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Retin-A Micro for occassional cystic acne (30, F)

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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.

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Hi there! I am an almost-30 years old woman with occasional cystic acne as well! I too started a retinoid (Differin) because of the cysts....I would get 1 or 2 during my ovulation week, sometimes right on my ovulation day! These cysts would last me forever (like a month or more) and would leave either slightly pitted scars or dark dark hyperpigmentation. :( I HATED THEM! I ended up getting 4-5 cysts during my 4th and 5th week on Differin due to the dreaded initial breakout. I still got cysts while using Differin, though less than usual (so instead of getting them every month, I would get them every 2-3 months). I have been using differin now for about 6 months (and recently incorporated MAMA lotion into my regimen, which has been fantastic), and though I don't get cysts as often, I still get mild breakouts. Just remember with any retinoid, you really need to use it for at least 12 weeks or longer, through thick and thin, before you can really say if it works or not.

I also have been taking zinc and DIM supplements and they seem to help my cysts as well. If your cysts are hormonal, you can try taking Aleve for a couple of days on your ovulation week or your PMS week. That seems to help a lot of women who have hormonal cystic acne.

Good luck!

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It the evening of day 2 (assuming I started on Day 0), and I notice I have some skin sloughing off on my chin. I've still be using the clyndamycin swabs when I'm not using RAM (i.e. used in the evening of Day 1, morning of Day 2) but I guess I'll stop as this is probably too drying.

Also, I guess I should report that my face is pretty much totally clear right now. I mean, I have one teeny tiny pimple at my hairline under my bangs, but that basically doesn't count.

My whole investigation into acne treatment was brought on my horrible skin that followed taking a Plan B pill earlier this spring (4/15?). The horrible cysts that came after that lasted until about 6/20, but I haven't had once since. Part of me wonders if all of those hormones didn't cause the entire two months' worth of breakouts?

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End of Day 5, not much to report, except some very very mild peeling again around my chin/mouth area. I am going to give Retin-A a go, but it's hard to want to go through an initial breakout right now when my face is totally clear. I have one tiny cyst basically in my hair above my ear that is going away (never noticeable), and I felt a tiny tiny spot at the top of my forehead (under my hair, hmmm...maybe my skin doesn't like my new pomade!) as well, but nothing that is visible. Still wondering if my skin this spring wasn't just all evil evil Plan B induced.

Also, I am using the clindamycin swabs on days that I'm not using RAM, for the record. Doesn't seem to be a problem -- I'm kind of nervous to just wash my face with Cetaphil (regular), and put on moisturizer/sunblock (Oil of Olay Total Effects 15 for Sensitive Skin) and that's it.

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Morning of Day 9. There is definitely no peeling or redness going on. Mostly my face just seems oily, and right now I have more tiny imperfections than I did when I started, but they are still not so bothersome. I had a cyst come in on my forehead under my hair that I spot treated with BP that went away quite fast. I still have dark marks where I got two killer cysts in June...would love for those to go away, but nothing seems to be happening with them.

I kind of feel like my skin could handle RAM every other day at this point, but I don't want to risk it. Mostly I just want to get the initial breakout over with!

BTW, if anyone has used RAM in this way -- easing into it using it at first every third day, then every second day, I'd love to hear how you think that affected the typical RAM cycle -- did it prolong it?

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I must be on Day 12 now because I know that tonight is a scheduled Retin-A night.

I'm still trying to figure out what I'm supposed to be doing on the days in between using RAM, and how quickly I will progress through the cycle with less than daily use. I got a few small zits -- not at all the kind I usually get (seriously, I usually ONLY get cysts) on my forehead and noticed more blackheads/whitehead on my cheeks this week, but I'm not sure what to attribute this too. Though my face had been extremely oily last week.

To deal with the oiliness, I started using a little BP and the clindmycin swabs as well. Then this started stinging so I stopped except for spot treatment of the zits with bp. My face is neither red nor peeling at this point, though the corners of my lips/mouth are burning and cracked -- maybe this is due to Retin-a? Though only as of today and it's been two days since I've used it. Needless to say I will be avoiding using it near those spots.

I guess that is about all -- mostly I'm just anxious about when all the horrible parts of this will come.

