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This Is Severe Comedonal Acne (+ Beginning Accutane)

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Hey guys,

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

I once went to an esthetician who told me I just need to exfoliate more and that my type of acne was among the easiest to treat. I was so offended given the amount of energy and money I've put into fixing my face over the past 12 years with absolutely nothing to show for my efforts. There seems to be a trend of misinformation around the "acne community" with this particular form, even from dermatologists who are supposed to be highly trained in treating all types of the disease. I've seen many "professionals" (like that esthetician and various dermatologists) communicate baseless and contradictory claims, and it's really just unfortunate.

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!

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I know how stubborn non-inflammatory acne is, because it's mostly what I have. I have blackheads that have been there for 5-7 years! I don't know about your beautician, as most will agree that it is in fact the hardest type of acne to treat, but also the most overlooked...everyone is concerned with the big red pustules that go away in a week...they are the least of my concern because I know they won't last.

Anyway, it will be interesting to see how well Accutane works for you and I wish you the best of luck! :)


Finished Tetralysal on 12/04/13

Quinoderm 10 once a week

Gedarel 30/150 as current treatment.


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please keep us posted man and good luck

this is also kind of the same type I get, though not quite so grouped up or above the surface (unless it's left untouched for too long them it will start to form a bump) mine is more under the skin and spread out everywhere, all the way to right around and behind the ears as well as on the front and back of the earlobes sometimes, I can "check" for new ones by stretching my skin out and this reveals it all, even the tiniest ones. But even when not stretched out, it just gives me whole face and skin a real rough kind of finish. It never looks completely flat or smooth, not to mention all the little scars I've given myself from being an aggressive picker...I feel your frustration with this type of acne. I feel like if I could go back to 13-14 years old and trade this type for a shorter lived yet more severe type of acne, I'd do it in a heartbeat. This 10+ year annoyance is taking it's toll on me mentally.

I admire your courage and self discipline to not pick at it too much. I would have destroyed my face in the process of trying to eradicate every last one of those bumps.

Do you get ANY actual inflammatory acne or are the ones that you do get caused solely from picking at comedones?

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please keep us posted man and good luck

this is also kind of the same type I get, though not quite so grouped up or above the surface (unless it's left untouched for too long them it will start to form a bump) mine is more under the skin and spread out everywhere, all the way to right around and behind the ears as well as on the front and back of the earlobes sometimes, I can "check" for new ones by stretching my skin out and this reveals it all, even the tiniest ones. But even when not stretched out, it just gives me whole face and skin a real rough kind of finish. It never looks completely flat or smooth, not to mention all the little scars I've given myself from being an aggressive picker...I feel your frustration with this type of acne. I feel like if I could go back to 13-14 years old and trade this type for a shorter lived yet more severe type of acne, I'd do it in a heartbeat. This 10+ year annoyance is taking it's toll on me mentally.

I admire your courage and self discipline to not pick at it too much. I would have destroyed my face in the process of trying to eradicate every last one of those bumps.

Do you get ANY actual inflammatory acne or are the ones that you do get caused solely from picking at comedones?

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Heya, just wondering how the accutane is doing, I had exactly the same thing as you and my acne got worse for the first 3 months. So don't worry if you think its not working.

With comedone acne such as ours it takes so long for it to go away. Finally mid way through my 4th month the comedones just went.

Unbelievable, nothing else worked

Now I have none

I am so happy

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Have you looked into systemic anti-fungal treatment, e.g. Diflucan?


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GreenGables

 


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Yours is such a strange case, I wonder how/why they don't get inflamed?

I think that's lucky in a way.

For me for example every bump I get flares up.

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I have comedonal acne, i'd even say mine is worse than yours. but yours looks different. It's not red.

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Hey guys

So I started the accutane November 7th and I just came back to this thread and the pictures gave me chills. I didn't realize how much my skin has already improved until I looked back at how it was. Accutane is definitely working.

I've gotten most of the normal symptoms. Dry skin, some small rashes on my hands, super chapped lips. My neck and arms were so dry and scaly for months, and just recently I think they've finally adapted. The skin all over my body is SO SOFT now.

After the third week I got what everyone seems to get, where all the blackheads on my nose dried up and just kind of fell out. It was so weird, my skin felt what I would describe as fuzzy; I hear other people describe the same response. Right now I don't have a single blackhead on my face.

The closed comedones are much more stubborn but they are slowly fading out. One thing I've noticed is that when I squeeze them, for the first time in my life they don't come back. I had a few on my chin that just wouldn't go away so I squeezed them, and they disappeared for good. I've been avoiding squeezing because I don't want to damage my skin but two days ago I finally broke down. I squeezed the bumps on my cheeks like I've never squeezed before and didn't care about the consequences, I just wanted to see if they would come back or not.

So my face got super red and horrid looking after I did that of course, especially because it's extra sensitive from the accutane. After a few days the redness is starting to go away and I'll be able to see how well it worked in a couple more days. I'm not going to post pictures right now because you'll just see inflamed skin and won't be able to see the actual comedones. But I'll definitely post some progress photos this weekend.

