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Documenting my spironolactone, doxycycline, tretinoin, acanya treatment

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Hitting my one year anniversary and I couldn't be happier. My skin barely breaks out, and if it does, it's a tiny clogged pore and is gone within 2 days. I haven't had a cyst in a really really long time, I can't even remember when. Such a drastic difference from last year -- I would literally have 4-5 large painful cystic breakouts on my chin and cheeks at all times. Dermatologist visits happened almost weekly, so I could get them injected with cortisone to ease the swelling. I'm so happy I stuck with the spiro and made the decision to stop taking antibiotics. And I'm also very happy that I never took accutane, even though my dermatologist told me numerous times I "needed" it. Looking back, here are the factors that I think helped my skin improve:

  • Moisturize in the morning and at night, every day! I like cerave AM and PM, it's gentle and really effective without being greasy.
  • Don't pick, ever!!! This was the hardest thing for me. I used to squeeze and pick and do all sorts of icky stuff to my face, and it never ever helped. It always made it worse, and I have the scars to prove it :(
  • Don't use harsh ingredients like salicylic acid or benzoyl peroxide if you're using any kind of tretinoin cream. These ingredients were making my skin so much worse - they were not helping at all.
  • Use tretinoin cream every night, and always moisturize after.
  • Eat veggies and fruit and drink water! If I have a crazy weekend and eat a lot of carbs and junk food and alcohol, my skin always suffers. It looks dull and I have clogged pores and it takes a few days to get back to normal after that. I really noticed how an organic, healthy diet that is low in sugar has helped my skin look and feel great.

And of course, use the spiro. I think my hormones played a large role in the ups and downs of my breakouts, and now that they are under control, I hardly think about my skin anymore. Literally, my skin was ruining my life. You can read some of my earlier posts to see just how bad it was -- but I was basically depressed and always worrying about my makeup covering up my inflamed red skin and who was looking at me and it totally took over my every thought. I didn't want my boyfriend to sleep over (see me without makeup?? no way!) and I didn't want to go swimming in the summer and all sorts of other activities that I really missed out on. Now, I'm living with my boyfriend (with a ring on the way soon I think smile.png ) and I hardly give two seconds of thought to what my face looks like. My best advice is to stick with your treatment, be patient, and have hope, because I struggled for a long long time, basically from the age of 15-29, and I promise it can get better if you find the right solution!

It's been a while since my last post... mostly because I hardly have to worry about my skin anymore! I've been taking spiro for over 8 months and have never been happier. I'm still using tretinoin cream at night and moisturize with cerave PM. In the morning I use cerave AM. That's all! Every other day I use St. Ives apricot scrub to help clear away the dead skin from the retin-a. I stopped using all benzoyl peroxide and salicylic acid products. They made my face much more inflamed and irritated and dry. Since I stopped using that harsh stuff, I noticed my skin is more balanced and actually breaks out less. I think the cerave moisturizer is helping a lot.

I still get a pimple or two when I PMS but it's nothing too crazy or unmanageable. I'm so happy with my skin finally!!!!! My best advice to anyone with cystic acne is to be patient and give spiro a long time to kick in. It took months and months (with LOTS of ups and downs) before I really felt I had made significant progress. And not to mention 15 years of bad skin before that... !

My dermatologist was constantly telling me I needed accutane and I'm SO GLAD I didn't go that route. At 29 years old, I didn't think that would be a long-term solution. Most women at my age who use accutane have relapses and have to do additional rounds. I think that my acne was mostly related to stress, hormones and years of putting harsh acidic topical irritants on my face. And diet too --- I've been eating an organic, GMO-free and dairy-free diet while minimizing my intake of processed food. I think that has made a huge difference. There are some awesome sites about how GMO foods are causing lots of health concerns and I whole-heartedly believe my skin breakouts were directly related to food allergies and/or upset stomach caused by overly-processed food. Corn and soy ingredients that are genetically modified are being linked to lots of diseases like autism, cancer, and more... it's crazy. Okay enough about food! I hope anyone who tries spiro sticks with it and sees great results like I did :)

Can't believe it's been 6 months! I started taking spiro back on October 23, 2012. Time flies. I've had ups and downs, and here are my latest thoughts:

-- Spiro is great at keeping hormonal levels in check. In addition to a birth control pill that is low in androgens, I 100% think spiro is a great option for women who struggle with acne brought on by stress, PMS etc.

-- Spiro does not make miracles happen. Don't get me wrong, it helped A LOT, but I also learned that there were other underlying issues causing my acne:

-- Picking at pores. I know it's gross but I would pick and pick and pick and then immediately regret it when a simple blackhead turned into an inflamed, icky sore. Spiro will help, but I HAD to stop inspecting my face every night!

-- Diet. I cut out dairy and that helped a lot too. My stomach was always upset and once I stopped eating ice cream, milk, cheese (basically all the yummy stuff, boo) I noticed my face was less inflamed as well. When I eat veggies and fish and drink a lot of water, I feel great and I look great. When I eat sugar and loads of junk, I look like junk.

-- Makeup. Obviously I want to cover up my acne marks and breakouts with concealer, but I realized the kind of makeup I was using was causing more redness and irritation. I used to use neutrogena concealer with salicylic acid, thinking that would help clear my skin also. It wasn't until I switched to a maybelline product formulated with vitamin c (meant to clear dark spots, etc) that I noticed how much smoother and less irritated my skin felt. While acne products can be great for some skin types, I'm 29 and think that keeping my skin moisturized is more important than drying it out with harsh chemicals. They seemed to do more harm than good.

-- Moisturize at night. I didn't fully understand how important this was until recently. I was getting really upset because the spiro seemed to stop working, until I realized that my breakouts were beig caused by dry skin (thanks to tretinoin, which works wonders on clogged pores but can really suck the moisture out of your face). When I used tretinoin at night and didn't follow up with a PM moisturizer, my skin would dry out and flake and get irritated and red and 2-3 days later I would magically have breakouts in the dry patches. I think my skin was confused, it would dry out and then start pumping tons and tons of oil to compensate, leading to more acne. Now that I use a moisturizer every night, no matter what, I've noticed my skin is constantly "normal" and isn't swaying between crazy extremes from dry to oily to wacky to acne. That always seemed counter-intuitive to me, that putting moisture on a breakout would make it worse, but the right moisturizer will help it heal and reduce redness (like cerave) while products like clindamycine and benzoyl will only make it peel and look worse. Granted I know those products can work wonders for some, just not right for my super sensitive skin.

-- Stay calm. This sounds funny, but as much as spiro can help, if I'm super stressed about something (work, personal life, the fact that I'm breaking out again and don't know why, etc) my skin gets ten times worse. It's a fact. At this point, even with all info about spiro and tretinoin and diet, I will still get a nasty acne flare-up that takes weeks to heal if I don't stay calm and stress free.