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I hope this is helpful. My IB on RAM was basically taking my worst day of acne and having it continuously happen for about 2-3 weeks. With that said, I never noticed an increased number of pimples, however they just kept popping up as soon as one would heal. Eventually, the IB broke off and my entire face started to heal. Good luck!


Began RAM on January 20, 2008 - bumped up to 0.1% on 10/09/08:

Morning:

Wash with Cetaphil Gentle Cleanser (CVS brand works just as well and is cheaper!)

Apply Clindamycin solution to skin....wait until dry

Apply Oil of Olay for sensitive skin moisurizer

Night:

Wash with Cetaphil Gentle Cleanser (CVS brand)

Wait 30 minutes

Apply RAM 0.1%


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Late night Day 14/early morning day 15. I feel like this is more of a zit log than a Retin-a log!

Which is to say: one new cyst on the side of my nose, one above my upper lip on the left, one below my lower lip on the left. The good news is that the two around my mouth are teeny tiny, and if I can keep my fingers off them, I think they will be gone pretty quickly and with minimal visibility. Dousing them all with BP in the meantime. Also, I haven't gotten nose zits in like 15 years! What gives? Oh, I wish I knew.

The pimples on my forehead from a few weeks ago are all flat, and of course the one that I picked is not totally beautiful/gone, but the rest are.

Some dryness on my chin but nothing horrible. Overall, I think that my skin is maybe looking more even? I don't know. Or maybe more rosy (not red), which is nice as I have pretty yellow toned skin (Causasian with light but not fair skin).

I think this journal is mostly just getting me through the waiting. And again, I feel like it's hard to know what is going on, since having more pimples than I can handle is a new thing for me, so I never know what is responsible for what.

I do have to say that I'm glad to be starting Retin-A in the summer when my skin is vying for OPEC membership as opposed to the winter when I have to use serious moisturizers.

Retin-A tonight, and then I think I'll try going to every other day?

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Well here we go on actually having some symptoms of Retin-A use.

After I wrote the last post, I decided to -- that night, switch from once every three days to once every two days, so I applied RAM before bed on Day 14. I figured that since I was seeing no side effects and it had been two weeks, why not.

Those zits that I talked about last time were definitely hormonally induced. When I woke up after Retin-A that night, spots on my forehead were definitely getting better, the spot on my nose was popable (squirt!), and the two cysts were developing into nice tiny cysts. And by nice I mean horrible, but at least small.

Anyway, that was kind of all well and good. Then I used RAM again on day 16 (today is day 18), and now, hello peeling! One of the cysts did totally flatten out after day 16, but the other one is still raised and hard and going and sadly, I keep picking at it. In fact I am kind of picking at everything right now because I am peeling. Basically I go to apply concealer, and it turns like WHITE because I am peeling -- especially around the actual zit areas, and then I peel it off, am red underneath, repeat ad nauseum. The worst part is that I am pretty sure that I am not even to the initial breakout yet and that these are just the result of my menstrual cycle. Oh, why did I pick?!?!

Anyway, at least my skin is kind of glowing/looking super rosy in the areas that aren't afflicted by horrible zittage (which I think is probably not as bad as I think) -- and it is only my T zone. No redness, just a lovely glow actually. Well, we'll see. Right now I think I have to stop the horrible pick wash makeup cycle and just try to keep my hands at my side and let things heal on their own. Because they do seem to go pretty fast with RAM.

Thus far the peeling is mostly around my chin, and a little on my cheeks. I's different than I thought -- less like a sunburn and looks more like I just have white residue in places. Ew. I am willing to sacrfice August if this can all be over by September. We'll see.

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good luck! i am doing clindamycin pads in the morning and RAM 0.04% at night. i'm in week 7 and have discovered cystic acne...joy. (note the sarcasm)

i'm rooting for you!


click here to read the best post on acne.org! (ok, IMO)

[[current regimen - updated 8/11/08]]

AM:

100mg doxycycline

wash with johnson's head-to-toe

clindamycin pad

eucerin everyday protection moisturizer with spf 30

PM:

wash with johnson's head-to-toe

wait 30 mins, apply retin-a micro .04% or .1% (or mama lotion 2x a week)

wait 15 mins, apply eucerin EP moisturizer to dry spots *if needed*

100oz water, hair/skin/nails multi + flaxseed oil every day; queen helene mint julep masque once a week. bareminerals, EDM or maybelline mineral power makeup (looking into colorstay for peeling days).