My experience so far is that accutane is a miracle drug since it's the only thing that could ever put a dent in my skin. I'm beyond thrilled about it and I'm so excited to see how it looks in another 3 months.

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good to hear man!! Can't wait for the progress photos, this just might make me pull the trigger if it's working as well as you're making it sound...my acne is not identical but yours is one of the most familiar looking I've come across so far in terms of resemblance.

I don't get quite as many surface bumps, most of it is smooth to the touch because it's under the skin sort of but it's still very much there and visible when inspected closely and if I stretch out the skin, the bumps I mostly feel behind my ears and on my neck and where the skin seems thinner I guess.

anyways happy it's working for you, please tell us your dosage details when you post back !! thanks

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Read your first post, I felt for your journey. It's frustrating trying product after product, going to expert after expert to no relief. Reading your most recent update, I'm very happy for you! It must be an amazing feeling. The way clogged pores seem to vanish for most people on accutane is amazing -- even the nose sebaceous filaments go away. I hope your school experience is going good as well!

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You have no clue how happy this post has made me. I have had comedonal acne since the 5th grade and no topical or antibiotic has ever worked for me. I just went on Accutane and have been on it for 3 weeks and 10mg everyday. It has done nothing for my comedonal acne so far and I just gained some hope reading this.

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hoping he doesn't just disappear after being cleared without updating... like so many of these threads seem to go lol

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Blah, sorry! I promise I won't forget about this thread, I just may take a little longer than expected to update :(

Yeah, sorry I didn't get those pics like I said. School has been so insane lately and I just had a really big interview I had been stressing about.

My dose is officially up to 80 mg. The good news is my acne hasn't started coming back. The bad news is that it seems like it has hit a plateau since my last update; nothing has really changed and it's bumming me out. It's infinitely better than it was when I started but still not perfect.

I will try very hard to get some update pics rolling this week. Don't hate me! Take care guys and good luck :)

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I actually just read your post.

I JOINED this site just so I could tell you that you have given me an unbelievable amount of hope & that I BEG you to continue posting about your journey.

I too am facing the exact same condition as you & I am about to commence on my journey with accutane in a little over 3 weeks.

I would really appreciate any updates & stories you have.

& I wish you ALL the luck in the world, I hope you have amazing results because I know how defeating this kind of acne can really feel.

Goodluck & hope to hear from you soon!

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Okay, I just came back to this thread and looked at the before pictures and I can not even believe my skin used to look like that. I'm literally speechless at how dramatic the progress has been. I'm almost entirely clear in just a few months after living with this for more than a decade. I can't even believe my skin used to look like it did in those pictures. It seriously looks so disgusting.

Sorry I've been slow to update, like I said I've been so busy. But I finally took some pictures and I'm so happy to post them and hopefully give you guys hope. As you can see my cheeks are almost completely clear. My temple area is being really stubborn but it's still so reduced from where it started and it's slowly getting there. The side effects are getting brutal since I started the 80 mg. My eyes are so dry all the time and my arms got all scaly again for a few weeks. My nose has also been bleeding frequently but I've had nosebleeds my entire life so I expected that. All the side effects are so worth it though, I have never felt so happy with my skin. If you have this kind of skin and are considering Accutane, DO IT.

Anyway, here are the pictures! I'll post them next to the before photos so you can see the difference. My treatment ends mid-April and realistically I probably won't post another update until then, lol. Enjoy smile.png

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holy shit man good stuff, very happy for you.

I realize you said you won't update but I gotta ask, did some of the white bumps disappear on their own simply from the accutane or did you have to extract each and every one at least once??

either way difference is huge and impressive...this is looking more and more interesting to me though I'm not sure I would want 80mg and side effects (don't think I'm even heavy enough for 80mg)

thanks for updating, can't wait to see end result and hopefully you stay permanently clear after this

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holy shit man good stuff, very happy for you.

I realize you said you won't update but I gotta ask, did some of the white bumps disappear on their own simply from the accutane or did you have to extract each and every one at least once??

either way difference is huge and impressive...this is looking more and more interesting to me though I'm not sure I would want 80mg and side effects (don't think I'm even heavy enough for 80mg)

thanks for updating, can't wait to see end result and hopefully you stay permanently clear after this

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Oh wow! That is a huge improvement! Well done man. How did people respond to the "new you"?

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well it's mid april and was just wondering if you were done, how it's going, final result pictures etc.

can't wait to hear back

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well it's mid april and was just wondering if you were done, how it's going, final result pictures etc.

can't wait to hear back

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My first reply on acne.org! :D haha whatever... My acne is like yours except that my skin looks pretty red and I have sort of a combination of comedonal/cysti acne...gosh, so horrible. However I know that comedonal acne is so stubborn and I sadly accepted the fact that it might never go away. Aaand I am also really tempetd to squeeze and squeeze...so I feel kind of related o your case. Thanks for giving me hope, you look great! I hope my comedones go away too! eusa_pray.gif

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Just wondering if you finished your course yet? I'm still on Accutane and its not clear yet but almost! I'm just finishing my 5th month! I hope my comodones don't come back when I get off the Accutane!

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