-- Antibiotics are overrated. Just my humble opinion. I took doxy at 200mg per day for about 5 months and recently just stopped. Yes, it helped with inflammation. Yes, my deep acne cysts were better when I took it. But my skin was also super sensitive to sunlight to the point where 15 mins outside and I felt like my face was burning off (I'm Italian and have olive skin and normally tan like crazy in the sun so definitely not normal) and I know tretinoin will obviously affect sun sensitivity but this was even more intense. My stomach was not normal, and in general long term antibiotic use is not good for your body's natural balance. Yes, I broke out when I stopped taking doxy (some of the worst cysts I've had in a while, to the point where my derm again suggested accutane and I resisted. And am still healing some of those breakouts) BUT I firmly believe that the outbreak will go away and it was just my body getting back to "normal." I'm also taking a probiotic and that has seemed to help a lot. So much of your outer appearance is linked to your inner health, and I firmly believe that antibiotics are killing way too much good bacteria along with the bad. I know they work wonders for some, but after a long thoughtful decision, I'm done with them. Call me a health freak, that's fine :) I'd rather get to the root of the issue (lack of moisture, stress, hormones, food allergy) rather than take an antibiotic that is only masking the condition. Antibiotics won't permanently cure acne, they only work to reduce inflammation while you're taking them, and there's no way I want to take them for an indefinite period of time. Just my own view on it.

I'm meeting with a nutritionist in a few weeks to review my diet in more detail. Since I cut out dairy, I've lost about 15 lbs but I'm also only a out 110 lbs now so I need to make sure I'm still getting the nutrients and vitamin d and calcium I need. Plus she may have some insight into the antibiotic vs probiotic topic, which is still interesting to me. Will keep everyone posted how that goes!

I guess that's it for now. Still healing some spots from stopping the doxy but altogether feeling great about the spiro, birth control pill and retinoid treatment I'm on. Also a quick note that I recently started using cerave products and LOVE them, absolutely recommend to anyone using a retinoid.

Feeling GREAT about my skin... finally! My derm and my doctor both said to let the spiro work for 3 months and then reevaluate my progress once my body and hormones have been able to adjust. At this point, this is the best my skin has looked in years. I'm absolutely amazed. There's not even one spot underneath my skin -- before I would have cysts forming every few days that I could feel when I washed my face. And now my entire face feels smooth. I went through some ups and downs, and I think it was just my body adjusting (and since I also switched my birth control pill in the process) but at this point I feel great. I have maybe 3 spots on my face right now, but they couldn't even be called pimples. They are just little pores that are blocked. It's a miracle! Granted, it wasn't an overnight miracle, and over the last 3 months I definitely had some days where I wanted to give up, and before my spiro treatment I struggled for 10+ years (basically since high school) with problem skin. So overnight ---- not so much! But I do finally feel like I've found the right mix of treatment. I have a lot of hyper pigmentation and a few scars that still need to heal, so I'm still a little dependent on makeup to cover those spots, but at least there aren't new breakouts forming. And anyone who has struggled with cystic acne can probably relate --- I don't care how red my face is, as long as I don't have huge bumps that are painful and swollen, I'll consider that a good day!

I've also learned an important lesson to let my skin heal on its own. All those years I was picking and squeezing and irritating my face was only making things a million times worse. I've realized that my body will take care of a clogged pore within 3 days, and if I squeeze it that will only create a scab and a scar and not heal any faster at all.

The only side effect of the spiro I've noticed to be lingering is the fact that I lost about 15 pounds. I used to weigh about 125 and now I'm around 110. I didn't change one thing in my diet or exercise, but I think the fact that its a diuretic just means I don't have any water bloat anymore. Not a bad thing! And my breasts feel bigger -- almost a little swollen? -- but they don't hurt at all, just seem to fill out my bra better. That's also a good thing I guess.

I'm slowly stopping the doxy, I don't think it was helping at all anyway. So right now I'm taking 100mg spiro in the morning, 100mg doxy in the morning, my birth control pill (Sprintec) and using tretinoin cream .025% at night. In 2 weeks I'll stop the doxy altogether. My advice to anyone who's struggling is to stay positive and be patient. It can take a while to see results with any program. And now I realize that less is more --- I used to try a bajillion products and all that really did was dry out my face and cause redness and irritation. Now I use moisturizer in the morning and at night, and no harsh astringents or creams that will dry out my face. It always seemed counter-intuitive to me, why would I moisturize my face when it's already oily? But now I know that maintaining a balance - not using too much product and not leaving my face too dry - is really the best approach for me. Okay enough rambling for now... I'll update in another few weeks with what is hopefully lasting results!! smile.png

Almost at the 3 month mark. Still experiencing some ups and downs. Have a larger outbreak below my nose (weird spot!) that sucks, but in general the spiro seems to be helping in terms of the severity. Any cyst-like outbreak shrinks must faster and tends to not even come to a head. It will just be a big bump under my skin for a few days, become a little red, then slowly vanish (as long as I don't pick, which I have gotten SOO much better at!).

I started having more whiteheads and blackheads, which was frustrating since I haven't had any of those in a long long time since using tretinoin every night, so I switched to a new exfoliating wash from St. Ives that contains salicylic acid. Usually I use the regular apricot one, which is great for getting rid of the dead skin cells the tretinoin helps to turn over. Well..... that was a bad idea. I used the salicylic adic one a few times this week and my skin was not happy. I think it dried it out too much, and so it started pumping out way too much oil to compensate. Yikes. Nothing so major but definitely a step back. I stopped using it and have been making sure to moisturize really well and my skin is starting to become more balanced, less red and overall more "calm."

Lessons learned: Don't use harsh things on my skin. Period. Don't pick. Ever. And keep moisturizing.

Another thing I noticed is that my pigmentation that's left over from past breakouts seems to have gotten worse. Probably just irritated from that harsh scrub. Yuck. I'm also getting my period so I think that one breakout might be a result of that.

All in all, still feeling good, no more side effects from the spiro at all, and just looking forward to another month with fingers crossed I continue to improve. Using 100mg spiro in the morning, tretinoin 0.25% cream at night and 100mg doxy daily.

Happy New Year! 2013 didn't start out as I hoped it would. Just got back from the derm and had to get 3 more spots injected with cortisone to reduce the inflammation and swelling. What the heck happened?? Well, I was wondering that too, since I was on such an awesome path with the spiro. Like anyone who has ever struggled with acne, or any kind of medical issue for that matter, I've googled a bajillion "solutions" to the problem. There are a lot of theories out there, most are a little crazy, but one thing I noticed during all that googling is that dairy kept appearing as a trigger. And while most articles admit that dermatologists do not officially consider dairy a cause of acne, recent studies have been able to link the hormones found in milk with acne-inducing hormones found in a human body. After all, milk and all dairy products come from a pregnant cow, so no wonder it can effect your body's own hormone levels. For me, hormones are absolutely the #1 cause of my acne. So the spiro has been awesome at curbing those major outbreaks usually brought on by stress or PMS. My birth control pill has also been a huge help. And for the little clogged pores, tretinoin cream is still working out really well.

So back to the milk.. Totally unrelated to my acne, I stopped consuming dairy products about 6 months ago after my friends and my boyfriend convinced me that I was lactose intolerant. It would go something like this:

Me: ouch my stomach hurts.

Friends: oh no, what did you eat today?

Me: yogurt for breakfast and ice cream after dinner.

Multiply that scenario by about 5+ years and you can see why I finally admitted to myself that maybe, just maybe, my body had a hard time digesting lactose and hence the belly aches. Since I've stopped eating it (did I mention how much I miss ice cream???) I've felt great. No stomach aches, no diarrhea (sorry for the TMI but it's true!) and no cramping.

Simultaneously, I've been starting a new regimen of spiro and loving it. Had a few ups and downs but overall my oil production is basically zero, my makeup stays in place like magic, and I don't even have to wash my hair every day which is a miracle considering how oily I used to get.