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UGH! I am on Day 23. Used RAM last night -- still using it every other day. And my lovely cyst friends keep on appearing. Let's see, of the old ones: on on the side of my nose, one on my upper lip, one on my upper chin on the right, there is still a red mark on my nose, the one above my lip is ALMOST gone, and the one below my mouth is a red, peeling, scabby mess. Yuck.

And now I have three more cysts -- two on my left cheek and on on the left corner of my nose, which hurts like hell but luckily isn't really visible. I've been looking at some old photos recently, and while I have always had a zit or two, I've NEVER had acne this bad in my life. I don't understand what it going on/has triggered it. And why I only get cysts.

For the record, I am also having all sorts of other health issues right now, despite having always been ridiculously over the top healthy (exercise 6x/wk, super low blood pressure/cholesterol, no family health problems, etc.). I had shingles on my face at the beginning of July (this is actually why I used RAM once and then stopped for a week or so), now I have a super itchy scalp that is also very painful in spots -- the back left side of my head feels like I have a giant cyst there or something. A week ago it felt like I had a lot of pimples there too, though most have died down. I also have a sore throat but only on the left side of my throat. I am seriously wondering if this is not all connected somehow. All I can say is that it all sucks.

It's also frustrating because I feel like RAM is not doing anything yet -- no initial breakout, no clearing up, etc. My face is SUPER oily still. I will stick with it because I also don't think it's making anything worse. But really, I just want to be better!

I also hereby swear not to pick at anything for a week.

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End of Day 24 and things are definitely better today, thanks mostly to BP, which I had been using to douse the two cysts that had been giving me problems. Both are are their way out, I hope.

And in general, my face is looking way better today. I can't tell if my skin tone is actually more even, or if I just have more zits now than ever before which makes the clear parts of my skin look better. I do think that my skin just looks a lot less fatigued. If there comes a day when I am finally zit free, it will look awesome. I am crossing my fingers!

Also, dear Initial Breakout, please just show up already!

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Morning of Day 27. I have no new active zits! I'm sure this is only temporary, but it is still exciting. I do of course have some serious red spots for all of the cysts I've have in the last two weeks, but what can you do.

I also have mono! I've been super super sick this summer, after a lifetime of perfect health, and I'm wondering if my sudden onset of cysts might not be related. (Still don't understand why I ONLY get cysts.)

My skin might also be doing better right now because it is not so disgustingly hot out (I have no AC), and I'm not exercising (since I have mono). My skin has also ceased being so ridiculously oily, which is nice.

We'll see what happens next! It's also been almost two weeks since I went from every third day to ever two days. I'm not red and when I have any peeling, it is only around the spots that I have, so I'm wondering when I should go up to every day -- which seems like a big jump. I have no doctor giving me instructions (my student health plan doesn't let me see a derm. for acne, just a GP, who was like, "just taper up."), so I'm kind of on my own here. Maybe I'll give it until the end of the week? I am ready to get this IB over with, and I don't even have the blackheads coming to the fore phase yet!

Oh, I also had a zit inside my nostril this week. I win! (Went away on it's own, but was pretty painful)

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End of Day 28. The most exciting development is that I threw the towel in and am now using RAM every night. So far, so good, still no new active spots.

Existing spots seem to MAYBE be finally going away. (I am still picking away at the dead skin that forms around them/hangs off them -- thereby prolonging their life I know -- but I'm really now trying not to. Really.)

My nose and the corners around the base of it might finally be getting blackhead-y? Who knows.

I'm psyched to finally be doing this for real.

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Morning of Day 31. Here comes a cyst! On my chin. I will douse it in BP and hope for the best. Otherwise, I think I have entered the blackhead zone, perhaps? They are definitely way more apparent on my nose, and the glow that my skin had for the last few weeks is kind of gone? I am hoping this means that I will finally start to progress through the icko parts of RAM. My face has returned to being kind of oily all the time -- definitely no excessive dryness here! I saw a *tiny* spot of peeling on my chin the other day, but I'm really not having any of those kinds of side effects.

I just want to get going with this!

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Evening of Day 38. 10 days into RAM every day, 24 days into RAM every other night.

