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Debate About Retinoids Causing Scarring

retionoid differin enlarged pores sudden scarring

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#1 leitot

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Posted 14 January 2013 - 09:58 AM

Hi all,

I have had a lot of acne since I was 18. During my teenage years I only had the odd pimple. Anyway for ten years from 18-28, I suffered with bad hyperpigmentation, especially since I picked at my pimples a lot. I did a lot of bad things to my skin to try to erase the dark marks, like I definitely overused acids and peels. However I never EVER experienced texture changes or true scarring. I cleared up completely for a year on 5% BP with 1% salicylic acid cleanser, but I stopped the BP in Feb 2012 due to concerns about it aging the skin. I broke out again after I stopped it, so I went to the derm for a retinoid. Again, up to this point, 2 months post-BP, nothing but dark marks.

In April 2012 I started using Differin gel 0.01% at night only. I did not overuse it as I still had half the tube left after five months. For the most part I would wait 30 minutes after showering as instructed by my dermatologist. However at the time I did live in a humid climate so my skin would still be damp-ish sometimes. I also did not use sunscreen. I simply stayed out of the sun.

I broke out badly for the first 10 weeks and then cleared about 70%. One thing I noticed was that a couple of weeks into treatment, an area on my right temple developed a bumpy texture. But they weren't quite pimples, yet bigger than blackheads. I thought it was part of the IB. The area continued to be bumpy and hyperpigmented until the day I stopped Differin cold turkey, which was in September, 2012. In total I used it for 5 months.

What stopped me was one morning I woke up and I had a dent in my forehead, right above my left eyebrow. It is quite large - maybe 5-6mm in diameter, and it is deep. I did not have a pimple in that area in the days prior to that. It could be weeks actually. I am still unable to figure out if it is a scar or an enlarged pore. When I inspected my skin, I also had what looked like a crack about 2mm long in the skin of the bumpy area.

I searched these boards and found a number of people who swore up and down that retinoids (topical or Accutane) had caused their acne to start scarring suddenly, perhaps because they made the skin more fragile or interfered with the healing process. I messaged some of these people but have been unable to get an answer as yet.

I have been in contact with someone from another board who used a retinol cream and developed dents all over her cheeks which turned out to be enlarged pores (she never had much acne). She told me that it had taken almost a year for her face to start healing (I've seen her pics and it really has gone away a lot) but she had to stop exfoliating and using products on her face.

I couldn't quite do that, so I have been using Philosophy's 1% salicylic acid cleanser twice a day. On four occasions I also put Garden of Wisdom's 5% mandelic acid serum on. Unfortunately I have to deal with new pimples although since changing my diet A LOT and drinking warm lemon water every morning, my breakouts are greatly reduced. To moisturize, I make a solution of filtered water, about 5% vegetable glycerin and about 5% baobab oil and I spray that on. If I use a traditional moisturizer, I break out.

Over Christmas, of course I fell off the bandwagon with the eating, and also I was back in a humid climate, AND I was trying out sunscreen. Oh, and coconut oil in my hair. My face definitely broke out more than usual. I had whiteheads all over my forehead and also in the bumpy area. I also had left the Philosophy here because I couldn't fly with it. I was using Clearisil's sensitive skin acne wash instead, which I think does nothing for my acne even though it's 2% SA with Triclosan.

Jan 2, I got back on track with eating and I went back to using Philosophy and my skin cleared up except for the usual 1-2 pimples a week. I also squeezed out a couple of blackheads in the bumpy area. When I looked at the bumpy area the following morning, I now see at least six cracks. To me they could either be very tiny acne scars or they could be stretched out pores. I am going to try to take pictures tonight but the lighting and the angle are difficult to achieve.

I can't figure out if
- the Differin has caused my skin to start scarring from acne
- the bumpy area is damaged from being bumpy so long (also thanks to Differin use)
- I have temporary enlarged pores from the Differin similar to the other girl I've been talking to

I'd like for people who believe retinoids caused them to scar to weigh in.

1. How long after stopping the retinoid did your skin go back to normal? It is almost four months for me and I just discovered the new cracks in the skin.

2. What did you do during this time? My friend recommends not using any products, and that definitely worked for her. But she doesn't usually have acne. I'm breaking out...It seems to me like a rock and a hard place because new acne could cause more scars. So I should treat the acne right? On the other hand I have to let the skin heal so that it won't scar anymore.

3. I guess what really really scares me is that it's the blackheads and tiny whiteheads that seem to be leaving behind the tiny jagged looking holes. Not cystic (well I don't really get cysts I think) or the pustules. And I have a lot of comedones. With diet and lemon water they don't get inflamed as often but my skin is congested so how many scars will I end up with eventually if this doesn't stop soon?

Hoping someone can shed some light on this.

Thanks!

Edited by leitot, 14 January 2013 - 10:01 AM.