Last week I went to the lab at my doctor's office for a lactose intolerance test. I wanted to be 100% sure I had to say goodbye to ice cream and pizza and cannolis before cutting them out, I didn't want to be missing out on something if it's wasn't even really a problem to begin with! The lab tech made me drink 12 ounces of pure lactose that tasted AWFUL and was like a big syrupy glass of luke-warm milk. Bleh. Then I had to sit around there for 3 hours while they tested my reaction at 15 minute intervals. Still haven't heard back from the lab about the results, but I'll tell you this: MY FACE WENT BANANAS.

Literally, the next day, I had about 4-5 super super red pimples on my face that were well on their way to becoming big swollen cysts. This probably sounds dramatic, and I know people can exaggerate, but I'm not even kidding... I went from having calm, normal-colored skin with a few little clogged pores here and there that no one would bat an eye at to having a red, inflamed, out of control complexion. I'm not a scientist, nor a doctor, but it's pretty crystal clear to me now that dairy, or lactose, or whatever you want to call it, is not a good idea for me. After months of getting my acne under control (not to mention the years I've spent struggling with it) suddenly it became obvious that dairy is a trigger for inflammation. It seemed like any little spot on my face went from being calm to being VERY angry almost overnight. Not fun.

I went to the derm today to get some of the spots injected with cortisone and asked her about a possible link. After telling her the history, she said that it's very very likely dairy is a "trigger" for my breakouts, just like gluten is for some other people, and that I should avoid it given what it seems to have caused. She said it's not uncommon for food allergies to manifest some symptoms in your complexion.

So.... needless to say I'm done with dairy. Soy milk is delicious, especially the vanilla flavored one from Whole Foods, and I'm taking a daily vitamin D pill that my primary care doctor recommended. I will miss ice cream for sure, but I won't miss my red, inflamed skin! Hoping once these bumps go down I will be back on track with my spiro success. I tend to be weary of people or articles that claim to have found a "cure" or a "cause" of acne, since so much of it depends on each person's individual situation. So I'm certainly not trying to say "everyone should stop eating dairy, it causes acne" duh that would suck and all the ice cream vendors would go out of business and that would be a very sad day. It's just so clear to me after this "experiment" (that was accidental in terms of testing dairy's effect on my skin) I can't eat it anymore! Maybe the best thing to do if you're curious whether a certain food (milk, gluten, etc.) is messing up your complexion is to cut it out of your diet for a few months, then carefully watch what happens when you re-introduce it. My derm said it's obvious there's a link there for me, so if you try testing out the theory you should pretty clearly be able to tell if it causes a reaction to occur. Sorry for all the exclamation points, I'm a little shocked myself at how obvious the connection was for me. Clear as day on Tuesday, drank a bunch of lactose, red inflamed yucky face on Wednesday.

Also as a last note, I'm still really glad I didn't take the accutane route. It might have cleared my skin in the short term, but I never would have realized the link between my hormones and dairy consumption with inflammation and breakouts. Trying to look forward and stay positive and although this breakout sucks and makes me feel like I took 12 giant leaps backwards -- at least now I know what to avoid and how to better manage my skin. But god, I'm going to miss ice cream!

Well that last post was quite a doozy. Thankfully my skin took a turn for the better after that.... The areas I was freaking out about on my chin are completely GONE now! I think I overreact a bit when I see something forming because of how bad my cysts were before I started spiro, and I'm so scared that it will revert back to that. But finishing month 2, I can honestly say this is the most confident I've been regarding my skin in a long long time! Still have lots of red marks and "scars" that will most likely fade other time, but I have no huge breakouts at all right now! And even more amazing, I have nothing brewing "under my skin" --- for anyone that has had cystic acne or those deep painful kind of breakouts, you know what I mean smile.png

Before I started spiro there was always at least one, if not two or more, spots on my chin or jawline that were just hanging out deep under my skin, ready to surface. The best feeling is when I wash my face in the morning and my skin feels completely smooth!! Granted, I still get a few clogged pores here and there, probably thanks to my makeup, but I try to do a good job of keeping my face clean and use a tretinoin cream at night to keep them clear. The major win for me is that my cysts are gone! I'll take a clogged pore or even a "regular" little pimple any day over those massive bumps. Feeling really positive about what the next month will bring, since both my derm and my primary care doctor both say the third month is when the full effects of spiro really kick in, once your body has fully adjusted to the treatment.

Side effects are minimal, no more dizziness, although I do notice I can't drink as much as I used to. That probably sounds funny, but seriously if I have one glass of wine I feel like I just took a drowsy benadryl. Oh well, not too big of an issue since alcohol isn't exactly an antioxidant and wasn't doing my skin any favors anyway wink.png

Also, I've lost almost 10 lbs since starting spiro, which is CRAZY since I haven't changed a thing other than taking that pill. No extra exercise, no change in diet. I think it's mostly water weight.

Just shy of the 2 month mark! I've had some ups and downs, but am still feeling confident this will be a good long-term solution. Taking 100mg/day of spiro and have tried to slowly taper off the doxycycline, which I've been taking 200mg/day of since August. I didn't think it was helping, but over the last 2 weeks every time I lower my doxy dose, I have a breakout! So maybe it was helping after all. I don't mind the daily spiro since I know that's okay for long-term use, but the antibiotics are really not my first choice since your body can build a tolerance and they're really not good for long periods of time. My derm recommened once I hit the 3 month mark with spiro, I can drop the doxy to 100mg/day for 2 months then stop altogether. So that's good there's an end in sight for the antibiotics. And I'm still feeling really happy I avoided accutane, even at the strong suggestion of my derm, since now I see how much my acne was related to my hormones and that I really can get it under control with spironolactone.

At my appt with my derm yesterday I asked her to use a cortisone shot for a breakout on my chin. There are 2 bumps that have all the makings of turning into swollen cysts, the kind that don't come to a head and just hang out on my face for 2 weeks. Since I haven't had any really large cysts in the last few weeks, and I'm trying hard to work on clearing my acne scars and hyper-pigmentation, I wanted to be proactive and try and get rid of these before they got any bigger. But she said she wouldn't inject them since there is too great of a risk of atrophy, which is when your skin sinks in and leaves a "hole" that can last for months, or even years. Sooo.... I guess that is a good thing? That they aren't that bad? I was a little disappointed since those shots are like little miracle workers that immediately make the bump go down, plus it's a $25 co-pay every time I go in, plus I have to take off work and travel to the office, so it's hard for me to get in there often. She said if they get bigger to just make an appt later in the week but I can't just keep trekking off to the dr. and leaving my job! Oh well. I guess I shouldn't complain since I've been relatively clear and these are certainly nothing like the kind I used to get. I think I just have such an emotional and knee-jerk reaction when I start seeing something forming. I immediately go into a kind of panic mode and worry that they are going to keep growing (which now I know makes it *even* worse since stress throws off your hormones and makes your body pump out even more acne-inducing stuff) so I try to keep calm. But it's hard when I feel like acne is controlling my life and my self-esteem and confidence basically goes down the drain when I see them appear. I feel ugly, I feel like a loser, I feel like no one will love me, etc. etc. of crazy reactions that I *know* aren't true but can't help from worrying about.