Basically, nothing has changed. I feel like my skin is pretty much exactly as it was before I started RAM, though maybe oilier and my zits are coming in different places.

That chin cyst got flat pretty quickly, but of course the scar is still around. Two other cyst marks are still healing on my left cheek. And the new zits are these painful spots on my nose -- which is a new spot for me to get zits. I'm not even really sure what kind of zits they are -- mostly they are red, inflamed, and hurt, but it doesn't seem like they are coming to a head. I had one down in the corner of my nose and another on the left side halfway up towards the front. Not *so* huge, but painful!

I know that my initial progress was probably slower due to phasing in RAM, but jeez -- 38 days and no progress? And why is my skin so oily?!?!

I'm going to keep going though.

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Week 4-6 was the worse for me. I too get the one or two cysts that never go away. Stick with the RAM and it will help normalize your inner pores over time so that you'll hopefully get less cysts. Have you noticed you get cysts during certain times of your month? Some people have had great success taking Aleve 2-3 days prior to the day they get cysts, which seems to help with the inflammation. I've been using that method now for a few months, and I haven't really had a real cyst in months. Good luck!

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Week 4-6 was the worse for me. I too get the one or two cysts that never go away. Stick with the RAM and it will help normalize your inner pores over time so that you'll hopefully get less cysts. Have you noticed you get cysts during certain times of your month? Some people have had great success taking Aleve 2-3 days prior to the day they get cysts, which seems to help with the inflammation. I've been using that method now for a few months, and I haven't really had a real cyst in months. Good luck!

Well, I am hoping this is the worst for me. I mean, it's not THAT horrible -- no worse that my skin has been since it started getting fairly bad this spring, but probably worse than at the beginning of RAM. I have no idea where I am in the IB cycle since I phased into it so gradually.

I haven't noticed when the cysts come in relation to my menstrual cycle. Well, maybe I have, but sometimes they are during ovulation, sometimes PMS-y. Right now I can't believe it -- I am getting one in the EXACT same spot as I had one two weeks ago -- where there is still a scar. GREAT. This is going to be an exercise in not touching.

Anyway, I will try the Aleve. Can't hurt.

I've actually read somewhere that RAM isn't really that effective for cysts. Do you think that's true?

For my own records -- end of Day 42, blackheads on my nose are gross, lots of slowly fading flat spots on my face (though no longer my forehead), got TWO zits on my noes that are still red and healing, scab from a cyst on my chin, and now another gigantic cyst in the same spot. Or nodule, not sure what to call it. A big bump under my skin that never goes away or comes to a head. Ow.

I guess my skin is maybe slightly less oily now than when I ramped up to RAM every night?

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Day 45.

Two more weird red spots on my nose this morning, and some whiteheads (?) on my cheek (which I popped and are now gone). Plus a tiny zit on my forehead. No big deal, those these weird nose spots are...werid for me. Never had them before, and I am just guessing that it is a result of the Retin-A doing its thing, and the one spot that I've had blackheads since adolescence is my nose. I am kind of thinking that I am in the initial breakout period at this point?

Also, cyst on my chin got flat FAST, and I am trying to keep my hands off it. Though there is still scabby grossness there from my LAST cyst in the same spot, about a week and a half ago. Why do I think I can squeeze these things?!?!

Some of my other red spots are starting to go away which is nice. Overall my face doesn't look that bad, but it definitely could look better -- especially the texture -- my pores seem exceptionally huge right now. Oily again too. Yuck.

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Late night of Day 48. Just about 7 weeks in. This really must be my IB on my nose is all I can say.

Today I did a very dumb thing too. The pimples on my nose are so painful, and I can tell that they all have pus way down in there that wants to come out. I squeezed one the other day that hurt like hell but that was invisible, and it popped all over the place, and then the pain and the zit were gone, just like that. Anyway, I thought I'd try popping another one, but I didn't want to squeeze with my fingers, so I sterilized a very thin needle and punctured the skin. White goo came out, but unfortunately, the charred mark on the needle from heating it is now stuck on the side of my pore. A new definition of a blackhead.

At this point my nose is so horrible (four active spots + swollen -- new ones keep coming everyday, and the old ones get better) that I'm just like, who cares at this point. Hopefully things will be better by next week when I have to start seeing people again.

