purpose w/ SPF 15 (will probably switch to Ultra Calming formula when this is empty)

Night:
Wash with Aveeno Ultra Calming Foamer Cleanser
Wait 20 minutes
Apply pea sized amount of RAM
Wait 20 minutes
Apply Aveeno Ultra Calming night cream

I'm beginning the first week with applications every 3rd night. The following week with be applications every other night, and the 3rd week will be applying every night. My doctor is hoping that this will alleviate some of the irritation.

I applied my first application last night and was surprised at how far a pea sized amount does not go, but I made it work. No burning, tingling or itching, so that is great. Active acne right now: I have a monster volcano that popped yesterday morning during my shower, 1 or 2 other active inflammed pimples, and a couple I can see and feel under the surface, in addition to a couple that are in the healing stage. Also, lots of blackhead on my nose, a few on my forehead, and a few on my chin. Overall, my condition today isn't too bad, and only applying the Purpose hasn't seemed to increase any oiliness during the day. We'll see what happens from this point on, but I'm really hoping this works.

I decided to move to Personal Regimen Logs to track my progress with duac and differin. Thanks for everyone who helped me figure out the best way to start duac and differin (I had a nightmare dermatologist who was not helpful).

HISTORY:
I am 29 year-old and have a history of acne, off and on, since I was 19 years old (so definitely adult acne). This time around, I started breaking out last year, possibly triggered by oral birth control. Usually, problems occur around my chin area, consisting of 1 or 2 large cysts a month that would last for weeks (due to scaring, hyperpigmentation, or they would be hard and dormant under the surface). I also would have smaller inflamed pimples on my chin and lower cheek. I tried using the regimen, which helped but didn't seem to provide long-term benefits. Also tried using alpha hydrox souffle, which helped with smaller pimples and hyperpigmentation, but not with the large cystic pimples I would get. Zeno made the large pimples get even larger!!! Finally got fed up after trying these things for a year, so I went to the dermatologist, who prescribed duac and differin gel (0.1%)

WEEK 1:
Differin every other night.
And the morning after, I put a very very thin layer of duac all over (hoping this will minimize IB caused by the differin).
And then on the nights I don't use differin, I just spot treat with duac (to minimize dryness).

I plan on decreasing my duac usage if I experience too much peeling. but i can't help but use it because i feel like it will help a lot with my inflamed white heads and cysts.

So far, my symptoms include:
1. small, red bumps on one side of my cheek, which may be an IB caused by differin.
2. 1 or two small, inflamed whiteheads.
3. an old deep cyst is finally coming out with a whitehead.
4. some dryness and peeling, but I'm moisturizing a lot with Complex 15 (about 20 minutes after I apply differin, but I will up it to 30 minutes based on your advice).

I am currently on this regimen

Morning-cetaphil daily cleanser
2.5% BP
Differin .1% Gel
Neutrogena oil free moisturizer

Night-Repeat

This regimen isnt seem to be defeating my acne..i was hoping for some suggestions on what to buy to get rid of acne....hopefully from someone who has had success with differin and has a good daily regimen

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'm a 16. My acne just started up a few months ago, about two(when school started).. It might be because I joined a extra curricular activity that requires a lot of sweating.. I honestly don't think my acne looks that bad, and I've had others tell me it doesn't look that bad, but then there some people who say it looks terrible. I started using pro-active but it really wasn't doing that much besides making my face feel fresh. My mother brought me to the dermatologist 3 days ago.. he gave me samples of two different types of medications, Differin (to put on at night) and Clenia (to put on in the morning. He told me that these medications will push out any acne left under the skin, and will prevent any more from forming. He said to come back in one month to see if the medication worked at all, and if it does, he'll prescribe it to me. I hope it works! Now what I'm wondering, can I use any part of the pro-active kit with these two medications? like, can I use the refining mask before applying those two medications?

PS: last night I was at a concert and somehow I got a cut on my cheek, and my chin.. how do I prevent scaring on these cuts? Thanks. *I put Neosporin on them already, hopping that doesn't cause a breakout*.


So right now this is my routine:

Before I sleep:
* Wash face with Clean & Clear Sensitive Skin Deep Action Cream Cleanser
* Pat down face with towel, let it dry for 5 minutes
* Apply Differin

When I wake up:
* Wash face with Clean & Clear Sensitive Skin Deep Action Cream Cleanser
* Pat down face with towel, let it dry for 5 minutes
* Apply Clenia


Should I be using the Clean & Clear Sensitive Skin Deep Action Cream Cleanser? Or should I switch to another face wash? My dermatologist told me I should use a face wash before I apply the medication, is Clean & Clear a good choice?