Last night I was thinking about all the times I either changed plans, or was in a bad mood, or stayed in, or avoided people including my boyfriend and friends, or snapped at my parents because of the stress I felt.... the list goes on. I know it sounds crazy but acne has controlled so much of my life for the last 10 years. It makes me feel sad and like I've missed out on feeling happiness and maintaining a carefree attitude. I see women around the city who are my age, late 20's or early 30's, who have perfectly clear skin and I seriously feel jealous. Jealous! Of complete strangers. I know it's not normal, but I can't help it. I think I might seek some professional help by setting up an appt with a therapist through a referral from my primary care physician. It's gotten really hard for me to relate to people and the only outlet I have right now for my stress is on this blog. Which helps! But I still feel like I have a lot of leftover anxiety, stress, and sadness from the experiences I've had. There were literally days last year when my face was so swollen that I would call out sick from work and mope around my apt all day by myself. I think that's borderline depressing. If not full-on depression. Granted, it goes in waves and is definitely better when my skin improves, there's a direct correlation. And everything else in my life is fine. I have a good job, friends, family, etc. so I know it could be way worse. But I can't stress enough how emotionally devastating it has been to look at my face in the mirror some days and just cry. Granted, it's way way way better since the spiro, thank goodness, and I don't think I'll ever go back to those terrible terrible days, but I do think I need to get a handle on how to deal with those leftover emotions. Some people say acne is a cosmetic condition, but I know for sure based on my experience that it can cause severe emotional pain. There were days I wanted to just curl up in my bed and sleep for days and days until the marks went away (which I obviously couldn't do, and didn't do) but still, those feelings are not healthy!! One big thing I've accepted in the past few months is that the more in control of my anxiety I am, the healthier I look. And since my anxiety is directly linked to what's going on with my face, I need to be confident that even if I have a breakout, or 4 or 5!, that it's not the end of the world and life goes on. Easier said than done, but I'm trying every day to work on my confidence and self-esteem. I start beating myself up that I'm inadequate, that my boyfriend will think I'm ugly, that he won't want to be with me, and loads of other craziness. When in reality, we've been dating for over 2 years and he's seen me without makeup at my worst. And has never said a bad or mean thing about it. He's also not super supportive, in that he doesn't understand how upset I can get when I get a huge cyst, but I think that's because he's never had anything like that and doesn't get why I think it's a big deal. I don't talk to anyone about it really, for that reason. I feel like no one understands how much it effects me. But that's just the thing...... it's my own fault for beating myself up about it! No one is making fun of me (or, at least, no one that I know of haha) and all the close people in my life love me unconditionally. I'm absolutely my harshest critic and feel this need to look perfect. I think a therapist could help me a lot. So that's my goal for 2013 --- to work on my self-esteem and improve my self-worth and stop beating myself up for not being perfect.

In terms of side effects of spiro, no more dizziness and only a slight increase in urination. Still need to drink extra water throughout the day. Other than the few spots on my chin here and there, no major crazy cysts and my forehead and cheeks are completely clear and look amazing. Chin is still on the mend, but my derm reminded me that 3 months is the ultimate mark for it to work so here's to hoping the next month is the best one yet! The tretinoin has been awesome in reducing my clogged pores and keeping my skin smooth, I've been using the 0.025% for over a year and love it. Lately I've been using it every other night, and just moisturizing on the "off" nights, which has really improved the tone and texture of my skin in the cold winter weather. I stopped using benzoyl peroxide and clindamycin (in the form of acanya or duac) altogether. My skin is MUCH less red. I noticed that without those topicals, my skin is actually in a better state. It's not flaking or scabbing or irritated, and that really those things were just making the cysts appear worse. Since not only were the cysts creating a bump on my face, the topical stuff was making the bump red and scabby. Without the redness, my skin can still look uneven since the cysts are deep within my skin, but at least the tone of my face is even (well, not perfectly even, but not red and inflamed and crazy looking!). I know those products can help certain kinds of acne, but for mine, I think it just made it worse. Mine are so deep within my skin that only cortisone injections or internal meds are going to make a big difference.

I spoke too soon yesterday :( Although this one is certainly my fault. I tried to squeeze a little spot on my chin yesterday (so so so bad, I know, ughhh I don't know why I do that!!!), and today it is completely swollen and huge and the entire left side of chin is basically inflamed. I can't blame this on the spiro or doxy though. I totally did that to myself, which is almost more frustrating. Gross. Keep calm....... hopefully it will go down by this weekend. Bummer. This sucks.

My skin looks the best it has ever been in the last 5+ years. I have maybe 2 spots that are totally minor. No cysts at all! And I'm getting my period this week, so normally this would be the worst my skin looks throughout the month. I'm so happy and so glad I stuck with the spiro. I saw my primary care physician yesterday and she said I can stop the doxycycline completely. So I'll just be taking the 100mg/day of spiro and my birth control pill. I'm still using the tretinoin cream 0.025% at night, but have switched to every other night since the weather has turned so cold and my skin is drying out a lot faster now. I am so satisfied with the results so far. I can't wait to see how my skin looks after another few months, since most people said it keeps getting better. Now just need to fade these darn spots from past breakouts....... ugh...

Definitely improved since my last post... The spot on my chin barely amounted to anything and is totally flat today. I don't have any "active" breakouts right now, at all, in fact. Just a LOT of hyper-pigmentation and some scarring. Seems like the spiro is doing its job! I have been able to go 2 days without washing my hair (which would NEVER happen before, I would be greasy after 12 hours) and my makeup is still staying in place really well, without needing to blot oil or touch up at all during the day. The skin on my arms and, really, all over my body seems much smoother and softer (which was actually the first thing I noticed back on day 5!) and overall I feel great. I got really nervous a few days ago when I felt another cyst forming, and am so thankful it didn't swell up like they used to. I think I finally found the right combination therapy after over a decade (yes, a whole freakin' decade) of trying every product under the sun! It seems like it's been a hundred years since I had clear skin. One big thing I've noticed since I stopped using "harsh" topicals is that my skin, even when its pimple-free, is much "healthier." Obviously it depends on the type of breakouts you have, but mine were all deep under the skin, very large (like the size of a dime, or bigger, all the time) and super painful. I used to put benzoyl peroxide and clindamycin and all sorts of drying agents on them to try and shrink them. I realize now, after talking to my doctor (yes, my primary care physician and not my derm, because all my derm kept telling me was that I needed accutane) that these breakouts weren't going to be cleared up by topical creams and if anything, those creams were just ruining the top layer of skin, making the area even MORE red and even more dry. Thank goodness I finally found something that works from within my system and gets to the root of the cause. My fingers are crossed the spiro keeps doing its magic and I stay clear of cysts, and once the acne marks fade, I could be makeup-free by 2013!!! And that would be the absolute best holiday gift I could ever imagine receiving smile.png

100mg/daily spironolactone

200mg/daily doxycycline -- still planning to slowly stop taking this, once I've gone 1+ week without a major breakout

Sprintec birth control pill

0.025% tretinoin cream at night

Spiro side effects: I'm not dizzy anymore after taking the pill, and even though it's a diuretic, I notice I'm not going to the bathroom as often as I did when I first started it. I definitely still get more dehydrated, so I'm making a point to drink more water throughout the day (good for my skin and health anyway, so that's a positive thing!). My stomach gets a little upset if I don't eat enough before taking the pill, but that's not a problem at all if I take it right after a full breakfast with a big glass of water. Overall, feeling great!

