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.
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