Im just curious. Since i started using it, as of this morning..
Anyone get any redness, any irritation, IB after using Dalacin T.
I've been told you dont get IB's since its an antibotic, im not sure though.
Supposedly works well for mild acne.
Thanks in Advance

Hey Everyone,

I’ve had annoying moderate acne since I was 12 years old and I am now 18 years old and still suffering from acne. I have used almost every acne treatment [ benzyclin, duac, differin, retin-A, doxycycline, birth control, benzyl peroxide washes, Arbonne Acne System, OTC treatments, taz]. I’ve used taz twice before; the first time I gave up after the first week because of the peeling and IB and then the second time after the first month. After the second time I used it, I just started using it as a spot treatment but stopped around June 08. I’m almost certain that it didn’t work before because I would skip several nights and then double up if I did. This time around I want to use it properly for at least 4 months. I’ve been browsing the taz posts and I see people recommending sticking with it for at least 6 months, I’m rather impatient, but I’ll try.

Today is my seventh day on taz and my face isn’t peeling as much anymore, but it is very flaky around my mouth. It also feels very tight and a tad bit uncomfortable. I have three active pimples on my lower left cheek, a smaller nodule on my chin, and several healing white heads on my cheeks, chin and forehead. I have very sensitive skin, so my face is usually a nice bright red hue when I don’t have makeup on. I also have a great deal of red marks from previous acne. If I didn’t have those red marks, I’m pretty sure my acne wouldn’t look as horrible as it does.
I think my acne has been so bad because I’m just about to finish my freshman year of college. Obviously college puts teens under a lot of pressure to make new friends, get good grades, party, etc. Plus when my face is starting to heal, I get my period and then my face just blows up. I’m considering getting back on Yasmin, but I gained 20lbs over a three month course of being on BC. I don’t know if I exactly want to compromise my weigh again because I haven’t been able to drop those 20lbs.

I wear makeup, so my face usually looks really nice, but since my face has been peeling so bad my makeup ends up looking disgusting. I know people say exfoliate, but sometimes my face will start burning if I exfoliate. Plus, no matter how much I exfoliate there are still peeling pieces. If anyone has any advice about exfoliating and makeup that would be AWESOME. Right now I use the following products on my face [all non comedogenic]:
- Physicians Formula Blemish Rx [it has great coverage, but it makes my face really greasy].
- Physicians Formula Talc Free Mineral Wear
- Maybelline Pure Makeup

As for my routine:
Daytime
- cetiphil face cleanser w/ St. Ives Apricot Scrub for Sensitive Skin
- Olay Complete for Sensitive Skin SPF 15
- apply make-up

Nighttime
- cetiphil face cleanser
- Olay Moisturizing Cream for Sensitive Skin [I think I’m changing this to the lotion]
- 0.1% taz [wait 10 minutes for lotion to set in]
I hear that some people put their moisturizer on before taz or after or not at all. I have read posts and I think I’m going to start putting my moisturizer on before and after using Taz. Also, is there anything wrong with using cream instead of lotion?? I greatly appreciate whatever advice you could give me. :]

I’ll try to update every so often.

Here are picture of my face on the third day of using Taz.

[img]http://s36.photobucket.com/albums/e46/usuckirock27/?action=view&current=015.jpg[/img]
[img]http://s36.photobucket.com/albums/e46/usuckirock27/?action=view&current=014.jpg[/img]

followng a ginormous list of medicines doctors gave me i finally went on accutane for 7 months. it didn't clear me off but it made my acne better. i had to stop cause i reached my weight limit. two months after i hstated to breakout again and it wouldnt stop.

i went to a new doctor cause i moved. so my doctor prescribed me differin and solodyn for my acne. i started differin first cause i had to wait for solodyn because my copay at the pharmacy was to high. im getting it through cvs caremark.

differin...over a month in to it, here i am now getting like 3-10 pimples A DAY. called my doctor and she said to stop it and wait for solodyn to start on it again. now i look like a giant ad for acne.

what did my doctor do to me? what can i do? is what should i do?