I guess it's 2 steps forward, 1 step back. I've been taking the spironolactone (in combination with doxy and tretinoin cream, both of which I've been using for 1+ year) for over a month now and I've seen improvements... but still not 100% clear. Overall, I feel like my skin is producing less oil and my makeup seems to stay in place for much longer throughout the day, versus pre-spiro when I would be shiny and oily by lunchtime. The total number of breakouts has definitely decreased, in addition to the severity. But last night I noticed another bump forming under my skin on my chin, and this morning it's big enough to notice even with makeup on. What the heck. Granted, the last few cysts I've had haven't been as inflamed or painful as the ones I used to get, but I'm still frustrated they keep popping up. I get so scared and anxious that they're going to keep growing and swelling, like they used to --- I would seriously do ANYTHING to never have another painful cyst on my face ever again. I try to keep reminding myself that it's an improvement, and it can take time to work (most reviews and medical journals say it takes 4-8 weeks to see a full response, and I'm at 5 weeks) but I can't help but feel upset and frustrated. At this point, I don't even remember what it's like to have clear skin or skin that's not scarred and not have to worry about applying makeup in the morning. I'm starting to think that I'm not able to objectively gauge the severity of my acne anymore. I've had so many marks on my chin and my jawline that even now, when I'm "clear" and it's just scars (and some atrophy sites from the cortisone shots) and the one little cyst on my chin, that it still looks "awful" and I need to cover it all up. I definitely need to stop obsessing about it, but it's so hard to not worry it will get worse again. Spending the week with my boyfriend's family and seeing every single person with clear, beautiful skin makes me feel so insecure and even worse. I thought I had major improvements, and then when I see that the only person with pimples is his 17 year old cousin, it makes me feel like even at my "best" it's still not good. It's hard not to feel embarrassed as a 28 year old. Granted, it's still a huge improvement, and one bump is WAY better than the 5 or 6 huge ones I used to get at a time, so I'm trying to stay positive. But seriously, I'm not sure how much longer I can deal. It makes me so irritable and my self-esteem drops so quick when I see myself without makeup on right after I shower. I have so many scars on my chin and cheeks and then whatever bumps are forming on my chin.... it's hard not to feel ugly. The last time I saw the derm she was really positive and called me pretty, which sounds funny, but it honestly made me feel so much better. I try and keep everything in perspective -- that overall I'm healthy and there's nothing seriously wrong, it's not life threatening etc. etc. -- but it still bothers me a lot and I spend literally hours of my day thinking about my acne. Why isn't it clearing up, why me, when did it get so bad, should I stop eating sugar, blah blah blah. My boyfriend says stuff like "it's not like you're dying" which just makes me feel worse. I know there are serious illnesses and other more threatening conditions, but I can't stress enough how much my mood is affected when my skin flares up. I just feel so helpless -- I've tried everything, taken every single piece of advice from the derm and my doctor -- and I'm still not clear. Ugh sorry for the rambling post... definitely the most frustrated I've been in a while and hoping that the start of week 5 sees some bigger improvements sad.png

Finally! I'm 28 days into my 100mg daily spironolactone treatment and am seeing awesome results. It was a little iffy for a few weeks -- I cleared up, then broke out, then cleared up, then broke out (first time was right after I started spiro, second time was right after I upped my dose from 50mg to 100mg) -- so I think I've finally moved into the clear with the initial breakouts. My skin is SUPER smooth, and for the first time in 2 or 3 years my chin doesn't have cysts or lumps on it. I'm hoping it stays this way, I'm traveling for Thanksgiving to visit my boyfriend's family and I'm dreading a huge breakout. The last time I saw them all I had 3 cysts on my chin that were MASSIVE and super embarrassing so I'm really hoping to stay clear and pretty for this week / weekend. Plus, I don't want to be stressing about being seen without makeup on or touching up during the day. I just want to be able to relax and not have to worry about what my skin is doing.

I feel a huge relief, since I've been battling this stuff for years. I know each person is different, and derms suggest different methods and medications and a lot of it is "trial and error" but I was getting so frustrated with taking something new, waiting 3 months, not seeing results (and most times, my acne getting worse) and then starting at square one again. Plus, as a 28 year old, it's pretty embarrassing in the workplace and socially to be dealing with this when most of my colleagues, friends, boyfriend and family haven't had pimples or acne since they were in high school, if ever! I always had a hunch my acne was hormonal based on when it would flare up and the kind of deep, painful breakouts I was having on my chin and around my mouth. And after trying literally everything under the sun, except accutane, I'm so glad I gave spiro a chance before resorting to accutane. Fingers crossed this keeps working and I stay clear!!

My routine ---

  • 100mg/daily Spironolactone
    • 200mg/daily Doxycycline -- derm recommends that I slowly stop taking this once I've been totally clear for 1+ month, and I agree, since I don't think long term antibiotic use is ideal and I'm not sure how much this has helped anyway

      • Sprintec birth control -- has a specific progestin that is the only one FDA-approved for helping acne, I switched to this brand last month after a long battle with other crappy pills that made my skin go bananas (I've been on BCP since I was about 16 years old) I absolutely think this is the best pill ever! check out more info on the hormone/BCP topic here

      [*]0.025% Tretinoin cream at night -- helps a lot with blackheads and clogged pores, love this!

Definitely improved!! The areas on my chin that were starting to get irritated have basically vanished. They were annoying for about 4 days, and I was really worried they would grow into large cysts like they used to, but by this morning they were flat and just a little red. It's finally making sense to me that topical medications are not going to heal my skin issues. I have been using the acanya (clindamycin and benzoyl combo) sparingly at night just where I have a clogged pore, and have noticed that the texture of my skin has improved since I stopped using it so much. Most of those products have just dried out my skin without ever actually helping the swollen cyst areas. Since starting the spiro, I still have had a few areas that *look* like they're going to get inflamed and sore, but never really surface, which is a huge improvement! At least now I know that all my breakouts (or at least the large, painful, cyst-like ones on my chin and around my mouth) were hormone related. I wish I had tried this medication years ago. I'm feeling great and really hopeful.

My side effects from the spironolactone are basically non-existent now. I don't get dizzy at all and no more headaches. I am a little more thirsty, but I just make sure to drink a little extra water throughout the day and it's fine. I'm hoping I stay clear, and once my scarring fades a bit (still have a LOT of red and dark spots from past breakouts) I should be set!!! It will be so nice not to have to worry about covering up nasty cysts with makeup, yuck. I seriously can't wait to be makeup free and not worry about what is going on under the surface of my skin. I'm feeling hopeful that my initial breakout is over :)


  • 100mg doxycycline
  • 50mg spironolactone
  • Sprintec birth control


    • 100mg doxycycline
    • 50mg spironolactone
    • 0.25% tretinoin cream
    • Spot treat with a tiny bit of acanya if I feel a breakout forming (benzoyl peroxide and clindamycin combo)

No real change in the last 2 days. Still have 2 areas on my chin that are swollen... they haven't grown too much, but they also aren't budging, so I'm really nervous they are going to keep swelling and become stubborn like all the others I used to deal with. Blah. I'm taking 100mg/day now, 50mg in the am and 50mg at night. Also sticking with the 200mg/day of doxy, which I've been on for more than 3 months now. Not sure that's really doing anything, but might as well keep taking it until I see my skin clear up because I don't want to change too many factors all at once. All the spiro reviews said it takes about 3 months to see real results, so I just need to be patient. I was just so excited when I saw such an improvement in my overall skin texture in the first 2 weeks! But 2 cysts aren't the end of the world I guess. Although sometimes it feels that way.

