cvd

I've found the best thing is to tell my derm exactly what is happening --- to keep in touch on how I'm progressing. If I were you I'd ask the question..."Is there anything I can do or take that will help with this flare-up?" I think taking an oral antibiotic when first starting a new regime can make it so much more tolerable. Plus you'll have less scarring. And it really doesn't hurt your body to take an antibiotic in this way. What is bad is taking an antibiotic for years as your only way of dealing with acne.

The regime your derm has you on sounds reasonable for the kind of acne you have. You may have to experiment with what kind of retin-a works for you. For example I was using generic tretinoin cream for years but then started getting more irritation and my derm just recently switched me over to retin-a micro because it is supposedly less irritating and it now comes in generic form which is less expensive.

If you can control your acne with topicals that works best. Another thing you can look into is spironolactone but that is usually for more resistant acne and if topicals don't work. You can google info on spiro. It isn't a hormone but it moderates androgen receptor sites which in turn helps with acne.

I have really resistant cystic acne and even I have been able to get almost clear skin (miracle) so I know you will. Just work with your derm. Another word of advice is to do exactly what the derm says. Ask for recommendations for cleansers and lotions, etc. For example my derm recommended DML lotion as being a very mild and truly non-comedogenic lotion. Now I would never have known that on my own...and surely never had heard of DML lotion before. But it is used and recommended by plastic surgeons and for people after laser work so you know it is mild.

Something else may be going on right now with your skin that is different than acne...especially in the way it is only happening around your mouth. I'd recommend you see a dermatologist for this because acne products may be too irritating and make it worse.

Actually my current derm is the one I had when I was in my early 30's (before I moved away) and he was the one who put me on two rounds of accutane. Believe me...accutane is a miracle drug. I loved it. While on it I was totally clear (after about a month of old cysts working their way out). He and I both hoped it would cure my acne. Sadly it didn't but it did change my skin to be much less oily and to allow other meds to work much better. Before accutane nothing worked...my skin always had cysts no matter what I did. After accutane I stayed somewhat clear if I was on full strength antibiotics or BP regimes but I still got several cysts each month. If I didn't do anything I got cysts weekly...a mess.

The biggest mistake I made was not following through with a good acne regime AFTER accutane. I just assumed I was cured so only washed my face. Plus while on accutane you have to use lotion and I assumed I could keep on using lotion eventhough my skin was getting a little oily again. In truth I didn't need it and I'm sure it was plugging up my pores. Not everyone needs lotion! Within two years I was breaking out again...much less but still getting cysts. I should have done what Dr Naverson recommended which was to always do some form of BP to keep down bacteria and pores open. I moved away and when I moved back went to his office (much bigger now) and saw another derm. She was okay but really didn't understand the tenacity of my acne. Then I saw Dr Naverson. He remembered me and got right to work clearing up my skin again. When I think of all the years I could have had clear skin if only I had followed through with him and his advice! Oh well.

What I'm trying to say is by all means do the accutane! It will really help even if it doesn't cure your acne. Then afterwards be sure to do everything recommended. You'll love accutane, especially if you have been dealing with cysts. Another thing is that cystic acne can become quite scarring so you'll want to avoid that. Accutane changes the severity of cysts, even if you continue to get them later.

One thing I did that really made a difference when I went to my current derm was to bring photos of my skin at its worst. I also brought a journal of what I'd used, how my skin reacted, and how my skin has been over the years. This helped my derm understand what I've been through. I think that derms hear many sob stories and assume patients are exaggerating. But photos don't lie!

Back when my skin was getting cysts I too could have a week here and there where my skin would look almost clear. And then later in the same day I could start to get swelling and by next morning would have cysts! It was wierd to go from almost clear skin to lumpy bumpy inflamed red and infected cysts all in 24 hours! That's why I always thought it must have to do with diet. But I followed a strict diet and no change. I too had times where when I went to the derm my skin magically would look better when only the week before it had been looking like a teenager's nightmare.

Never have been able to figure out why cystic acne works that way but my current derm says that deep cystic acne is actually forming weeks before it swells up. And the reason it suddenly seems to appear is because the pus (sorry) ruptures the pore wall which then results in an immediate reaction of swelling redness, etc. Then when the cyst ruptures on the surface either due to manipulation or normal release, then it goes down quickly since the infection has now been removed from the body.

This explanation helped me understand better why the regime my derm has me on works. It is specifically designed to stop acne before it starts...by strengthening the pore walls (tretinoin cream), removing plugs (tretinoin cream, monthly microdermabrasions, BP) and killing acne bacteria.

Re: monthly professional microdermabrasions. My derm says they are a cornerstone of this regime. So they are worth the money even if having to sacrifice elsewhere. I'd have to agree because my skin has been totally changed by them...and I mean totally. I look decades younger...I'm not kidding! Went out to lunch yesterday and my friend said I just keep looking younger and younger...no wrinkles.

Hi Amygims --- I too had acne that just got worse no matter what I did. And I did everything...accutane, retin-a, topicals, etc. I also used topical BP for years and it worked somewhat and then like you I started reacting to it, even a little bit of it, and I had to stop. Accutane only worked when I was on it. Salicyclic acid was the worst offender - red raw skin. The cysts got deeper and more frequent and I was getting into my 40's (sigh). Here's what finally worked for me and interesting insight from the two derms who were eventually able to keep me clear.

Acne that gets worse despite using all the usual methods is termed "chronic resistant acne" and it has to be treated differently. Diet helps but not eneough in these cases. I had two derms who approached it differently. One derm put me on Spiro and gave me Bactrim. Spiro only blocks androgens. It doesn't put any hormones into your body so it is usually well tolerated. Bactrim is very effective with cystic acne. Mino never worked for me. Doxy worked somewhat but only at full strength. I was on this regime (spiro + bactrim) for about 10 years and was pretty clear.

I moved and changed derms and the new one freaked out about me being on a strong antibiotic for so long and took me off. The cysts came roaring back. By this time in life I had been following an organic gluten-free, dairy-free allergy diet religiously and I took zinc, etc. Still had cysts. I was still on spiro but by itself didn't keep me clear. Nor did tretinoin cream (retin-a) that she put me on. Talk about depressed. Almost my whole adult life with cysts...

Over a year and a half ago I switched derms. He's tops in our area. He took one look at my skin and put me on the regime listed below. He says that this kind of adult acne has to be treated with a multi-prong approach designed for sensitive aging skin that needs to be repaired and treated at the same time. Here is the regime reasoning and the treatment in parenthesis. I have been clear since on this regime. I'll get a little red bump here and there but they go away in a day. That's it...clear skin.

Block androgens because most resistant acne is due to a sensitivity to androgens (spiro).

Kill acne bacteria with BP cleanser which is better for sensitive skin than BP topical (Panoxyl 4%).

Kill more bacteria with antibiotic topical which works better when used in combo with the BP (Cleocin-t).

Reduce inflammation with low dose antibiotic that doesn't interfere with gut flora (doxy 40mg).

Dissolve blackheads, loosen plugs and strengthen skin collegen (tretinoin cream 1%).

Open pores, get rid of excess dead skin that plugs pores, build collegen (monthly microdermabrasions).


That's it. Yes, it is a pain to follow such an exacting regime but it works and it is mild on the body. It is a regime I can follow forever if needed.

Hope this helps. Feel free to message me if you want.

Oh one more thing. My derm swears by DML lotion. It is designed for acne skin and is totally non-comedogenic. It is not natural but is incredibly mild, soothing and absorbs very quickly.

The De Vita sunscreen is also designed for acne skin. It is the only one I can use without a reaction. And it has lots of soothing zinc in it.