(ps can i even sue her?) i just pissed for no results after all these medcines doctors said would clear me, especially accutane ("it is 80% effective".....bullshit)

In Grade 9 I began experiencing some breakouts on my forehead. Only 3-4 pimples at most, ever congregated there. Then during winter in my Grade 10 year I broke out all over. These were the times I avoided all mirrors. I woke up early enough that it was still dark outside and I put on my makeup then, under very little light. I began seeing a dermatologist who suggested chemical peels, tetracycline and a vitamin A topical cream. I suppose that worked, though it took time. During this regime I went on holiday to Cuba. I was totally unprepared the strength of the sun and I burned badly on the first day. A strange combination of wearing no makeup, the sun and the healing sea water advanced my skin faster than the plan of my dermatologist. I went back home and continued the rest of my medication and the peels and of course since Cuba my skin was almost flawless. I continued into my Grade 11 year with only minor breakouts. Like a lot of patients, I thought I had gotten over my acne and proceeded to stop taking the medication. That was a big mistake because slowly, my skin's health began to decline. By my prom and the end of my last year in high school, my breakouts were noticeable again. I had gotten another set of peels, which only help once you stop breaking out. Otherwise new pimples form, and with it new scars or hyperpigmentation. Instead of going back to the dermatologist for medication I braved it out. Now I am faced with the worst skin I've ever had. I am distraught and frequently refuse to go on outings with my friends; thus I quickly made an appointment.

On November 10th I saw my dermatologist for the first time in over a year. He once again prescribed tetracycline, peels and a new cream called Retin-A. A few days before my family doctor had put me on Yasmin (a birth control pill effective against the hormones that spur breakouts) and gave me a gel with a strong dose of benzoyl peroxide. The gel seemed to work and scared of the initial outbreak that came with Retin-A, I began the tetracycline but not the Retin-A cream.

Which translates into: I've been on tetracycline and Yasmin for two weeks and used Retin-A for one. Within this last week my face has broken out worse than ever, peeling frequently and yeilding bumps I can only assume are blackheads rising. Tomorrow marks the first of six peels, and within the week I will update again to show (if any) improvement.

-- Kayleeee

[attachment=14913:Snapshot_20081124.jpg][

Hi everyone,
I decided to start this log so that other females with hormonal acne can follow along my progress with spiro (and retin-A micro). There are numerous accutane journals but only a couple spiro logs.

To begin: a little about me and my acne.

I am a 24 year old female and have had mild skin problems since I was about 12. My face was never terrible, just not super consistently clear for the most part. I was never ashamed about my skin because it wasn't that bad (except for those odd big ones that come from underneath and hurt like hell!). I did have bacne throughout a bit of my teenage years though, which wasn't the prettiest, but all in all, it wsan't bad. I have also always had blackheads on my nose, which somewhat bothered me but I dealt with it.
When I started to enter my early twenties and was finishing up my undergrad, I noticed that I was getting sporadic pimples on my face (cheeks) that took a long time to go away. I went to my doctor two years ago and he prescribed some super strong topical cream and minocyclin. the mino did give nice results (though the cream was much too strong), but it turned my teeth green! yuck, i know. but it happens to some. So I went off of it. My doctor said he would give me accutane (I didn't think it was that bad!!!!), but since I was away at grad school, he couldn't monitor me on it so I was never prescribed it. I went to my doctor at the student health, and she put me on birth control pills (Diane 35) and thought they would help my skin and regulate my period. she also put me on differin, which was not bad.
I should mention here that my doctor and derm suspect I have PCOS- which is characterized by acne and irregular menstrual cycles. I actually broke out more with Diane because I got more periods on it and would always have that pre period breakout. Also, Diane wreaked havoc on my emotions. It was really a shitty time for me and I think Diane played a huge role in my mental state. I also gained a bunch of weight (about 15 pds)
I moved at the end of last summer to a new city and had to wait a while before I could get in with a derm at a clinic that is supposed to be good. So I went to some random nurse practioner about my skin, because it was not improving, and she gave me erythomycn and took me off the pill. Emotionally I felt much better and I lost 7 pounds in about 2 weeks. It was crazy. That Diane really didn't agree with me. In any event, the erythomycin was somewhat useful. After about two months, I saw some very moderate improvement, though nothing fantastic. My derm then said to continue using it to give it some time (we can't keep switching all the time, he said). He also told me to talk to my doctor about PCOS symptoms because acne can be caused by this. So I did, and she simply put me on Yasmin (bp with antiandrogens- spiro), without really doing any tests (I have an appointment, with the endocrinologist in July to get something official there). That was a bit frustrating for me- her lack of desire to diagnose me with something that might explain my acne.
I went back to the derm a couple months later and told him it wasn't working. He said since I wasn't responding to the antibiotics or topicals that sprio is my best bet. I asked about accutane (I just want this done with) but he said it wouldn't work for me given the kind of acne I have. You need blood tests before spiro and he said to go when I first got my period. But since I hadn't started the Yasmin yet, my period was quite irregular. so i waited for about a month before I could get my tests. in the interim, my erythomycin prescription finished and my acne all of a sudden came back full force- the dangers of going off antibiotics! I wasn't eating as well as I usually was, so maybe this had something to do with it, but my skin isn't that great now. It actually looks more like your stereotypical case of acne, rather than sporadic zits here and there which was manageable at least.
I started spiro about 2.5 weeks ago and I want to have this journal here for those who are also on this medication (or think they should be) so you can see my progress (fingers crossed) or give me feeback. I really enjoyed reading Shortee's log quite a bit- it was tremendously helpful.
I find that my oil production on my face has diminished noticeably. I used to be greasy come mid-day, but not at all anymore. My hair also is also not as oily. I would have to wash it every day, but earlier this week, I was in a bit of a rush and didn't wash it one day. By the following day, it still looked okay!! In terms of my acne, I feel like it is slowly improving. Ever so slowly becasue I am still getting a few zits here and there but most is just a remainder of what was there before- what developed a month ago. I am a bit thirstier than before, but that is the only real negative side effect. Oh, I might be a bit more tired.