I've been drinking water and green tea and eating lots of anti-inflammatory veggies (who knows if that really helps.....) but at least mentally I'm trying to stay calm and not let myself feel all the anxiety I used to feel when I got a cystic breakout. I honestly think that when I get stressed about it, it gets 10 times worse because my hormones (and body in general) goes into panic mode. I'm also babying my skin a lot more. I used to be pretty aggressive (washing a lot, picking - bad I know! - and just generally beating it up with a dozen different products) and now I'm trying to stick to washing only twice a day (versus 3 times, since the urge when I get home from work is to just scrub my face!!) once in the am and once at night, and be very gentle so I don't break or irritate my skin's surface even more. My redness has decreased a little from that, but still getting these pesty cysts apparently. Okay spiro, time to kick in!!!! I'm ready for this IB to be over and to get on with those great results other women have raved about! :)

Still improved, but not 100% great. Yesterday I had 3 areas on my chin start to become a little irritated. Two of them are gone by now, but one has grown into a small(ish) cyst under the skin. It doesn't seem to be as aggressive as before the spiro, so I'm hoping it stays "calm" and just slowly diminishes. Hmm. Feeling a little bummed since 2 days ago I was on cloud 9 and raving about spironolactone. No more side effects at all really, definitely not dizzy when I take the pill and I'm not peeing as frequently. Most studies say it takes 4-8 weeks to fully take effect, sometimes as long as 3 months, so I'm going to stick with it. My skin isn't as oily overall, which is a great improvement. Still not where I want to be in terms of clear skin though.... blah. Trying to stay positive and hoping this cyst doesn't become too serious! Not sure how many more mountains I can take popping up on my chin. Ugh.

Does anyone have advice about the best dosage? I think in general it seems like you start out low at 50mg/day and increase to 100mg/day or more, but over what time period? I'm tempted to up it to 100mg a see if it makes a bigger difference, but am also a little nervous. I'll probably call my doctor tomorrow to double check, but would love to know if anyone saw a major difference when they upped the dose.

This is probably going to sound dramatic, but there's no other way to put it... My skin is freaking AMAZING since I started taking the daily 50mg of spiro!!! It's literally unbelievable. I keep waking up thinking "where is that huge cyst going to pop up?" and each day my face just looks better and better!! I even stopped taking the doxycycline yesterday. I was nervous to change anything in my routine, scared it would cause me to "relapse" but seriously, spiro has been such a miracle for me within the past two weeks, I seriously doubt I'll need the antibiotic anymore. I've had acne of varying degrees of severity since I was 15 years old, and 13 years later I honestly think this is the BEST thing I've ever done for my health. Every other product I've tried has cleared a little (from benzoyl peroxide to salicylic acid to tretinoin cream to antibiotic pills to removing dairy from my diet to drinking more green tea to clindamycin gel... the list goes on and on!) but has never ever ever improved the overall health of my skin. I'm realizing now that those products all just dried out the surface of my skin, leading to cracked, icky dry patches that STILL had cysts under them! Other than the cortisone injections that help alleviate the swelling (I highly recommend them as a last resort if you have a painful cyst that just keeps growing under the surface) I've never experienced such a dramatic improvement ever in my life. And I finally feel like this medication is addressing the cause of my acne, versus treating the symptoms of my acne.

I know that not all acne is related to hormones, so I'm sure accutane has great benefits for certain patients, but I'm feeling relieved I didn't take that route. As an "adult" with acne, I felt my skin issues were more related to hormone fluctuations (more info on that here) and would most likely come back after the accutane treatment. There's a great medical article that explains how spiro is the best option for post-adolescent females:

"This group of patients seems to exhibit higher treatment failure rates with traditional acne therapies. In a study of women over the age of 25 with persistent [acne], approximately 82 percent failed therapy with multiple courses of antibiotics and 32 percent had relapsed after treatment with one or more courses of oral isotretinoin [accutane] ... At a lower dosage range of 50 to 100mg/day, spironolactone has been shown to reduce sebum excretion rate by 30 to 50 percent and improve adverse events ... In a 12-week, randomized, placebo-controlled study of spironolactone 50mg daily, 24 of 34 patients were clear of acne lesions as compared to improvement in 2 of 31 patients in the placebo group."

I first noticed the skin on my arms was really soft and my hair was shinier, and then I noticed my face felt softer and smoother, and by this morning I literally have NO BUMPS on my face at all! I haven't been this happy in a long long time. I also noticed my mood has improved -- obviously part of it is how happy I am that my chin is cyst-free for the first time in over a year -- but I also think my hormones have really evened out and I feel less anxious in general. I used to feel extreme anxiety in the morning, thinking "how the heck am I going to cover up this massive bump on my chin??" and now I just feel tired until I drink coffee smile.png

I hope my skin stays this way. If anything, it's getting better each day, so I'm pretty hopeful it will! I still have a lot of red marks and scars from past breakouts, but the tretinoin cream should help that over time.

Side effects -- no longer have to pee as often, although still more than before the spiro. No more dizziness when taking the pill. I had a major hangover on Sunday morning after 3 glasses of wine Saturday night, but I think that was because I didn't drink enough water and spiro tends to make you dehydrated anyway. My breasts feel a little sore, but they are bigger (which I think is a bonus!) and my sex drive seems to have dropped off a bit, but nothing worrisome. Overall I'm producing much less oil in general, I notice my face isn't shiny when I wake up in the morning and during the day I only have to blot once or twice, versus the 20 times I would do before. My makeup isn't sliding off my face. It's a miracle. Seriously, I feel like I'm in a dream and am going to come back to reality any minute now. But so far, so good!!!!

No new cysts have formed at all since my initial breakout on day 7. They have all cleared up and my skin has never felt softer. I can't say enough good things about this medication! Hoping to see more improvements and stay cyst-free. Will keep you posted in the next few days!

(Also just a sidenote, I noticed on some of the spiro reviews women were complaining that they tried spiro but their acne came back after the 3 month treatment. Spiro will only work for as long as you take it. If you clear up while taking spiro, you have to KEEP taking it in order for it to be effective in the long-term. Unfortunately you have to stop while trying to get pregnant and while breastfeeding, but other than that, you would need to basically make a long-term commitment to take a daily dose every single day. Generally, doctors can lower the dose to a "maintenance" of 25-50 mg a day, while initially some people will need up to 150-200 mg a day to see clearing results. Other than the annoying side effects like peeing a lot and not being able to eat bananas because of high potassium levels, this is a very safe medication for long term use.)

I feel awesome!! Last night I noticed the hair on my arms was super soft and almost blond. I'm Italian and olive-skinned and have had dark(er) hair all my life. Not the reason I started spiro - I had cystic acne - but all of a sudden I noticed that the skin all over my body is softer and smoother. Bonus! My mood is great too, I feel like my hormones are evening out and I'm not feeling mood swings like I did on my old birth control (junel). I'm hoping this is more than coincidence, and that the spiro is kicking in. In terms of my face, I think I had an initial breakout that started to appear on day 7 and consisted of a few cystic areas around my mouth and chin and just a general "freakout" of my skin -- I felt out of whack. Yesterday I got the cysts injected with cortisone at the derm office and this morning I felt great. Even the other spots where I had some little clogged pores (and what used to turn into deeper cysts after a few days) are almost gone this morning. Other than the healing areas where I had the cysts, my skin overall feels great. I hope that was the worst of it and from here on out I stay clear of the cysts that would pop up every week! The only thing that has changed in my routine is the new birth control (switched to sprintec from junel, check out the reason why here) and the daily spiro. Everything else has been the same for the last 12+ months.