#2 michi31

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Posted 14 January 2013 - 10:29 AM

Yeah this is a really big debate and I wish I knew the answer for sure. Derms will swear up and down that retinoids do not cause scarring so you can't even get anyone to engage in the discussion with you. So my experience was that in December and January I broke out with cysts on the side of my chin. I went and had multiple cortisone shots several weeks in a row. In April I started using Differin - and I did so for 7 weeks. It was during this time that the area atrophied. I now have rolling scars on the side of my chin that have not gone away. I did use some harsh products sporatically afterwards - tried a very low percentage lactic acid peel, and was using Mario Badeschu product for cysts that contain alcohol - didn't use these too much but wish I didn't use them at all. For a long time I blamed the Differin. Then I blamed the cortisone shots. Today, I belive it was most likely a combination of the acne itself and the cortison shots - I have a couple smaller permanent dents from previous shots and I am an IDIOT for getting more - but I was in a panic.

I was reading up on Differin and supposedly it only interacts with the epidermis - whereas retin-a interacts with both the epidermis and the dermis. I will try to find the exact thing I was reading and post it - but if anyone has anymore information on it that would be helpful. So I don't believe a medication that only causes changes in the epidermis could cause scarring in the dermis. I do belive it could make scarring look worse by thinning the epidermis.

I was thinking about retin-a last night and supposedly it builds collagen. But has anyone looked at how it interacts with collagen that is actual scar tissue? Does it just build up more irregularly layed collegen (more scar tissue) or does it build regular collagen around the scar tissue. What would the asthetic effect of this be? I have a lots of questions and no real answers.

So I am wondering about your bumpy areas. When I used Differin for a couple years prior to my most recent experience, I developed bumps throughout my chin area. I was also using Duac (5% bp). I blamed the topicals for a long time but now think it may just be loss of collagen from years of acne that is giving it a bumpy look. What do you think?

Edited by michi31, 14 January 2013 - 10:40 AM.


#3 Green Gables

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Posted 14 January 2013 - 10:45 AM

I think that perhaps the problem is that retinoids build collagen too much. Especially if you are female. If you look at women without acne and men without acne, the men naturally have thicker skin. Retinoids ultimate goal is to thicken skin. When you're female and put in retinoids, you give yourself thicker, more-male like skin. I know lots of men who never had acne with that natural "orange peel" texture. Only women I know who have orange peel texture are those who've used retinoids.

#4 leitot

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Posted 14 January 2013 - 11:46 AM

Hey, thanks both of you!

Michi, have you ever posted this story on another board? I swear I've read something like this before where someone had cysts but did not scar until months later when they used a retinoid.

I'm glad I was only on Differin, if what you say is true about the dermis, and glad I was on the lowest strength. I went to a new derm when I first noticed the textural changes and as you predicted, she swore Differin couldn't do that. I'm thinking about getting a consultation with an aesthetician, just so she can tell me if it's scarring or pores or whatever. I feel like I want a professional to diagnose it but a doctor probably isn't going to be much help.

So what do you guys think I should do? Try to treat the acne so it won't form and scar? I don't know how to do this without going back on BP (which gave me a wrinkle, and I see some people on here claim BP causes scarring too) or exfoliating a lot (which probably won't help heal my skin).

Or do you think I should stop using anything medicated at all and just not squeeze anything and hope for the best?

How long do you think these negative effects from Differin will last. I understand that any scarring may be permanent but I mean this tendency to scar.

Thank you again for your quick replies.

Green Gables, I feel like I'm only starting to scratch the surface with diet but I've reached a roadblock in that I'm only like 75% clear. If drinking warm lemon water helps me more than anything else (even green smoothies) what does that suggest to you? That I have unhealthy gut bacteria? That my liver is congested? I want to figure it out so I can attack the problem more.

#5 michi31

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Posted 14 January 2013 - 03:36 PM

Yeah it's tough because topicals may harm skin, but acne probably harms it even more. I want to cure it from the inside - it's tough to know how to do that. Have you had your hormones tested?

#6 Green Gables

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Posted 14 January 2013 - 07:19 PM

Hey, thanks both of you!

Michi, have you ever posted this story on another board? I swear I've read something like this before where someone had cysts but did not scar until months later when they used a retinoid.

I'm glad I was only on Differin, if what you say is true about the dermis, and glad I was on the lowest strength. I went to a new derm when I first noticed the textural changes and as you predicted, she swore Differin couldn't do that. I'm thinking about getting a consultation with an aesthetician, just so she can tell me if it's scarring or pores or whatever. I feel like I want a professional to diagnose it but a doctor probably isn't going to be much help.

So what do you guys think I should do? Try to treat the acne so it won't form and scar? I don't know how to do this without going back on BP (which gave me a wrinkle, and I see some people on here claim BP causes scarring too) or exfoliating a lot (which probably won't help heal my skin).

Or do you think I should stop using anything medicated at all and just not squeeze anything and hope for the best?

How long do you think these negative effects from Differin will last. I understand that any scarring may be permanent but I mean this tendency to scar.

Thank you again for your quick replies.

Green Gables, I feel like I'm only starting to scratch the surface with diet but I've reached a roadblock in that I'm only like 75% clear. If drinking warm lemon water helps me more than anything else (even green smoothies) what does that suggest to you? That I have unhealthy gut bacteria? That my liver is congested? I want to figure it out so I can attack the problem more.