current acne:
On my left cheek, I have many individual zits of varying sizes and kinda red.
on my right cheek, I have a patch of acne (yes a patch- which I have never had before- like bumps). Some of these are whiteheads and some just red bumps. It was super painful when they developed last month.
On my temples, I have a few small zits and a couple bigger red ones, which are fading. My nose still has blackheads covering it (the usual for me though). My forehead is alright- kinda bumpy but not red or anything. My chin is alright as well. I have the remainder of a zit from a couple weeks ago under my nose- just red now.
on my chest- many small zits. they were never there for the last year at least, so don't know where that came from.
I think that sums it up.

my REGIMEN:

morning:
-wash face with neutrogena oil-free acne wash (2% SA)
(- i might add in Benzagel here in a few weeks, but in the past I didn't like the redness it caused)

supper time:
-spiro (100mg)
-Yasmin birth control

bedtime:
-wash face with neutrogena black head remover acne face wash (2% SA)
-retin-A micro gel 0.1%

I have heard doctors recommend not taking spiro at night because it is a dieuretic, but because it makes me kinda more fatigued I decided to take it with my dinner so I will be tired in the evening, rather than all day if i took it in the morning.

I just started retin-A last week. It has been causing some moderate dryness and seems to gradually be drying out that patch of zits on my right cheek because there are less white heads now. I will get a moisturizer though soon with SPF in it. That should help. I will apply that in the morning.

Anyways, that is it for now. If you have any questions please ask. I will try to update every few days!

Lolo

****EDIT: Diane 35 log starts page 3, post 43.****


Seems a bit late to be starting a log, but I keep saying there's no point because soon I will be clear. And here I am 8 months later.

HISTORY:

So I guess i will start with my history. I developed moderate acne when I was 12 on my face back and chest. When I was about 15 or 16 my doctor suggested I use some perscription meds, I had never trued to clear my skin before this because I didn't think there was anything that could be done. She started me on T-stat, did nothing, then oral tetracycline, did nothing. Then when i was 18 she put me on Diane 35. After 6 months I was totally clear.

I stayed that way until I moved to a big city for University. I was so stressed that i kept forgetting to take my Diane, well i started breaking out again, body and face. After that Diane didn't work as well as before. Probably because the city and pollution made my skin worse. Well I started using benzamycin in combination with the Diane at night. Cleared me some, but i was never totally happy.

In the winter of 2005 I started putting 2% SA on my skin during the day, and noticed I was much clearer. So I stopped the benzamycin and used SA day and night, I was totally clear! Well, I had been worry for awhile that the Diane was aggravating another medical condition, so i decided to stop it to see if the SA would clear me on it's own. A month off Diane all my acne came back full force.

I decided to try other treatment options before going back on Diane 35. I decided tretinoin would be a good idea, and my doctor agreed. I started with 0.01% for 5 weeks, then 0.025% for 5 weeks, then 0.05% for 3 months, and now I am on 0.1%.