Side effects -- still have to go to the bathroom often, and drinking a ton of water. Had a few stomach cramps yesterday but I think that was because I was a little dehydrated. They are gone today. Also don't feel dizzy or lightheaded when I take the pill like I did the first few days. Overall, side effects are mild and I don't mind peeing a lot if it means I can have great skin :) Happy Friday!!

My a.m. routine

  • Olay sensitive skin foaming face wash
  • Olay complete all day UV moisturizer SPF 15 for sensitive skin
  • Neutrogena skin clearing blemish concealer (applied with a tiny makeup brush just to red areas)
  • Neutrogena skin clearing mineral powder (applied lightly all over to set makeup and reduce shine)
  • A little bronzer smile.png
  • 100mg doxycycline
  • 50mg spironolactone
  • Sprintec birth control

    My p.m. routine

    • Olay sensitive skin foaming face wash
    • Once or twice a week I very gently exfoliate with St. Ive's apricot scrub because the tretinoin cream can make my skin a little flaky
    • 0.25% tretinoin cream
    • Spot treat with a tiny bit of acanya if I feel a breakout forming (benzoyl peroxide and clindamycin combo)
    • 100mg doxycycline

Quick update! Woke up feeling great this morning. Drank a ton of water last night and finally stopped feeling dehydrated. My skin is ehh... I have 4 cysts that will be injected with cortisone later this morning at the derm office, and about 5 other active, smaller pimples (more like clogged pores) around my chin and mouth. It's definitely more than I'm used to having at once, but for some reason I think this was the initial breakout and I'm feeling confident that once these clear up I'll be good! At least that's what I'm hoping. My mood seems to have evened out --- the first few days I was on spiro I felt kind of "off" almost like I was PMSing, my heart was racing, felt mood swings, etc. But today I feel great. I hope that means my hormones are calming down a bit and adjusting.

I've lost 4 lbs in the last 10 days. Nothing in my diet has changed except drinking more water. I'm 5'7" and weighed 115lb on October 23, and currently weigh 111lb. Crazy! It seems to be all water weight, my stomach is soooooo flat. I'm curious to see what will happen when I get my period in the next few weeks, since normally the week before I have major bloating.

I also forgot to mention this in my last post. I researched the different kind of birth control pills because I wanted to better understand the reason for my primary care physician to change me from junel to sprintec. Here's what I found:

There are 2 kinds of birth control pills: combination pills and mini pills.

Combination pills are the most commonly used and contain two active ingredients: ethinyl estradiol (a synthetic estrogen) and a progestin. There are three kinds of combination pills:

  1. Monophasic - the level of hormones are the same for all 21 days of the cycle, then 7 days of "filler" inactive pills. This tends to be a good option for someone who struggles with hormonal acne because it keeps your estrogen levels constant, versus waving all over the place each week. Examples include Levora, Sprintec, Ortho-cyclen, Junel and Ovral.
  2. Biphasic - these have a fixed amount of estrogen, but there are two different strengths of progestin. The first 7-10 days are one level, and the next 11-14 are another. The last 7 days are the "filler" inactive pills. Examples include Jenest-28 and Mircette.
  3. Triphasic - depending on the brand, both the estrogen and progestin levels change throughout the 28 day cycle. The first 7 days are one strength, the next 7 days are another, and the third week is yet another. The final 7 days are "filler" inactive pills. This creates a changing level of hormones each week throughout the month. Examples include Ortho tri-cyclen, Tri-levlen and Tri-sprintec.

So based on that alone, I was excited that my birth control was monophasic. Except then I was even more confused because junel (the "bad" pill for acne according to my doctor) was monophasic, and so was sprintec (the new "good" pill). So what was the difference?

I looked into the active ingredients in both junel and sprintec. It turns out that both pills contain the standard dose of ethinyl estradiol at ~0.03mg. But the progestin ingredient was different. I found this great article (cited by a doctor) that breaks down the 8 different kinds of progestins, and this is what I concluded:

Junel contains norethindrone acetate: low progestational activity and slight estrogenic affects. It is a first-generation progestin. It tends to be less androgenic than the second-generation progestins, but more androgenic than newer progestins, like desogestrel.

Sprintec contains norgestimate: a third-generation progestin that has high progestational activity while showing slight estrogenic effects and tends to be less androgenic. The low androgenic effects of norgestimate have resulted in successful treatment of acne. In fact, birth control pills that contain norgestimate are the only ones FDA approved to help reduce acne.

I was blown away! The key word in those descriptions is androgenic (definition here) -- this is something that you want very little of, as a woman. So "low androgenic effects" is great to see. It's the same reason why doctors believe spiro has such a positive effect on hormonal acne in women -- it stops the absorption of testosterone and androgens. To put it in perspective, spiro is prescribed at very high levels (~250mg+) for men who undergo sex change operations to suppress their male features like hair growth, etc.

Okay this was a little longer than I had planned to write (so much for the quick update) but maybe one of the reasons I feel so positive today is that I finally understand the *reason* behind the science. I think it's really important to understand why a doctor or dermatologist is prescribing something, rather than just taking their word for it. I spent way too many years upset about pimples, and cried too much about my crappy skin, and didn't go swimming because I didn't want my makeup to smear off, to not take advantage of all the resources that are available now to educate myself about what's causing my acne and how to treat it. Granted, every person's body is different and different medications obviously effect them in varying ways, but I feel relieved that I'm on the "right" birth control. Phew! Happy November!

Also, I'm curious if anyone has any comments (positive or negative!) about this treatment. I've read a lot of the reviews on the site but am curious if anyone is in the same exact situation. And also if this info is helpful --- or if it's overload smile.png You can read my first post here.

Another great article I found in a medical journal about spiro. Has a lot of medical terms and I struggled to understand all of it, but in general provides great statistics about the drug: Oral Spironolactone in Post-teenage Female Patients with Acne Vulgaris: Practical Considerations for the Clinician Based on Current Data and Clinical Experience

Hello! The purpose of this blog is to document my struggle and (hopefully!) my acne cure. I've had acne-prone skin since I was about 15 years old, and am currently 28. Here's a quick recap (you can skip this part if you don't want the long version :) ) ---

  • From 15 - 18: struggled with various breakouts that would get better with drug store-brand topical medication, but I was also VERY bad about picking at my face so I think it made it much worse. Started birth control when I was 17.
  • From 19 - 24: generally more clear, but instead of small breakouts I would get deep, large cysts the week before my period, and I was also very bad about poking and trying to pop them, leading to really painful, bigger cysts! But once they cleared up, I would have a few weeks of clear skin.
  • From 25 - present: very common to have at least 2-3 deep, large, painful cysts form under my skin that take about 2-6 weeks to go away. Almost always on my chin and around my mouth (cute, huh?).

I finally went to a dermatologist in September 2011, when I was 27, after I realized I needed more than over-the-counter benzoyl peroxide to treat these massive breakouts. Plus, I was past my breaking point of feeling embarrassed of my skin. I basically never leave the house without makeup on (yuck -- would not be my choice!) and have serious anxiety about my boyfriend seeing me without cover-up. The dermatologist said I had moderate acne and prescribed tretinoin cream 0.25% at night and clindamycin gel in the morning.