I do think that the blackheads on my nose are going away though. Curiously, in the corners of my nose first. The rest of my face is just suffering from a few red marks, plus the scabbing from the two cysts in the same place on my chin.

I am hopeful that RAM is really going to work for me.

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Day 49.

Hello millions of blackhead-y bumps on my forehead! Hello horrible nose! Hello initial breakout -- I hate you!

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Day 50. Mostly just reporting so that when people want to know what an IB is like in the future, they can read this.

Most of my nose activity has flattened out (yay), though I still have one more spot emerging. Which makes NINE zits on my nose in NINE days. My nose is not that big people. It is awful. Though at least now not that painful, and somehow more bearable -- visibly -- on my nose than elsewhere? I just look like I have a sunburned nose tip, complete with peeling, or like Rudolph.

Dear IB: PLEASE STOP.

I think my face keeps reaching new lows where I'm like, wow, it's NEVER looked this bad before. I have had about three days of being clear this summer, and I'm tired of thinking about this all the time. Sucks.

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Day 51. My nose is back to hurting like an MF, though at least it's only that one spot. This is absolutely my IB though, as I can see that in areas of my nose that are healing, my blackheads are gone. It's just unbelievable to me how many of my pores in my nose are getting inflamed though. I mean, looking at my nose, I guess I understand since the whole thing is swollen, and the blackheads actually look deeper because of the swelling, so I guess stuff if trapped in there? Glad to get it out and all, but please please please be over soon. My nose is soooo red, it's awful. Also, my forehead is a sea of very small bumps -- a few small inflamed spots but not so many thank god.

Man, I am so ready for this to be over. My nose hurts so much that when I wash with Cetaphil and warm water (and my hands), it hurts to touch it. I am too old for this!!!!!!

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Day 52. I know, there is no point in updating this everyday -- it's more for my own sanity. We are now on 11 inflamed spots in 11 days on my nose. ELEVEN. Before this, I had ONE pimple on my nose last spring, and then the time before that was probably 10 years ago. (I got lots of pimples other places inbetween.) My nose is SO inflamed right now -- all over. The good news is that I wasn't home alone today, so I basically had no opportunities to touch to pick at my nose, which I hope will make it better sooner?

I guess this makes sense since I had really persistent (though stable) blackheads on my nose for so long and they have to come out somehow, but god, make it get better! Also, now the IB is moving to my upper lip area, where I have two emerging spots/cysts that I will NOT touch/pick. (Okay, I guess one of them gets itchy so sometimes I'll give it a little itch accidentally.) My forehead is maybe making a little progress in getting less bumpy? It's still pretty bumpy (whitehead-ish), though at least for the most part not inflamed. And my face is still an oil slick -- I thought RAM was supposed to dry my out? I am using BP on my forehead in the morning at this point to help things. Who knows what that is doing - kind of hard to tell.

I am really hoping that the IB is over by the end of this week. I read a story today on Jezebel about Retin-A that gave me hope I guess -- both in the sense that I am not the only adult who wants to wear a bag over her head during the IB, and that RAM actually worked for this person. I think I need to expect possibly one more month of crappy skin before it gets better? Hard to imagine that I'd ever have porcelain skin, but I am hoping that this is the worst of it, and that it will be worth it.

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Day 53.

Things are getting better. I have one remaining painful spot, though it is very small and unpainful compared to the others, and the rest of my nose is just red and horrible looking, but at least no longer inflamed. The morning I saw someone who I hadn't seen the entire summer and she was like, I see that you have got a sunburn -- ugh, I was just like, don't say anything! Because it's really splotchy looking from where all the zits were, not just like a sunburn.

The good thing is that nothing new has come up today. And the pain has stopped. I really really really hop that was the worst of it, because I can't really handle more than that. Also, I've been noticing that within like 30 minutes of putting the RAM on at night, my nose gets slightly better/less painful.

I still have blackheads on my nose, but they look different now -- first, fewer, less prominent, and scarily, they seem further down, though I think that is just because my whole nose is still swollen. I didn't realize the extent of the swelling -- not just in the areas where I had pimples, but everywhere, until now, when the swelling is going down further up my nose and I can feel my cartilage along the ridge of my nose again.

Seriously, I still cannot believe how bad this was.

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