My skin has followed the standard course. First couple of weeks are good, then irritation and a breakout, with slow steady improvement after week 7.

Wow, this is longer than I had thought!


TODAY:

Okay, so now I am at week 13 of tretinoin 0.1%. I still seem to be purging, but around week 11 I started seeing some better improvement, alot less crap coming to the surface. I'm not getting alot in the way of huge pimples anymore, really just little red marks as small plugs come to the surface. This is why i am certain that this med will clear me up enough. I beleive I am still in a purging stage. And, I am much improved! I have maybe 3 or 4 active pimples on my face, and the rest is just red marks that will fade quickly. My chest has a couple little plugs coming to the suface, but they are all rimmed with red. Not really real pimples though. My back has a good 20 of the little red spots.

Hi,

So I started the retin-a cream for my acne. I'm going into week 8 of my treatment, but I'm still breaking out 3-4 pimples at a time every few days, mostly on my cheeks. Once those goes down, another 3-4 pimples will pop up. I started having moderate to severe acne since April 08, ever since my trip back from China, I swear that was the underlying culprit but it's been 10 months now and I"m still breaking out. Before that, I was breaking out monthly, now, it's weekly.

Before retin-a, I was on benzamycin (erythromycin/benzoyl peroxide) since I was 14 and it helped a great bit. Now I'm 23,, and it stopped working for me like 2 years ago. Ever since then, I wasn't quite able to get my acne under control again.

And I have cystic acne now - the kind where it's inflammatory, deep, painful, and are mostly blood inside.

I think I got my intial breakout at week 5 or so, and it's not clearing up and I'm getting into week 8. I've read that alot of ppl have their IB at week 2 or 4 and seem to only last a week or so. Has anyone's IB lasted for this long and continues to get cystic acne? Plus, they're showing up at places where I rarely get acne before- forehead, side of my face, next to my eyes/eyebrows...Should I continue to wait until the 3 months mark before I give up? I'm really pissed and depressed about all this, don't even want to see my friends. The shitty part is that every small or big acne leaves a brown spot on my face, so i really want the acne to stop so I can deal with the brown spots.


I tried using tea tree oil, benzoyl peroxide, salicylic acid for spot treatment but it does nothing to its natural course! It just continue to grow like normal then flatten down as days go by.Not to mention drying and reddening my skin more than retin=a.

The positive feedbacks on these forums is really what's keeping me on retin-a. Any feedback is greatly appreciated! thank you!


I know some ppl say an ingredient in the cream (isopropyl mystirate) is suppose to aggravate acne, but I put so little on that I don't think it really plays a factor in it. I'm seeing a derm next month for the first time, so I guess I ask him then.

ok so i went to the dermatologist today...and after two months of taking minocycline 200 mg a day and benzamycin..he tells me to stop using the benzamycin and prescribes me tazorac..which he claims will help with the dark spots left on my skin from taking one of the two (minocycline or benzamycin)..he wants me to continue using the minocycline

So i have a couple of questions..
my dermatologist told me to dilute the tazorac with aquaphor healing ointment before i put it on my face..is that a smart decision?

he wants me to put it on twice a day....on other websites i see it says use tazorac only at nite

if i do use it only at nite wit the aquaphor..can i wash my face in the morning with purpose cleansing bar and then use purpose moisturizer spf 15

Thanksss

Well... this is my journey. I hope you all decide to read this and respond. I'm actually pretty upset about this all.

I'm fourteen years old, almost fifteen. I started to get mild acne when I was ten and a half. When I was about 12 1/2 I was sent to the Dermatologist. Over the course of about what? Give or take two years, I have been put on many lotions, potions, pills and whatever else. Until this year I was put on Retin A Micro, Tazorac, Benzaclin, and now Differin.

I have very sensitive skin. It is also very oily, about twice as bad as what oily skin would be referred to as. I don't have a major problem with pimples more whiteheads than anything. Retin-A worked a little, then stopped. Tazorac actually made my skin look normal and not an oil slick. But still it didn't help in the whitehead department. And Benzaclin, well it just didn't work. I'm now on Differin starting today, and I want to know if this had any luck for you.

I know my skin is not nearly as bad for Accutane, but if this doesn't work, then what will?

I know most of you will read this and not even reply, but PLEASEEEEE reply, I just want to know your fails/success stories on all these products!