Initially, I experienced redness and peeling from the tretinoin but after a few weeks this went away, and so did all of clogged pores! Yay! My cheeks, nose, and forehead were totally clear, even though I never had any major issues there to begin with. But the large cysts were still popping up on my chin and around my mouth every few weeks. The clindamycin was very irritating so I stopped using it. I also stopped picking and noticed a reduction in the severity (duh... I should have stopped doing that sooner!). I had a few months of clear(er) skin but after six months of nightly tretinoin cream, it was getting a little worse.

In April 2012, she prescribed 100mg of doxycycline twice a day, so 200mg total. After about 10 days, my stomach aches and, let's just say bathroom issues, were too severe so I stopped using it. Around this time I also stopped eating dairy after reading a ton of articles about how the hormones in the dairy can make your skin worse. Who knows how legit this is, but I kinda feel like it's helped a little.

In May, she recommended I try accutane but after doing a TON of research on it, I didn't feel like I wanted to take that route. It seemed a little too aggressive for the kind of acne I was dealing with. Still just used the tretinoin cream.

In June, she recommended I change my birth control pill since sometimes hormones play a large role and maybe switching would help. And I had always felt like my acne was directly linked to either my period or stress. If I traveled for work and had a big meeting to present at, I would get a cyst! Like clockwork. I had been on tri-sprintec for years, and my ob-gyn changed me to junel. My skin went BANANAS. Usually, I could kind of predict when a cyst would appear based on my period's cycle. For the entire summer my skin was just a MESS. At least 3-4 cysts on my chin at a time, smaller blemishes on my cheeks, and no rhyme or reason. It was the worst it's ever been. They said it would take about 3 months to see results, so I was trying to be patient.

In August, I started taking the doxycycline again because I couldn't stand the cysts anymore. My stomach tolerated the medication much better, and I actually wonder if initially my issues were more linked to stress rather than the antibiotic. I'm notorious for getting stomach cramps when I'm nervous or stressed out, and I was totally stressed back in April when my skin was icky. I noticed a little improvement, but still kind of a mess. Now the red marks, even once the blemishes were gone, were getting really bad. I have olive-tone skin so I tend to scar easily, and always tend to have a dark mark for a week or two after a blemish, but now they were all over and hanging around for what seemed like months. Even if my face was "clear" of active pimples, it looked like I was all blotchy and still used cover-up.

In September, I started getting my cysts injected with cortisone. This was AWESOME! I mean, it hurts, and it sucks to have to make an appt and pay the co-pay and travel all the way to the doctor, but within 6 hours my huge, painful, deep cysts would be flat! I didn't want to make a habit of it, because obviously it was just treating the symptom, not the cause, but it certainly made me feel better that in a crisis, there is a (somewhat) quick fix! If only I could do it myself.... ok just kidding that would be insane to stick a needle in your face, on top of the fact that I'm accident prone and would probably end up losing an eye. But seriously, for anyone with deep cysts, I would really urge you to try this at your derm when you're feeling desperate. She also urged me to use accutane again, but after talking to my friends and boyfriend, they all thought it was a bad idea and I followed my gut -- which said to avoid it. After one visit for an injection, she also gave me a prescription for acanya, which is a mix of clindamycin and benzoyl peroxide in gel form. She said to use it at night after I apply the tretinoin to just the spots where I have a breakout -- to kind of "spot treat" my issue areas. This helped, but wasn't preventing the cysts, only helping to clear them faster. But even with the acanya, doxy and tretinoin, I was still getting 1-2 large painful cysts that never truly went away - even after they weren't throbbing with pain, they would lie dormant under my skin - I could feel a little bump under the surface. It was like having a chin with a bunch of volcanoes and never knowing which one was going to suddenly erupt! Except they rarely came to the surface, they would just swell and make my jaw look disfigured and as long as I didn't pick at them, eventually go down after 2 weeks.

One of my best friends had struggled with acne off and on for the last 10 years and she raved about spironolactone. She would mention it to me here and there and said it was a high-blood pressure medication that also happened to treat acne. I never gave it much thought, but when I finally googled it I was blown away. It sounded like exactly the kind of cure I was looking for, since I believe my acne is hormone-driven. Spironolactone is in a class of medications called aldosterone receptor antagonists -- basically, it stops your hormone receptor cells from binding with testosterone. Too much testosterone in a woman's body is believed to be a contributor to acne, as well as facial hair and other symptoms. Which, now that we brought that up, I randomly have like 3 black hairs on my chin I always pluck. Too much information? Ha okay anyway, I was excited about asking my derm about this.

In October, I had a yearly check-up with my primary care physician. I had a laundry list of questions for her, including her thoughts on spironolactone, accutane, my birth control pill, and doxycycline. Before I even mentioned spiro, she brought it up! She thought I was a perfect candidate and prescribed me a 50mg daily pill. She said I could continue with the doxy pill and tretinoin cream. She also said that junel, the birth control my ob-gyn changed me to, is TERRIBLE for people with skin issues. Who knew! She changed me back to sprintec, but instead of tri-sprintec she just used regular sprintec. Something about the kind of progestin that was in it.

Days 1-10

October 23 - Day 1 of my new spiro treatment! 50mg daily spiro (in the morning), 200mg daily doxy (100mg in the morning and 100mg at night, I've been taking this since August and it seems to help a little with swelling), sprintec birth control, acanya spot treat at night and tretinoin at night. I wash with a mild cleanser and use sensitive skin moisturizer. The makeup I use for cover-up is Neutrogena skin clearing blemish concealer. I use a makeup brush to just apply to the red areas, and then use a mineral powder to finish all over. I try to use as little makeup as possible! In general the first week was fine, considering the only change in my routine is the spiro and the new birth control, and I think those will take a while to make a difference.

October 27 - Day 5. Skin looks great! Nothing major except the red marks/scars from past breakouts. Have to pee constantly. Drinking water like it's going out of style, thirsty all the time. A little lightheaded but nothing major.

October 30 - Day 8. I have 3 major cysts, one on my left chin, one on my right chin, and one in the fold of my nose. But 2 of the 3 were deep within my skin for a few weeks prior, and just now surfacing, and the other one was a cyst that popped up over the summer and seemed to resurface, so I'm not convinced they have anything to do with the spiro or new birth control. Haven't noticed any difference in the oil production on my face -- some other reviews said sprio reduced this, but I'm still an oil slick.

November 1 - Day 10. Going to get 2 of the cysts injected with cortisone to speed up the recovery. 2 year anniversary with my boyfriend this weekend, I need to not have a huge lump on my face! Not cute. No change in oil. Still super thirsty and drinking water all the time.

That's all for now, I'll try and update this each week or so to share my spironolactone experience. In general, it takes 3 months to see the full benefits, and I'm honestly nervous about a crazy initial breakout before it improves because I'm traveling for Thanksgiving and want to look pretty, not full of acne. Some people said they had IB, but I also wonder if that was because they also started using new topical creams at the same time. For me, the only change is spiro and a new birth control pill, which is actually going BACK to my old pill (that seemed fine), so I'm pretty confident that whatever changes I see in my skin are going to correlate to the spiro treatment. I hope this helps at least a few people with the decision between accutane, antibiotics, and sprionolactone! I know it's helped me a lot to read other posts about how people are dealing with this issue. At least I know I'm not the only one smile.png

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