Lemons stimulate the production of hydrochloric acid. Your stomach acid may be low. Low stomach acid causes all sorts of problems. You need to supplement with Betaine HCL at every meal.

#7 leitot

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Posted 15 January 2013 - 08:48 AM

So I am wondering about your bumpy areas. When I used Differin for a couple years prior to my most recent experience, I developed bumps throughout my chin area. I was also using Duac (5% bp). I blamed the topicals for a long time but now think it may just be loss of collagen from years of acne that is giving it a bumpy look. What do you think?


I am so far from an expert on this but if your bumps are raised then maybe it's not from loss of collagen? I am just going to hope and pray that this is inflammation from the Differin and it will subside.

Michi, have any of your pimples formed new scars while you were off Differin?

Does anyone have a good idea how long it takes for skin to go back to normal after retinoid use in terms of healing capabilities?

Green Gables, I'm currently on the Perfect Health Diet for the past week and a half. I guess it's worth it to start a log here. I will try adding the HCL supplements. Also I was reading a thread here on cinnamon. I can't see that hurting. Thanks very much.

#8 michi31

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Posted 16 January 2013 - 09:51 AM

My bumps aren't raised - they are deep in the skin...I think it's either small points of scar tissue or just how it looks when the fat pad starts collapsing. I haven't had any new pimples form since starting differin - actually I started using it again haha. And still haven't. But I haven't been getting the scarring type of acne either. Also, the scarring I have is from cysts that were gone for months before I started using the Differin - those spots just started scarring once I did.

#9 Doddy46

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Posted 11 July 2013 - 06:21 AM

I have the same thing going on, except it was more dramatic, like, overnight. My poison of sin was Derma E microdermabrasion and neutrogena 3-1 hydrating acne moisturizer. I woke up to enlarged black holes all ove my face. The only thing that seems to be helping is not using ANYTHING on my face. Every other day or 3 I'll wash lightly and quickly (not massaging cleanser into face, just lightly gliding it over skin very gently for a few seconds) and rinsing it off with warmer water. Very gently dry skin with a thick soft towel thats good at absorbing water (some towels ARE better than others)

 

If you smoke, STOP, RIGHT NOW. SMoking hinders skin renewal. Drink alot of water and gatoraid. Maybe look into getting an electrolyte balancer supplement. Medium doses of Vitamin C throught the day will help.

 

So, Heres what I have been doing for the last week, and so far..very ..very minor improvment, but improvment none the less.

 

-Less washing face (I use spectro jel purple, there are better more gentle choices out there)

-No smoking, dont be around smokers

-No drinking alcohol

-Get 15-30 mins UNprotected sun throughout the day (the sun IS damaging, but its also HEALING if not overdosed, you will have to judge what amount is safe for you. Certain things will cut down on safe exposure, such as antibiotics, and some topicals, damaged irrated skin)

-Get a GOOD vitamin C supplement (I use Pure Synergy Pure Radiance, but Truly Vitamin C is good too, if you dont mind added maltodextrin)

-Get a GOOD hyalaurnic acid supplemnt and take this with fats (fats help absorb the acid into the soft tissue where it needs to be, without added fat you wil not get good results)

-NeoCell Fish collegen, take this with your vitamin C, as vitamin C increases the bio availability of this product

-Eat small meals throughout the day (5-6 times) this make it easy for your digestion to absorb more nutrients

-Reduce ALL stress however possible

-Remember there IS a chance your skin will recover, and you general health will play a key role

-Get a GOOD antioxidant supplemnt, I recommend a good astaxanthin (havent got yet myself, still looking into who makes the best, purestest form, will report back on this) and antioxidant extreme from Healthforce nutritionals. Use these before 30 mins end after getting excercise (excersize IS good, but creates ALOT of Free radicals, which are damaging, you will NEED these for post workout care) and take before bed.

-This WILL take A LONG TIME, skin renewal past 18-19 i think it is renews on average of every 28 days. you will need to go through a good multitude of healthy renewals before your skin can start recovering.

-Get a fair amount of protien and fats into you, your skin needs these. eat clean for good vitamin intake

-Maybe get a trace mineral supplement (I dont have this but may be helpful, just please do your research and dont cheap out, get a good one, not the first one you find)

 

I've read posts about certain creams and lotions helping, things that have ceramides, lipids, cholesterol and urea. these ARE healing for the skin and you may wish to try them, however Im from the belief that products did this to me, and i will not use them again..any of them. you may choose different. (dry skin doesnt heal, do  if your skin is chronically dry, you may actually NEED a moisturizer in which case I think a good Urea with as few other ingridients as possible would be a good choice)

 

Get an appointment with a highly regarded esthetian (sp?) so s/he can tell you if your skin is dehydrated and what not (if she offers ANY sort of treatment, be it laser or dermabrasion, I advise you pick up your stuff and polietly walk out and find another one who will offer advice only)

 

Avoid Sugar!!!


Edited by Doddy46, 11 July 2013 - 06:31 AM.