I'm a new member here but not at all new to living with a face full of acne. My journey has been similar to most of you: I had baby smooth skin until puberty, then all hell broke loose and I had hormonal, teenage inflamed acne for a few years, then that went away around the time I went off to college. What's different about my situation is that the form of acne that has given me so much grief and suffering is actually comedonal, non-inflamed acne. This is the type of acne that goes unnoticed from a distance and in photographs, but looks really unpleasant up close. I would consider my case one of the most severe, aggressive cases I have ever seen of this type of acne and I constantly wonder why I had to be the lucky recipient of this rare curse.
I'm writing this post to hopefully create some awareness of this enigmatic skin condition and to clear up some myths. This thread is also serving as a way for me to just unload my feelings and vent to some people who will listen, and I apologize for how long this will be. I've become so insecure; I can't even explain the level of anxiety and discomfort I feel when people get close enough to see my face in detail.
I'm posting these embarrassing photos of my horrifying skin to put out there what this type of acne looks like. I'm also posting a few "normal" photographs so you can see just how extreme the difference is given the right conditions. My skin looks perfect in some pictures, but the severity of my acne was exactly the same in each of these photos; the only thing that changed was the lighting and distance of the camera from my face. I've suffered from this condition since the 7th grade and I have spent thousands, if not tens of thousands of dollars to try to combat it. It has been so depressing because nothing, and I mean NOTHING, NOTHING, NOTHING, has ever been even marginally effective.
If I squeeze them, a stringy, white substance comes out and the open comedone comes back, literally, the very next day if not sooner. The left side of my face has many more whiteheads than the right side, and no, before you ask, I actually don't sleep primarily on my left cheek. That's just how it is... that's how it has been for years. It's like my face is just permanently like this; I swear the bumps I have now are the same ones I had 12 years ago. One of the worst parts is that the amount of information and research behind this type of acne is so incredibly limited. I am a master of Google, and yet after (literally) hundreds of hours over years of research, I have never once been able to find a "before and after" photo showing someone successfully recovering from skin like mine. How depressing is that? I'm still not exactly sure of the cause of my specific condition, but it isn't bacterial. I imagine it's one of three things or, more likely, a combination of them:
- Overproduction of sebum causing buildup and blockage in pores
- Incorrect production of sebum (e.g. sebum produced is too "thick" and clogs pores)
- Abnormal cell turnover and sloughing irregularities clogging pores
Many people with comedonal acne claim to have success with topicals like Retin-A, Differin, and Tazorac. This concerns me and makes me think that my case must be far more severe than others, or that my skin is just this unsolvable mystery that has never been documented before. Doctors claim that retinoids are highly effective in treating comedonal acne, so why is mine so resistant? I've done it all. I've tried every OTC product, every kit, every prescription I could get my hands on. At best, the drying effect of these topicals gives the illusion that the bumps had slightly decreased in size (not quantity). After months of using each product, my face would revert back to the same old oily mess I've come to know within a single day.
What have I learned? Topical creams and gels do not and will not work on my stubborn skin. The only way I will ever achieve normal skin is if I attack the problem internally. I've wanted to try Accutane for years now, but as a broke college student without parental support and no health insurance, that price tag has always been an issue. I finally bit the bullet and took out a loan to purchase it out of pocket because I'm sick of living like this.
I'm only a few days into my course at 40mg a day. After a few months my doctor will likely raise my dose to 80mg. I don't know what to expect, but this is truly my last resort. I've read different accounts of how effective Accutane is in treating comedonal acne; I've heard it's not at all effective, and I've heard it works miracles. I know everyone responds to treatments differently, but I believe these huge discrepancies are likely due in part to people incorrectly self-reporting what type of issue they actually have.
Given the nature of how Accutane works by decreasing sebum production and regulating cell turnover, I can't imagine it not improving my skin (since those factors are what I believe to be the root of this type of acne). Time will tell if it actually has any significant effect. I'm a very busy senior biology major juggling writing my honors thesis and applying to dental schools while maintaining my GPA, but I will do my best to come back here from time to time and report any changes in my skin. In the unlikely event that there is someone else out there with skin like mine, maybe this thread can give them a little insight from someone in their shoes.
Thanks for listening; wish me luck!