cvd

It's very hard to figure this all out because acne is an inflammatory skin disease much like other inflammatory skin diseases and just about anything can inflame it, including hormonal imbalances --- and everyone gets those due to biology, stress, etc.

I went to an endocronologist to test and help me understand it all. Personally, I have a few things affecting my acne (high-normal IGF-1, sensitivity to androgens, etc.)but the endocronologist said that unless it is extreme not much can be done for these kinds of things because the treatment side effects outweigh the advantages. That said, my derm has me on Spironolactone for the androgen sensitivity.

Both told me the key to controlling acne is changing how the pores function. Then it doesn't matter what is happening with the hormones, etc. To do this often requires a multi-prong approach, especially with adult acne. I now have almost 100% clear skin due to the regime below. I guess what I'm trying to say is that there is no way to control everything the hormones do. Some tweaking can be done for specific ailments like your wife has but even then it is virtually impossible to understand how everything is affecting everything else.

I am a researcher and, like you, spent much time trying to figure it all out...changing this and tweaking that, getting lots of testing. But after a certain point realized I couldn't control all the variables.

I hope this helps. Feel free to message me if you want to talk more in depth about this. Personally, I think there is a middle ground to the task of trying to find causative agents for acne. It helps to a point and then there is the realization that for many of us there is no magic bullet cure as it were...just the boring task of keeping on doing a regime that keeps the pores functioning better. I am older (62) and have been dealing with this since age 15 so I know what it is like to keep on trying to find something that explains the ongoing problem!

It's great you've taken on the task and are helping your wife try to figure this out. My husband is also very supportive and stood by me as I tried and tried to control the problem. He was a lifesaver and I couldn't have made it without his support. I'm sure your wife is very appreciative!

Hi --- I think we've talked before but I totally understand your anguish.  You have exactly the same kind of acne that I have struggled with for my whole adult life (decades).  Why are you resisting accutane?  It really is not that bad and it sets your pores up so that medications that didn't work before suddenly start working.  How does it do this?  By resetting the amount of oil that your pores have to deal with.  So you will be clear while on it and better able to control acne when finished.

Chances are your hormones cause you to have too much oil and then on top of that you are sensitive to the hormones (androgens).  There are ways to get around this without doing spironolactone.  First off you have to have a regimen that is for sensitive skin but still kills acne bacteria and gets your skin to shed better.  There are 4 things I do that I feel have been the cornerstone of my FINALLY having clear skin.  It was my current derm who prescribed my regimen (see bottom of page).  He is the tops in our area for adult acne.

1. Wash with a benzoil peroxide cleanser.  I use Panoxyl-4 which is patented for keeping skin clear eventhough it is mostly washed off.  It is also good for sensitive skin that otherwise could not tolerate BP.

2. Use an antibacterial toner.  I use Cleocin-T.  This is a perscription toner but is hands-down absolutely amazing for stopping acne bacteria and inflammation.  I can put it on emerging bumps and they never get bigger or become infected.  It is a lifesaver for me!

3. Use a topical retinoid.  I use a 1% generic tretinoin cream very sparingly.  This is essential for good cell regrowth and refining the pores.  Also kills acne bacteria.

4. Do a monthly microdermabrasion.  This also has made ALL THE DIFFERENCE IN THE WORLD as far as my skin texture and ability to shed dead skin cells.  Persistent red acne that is deep and cystic like yours means that your skin is not shedding properly at all.  This may be a genetic problem but the regular monthly microdermabrasion can compensate for this.

As you can see attacking this kind of acne takes a multi-prong approach.  This is how my derm explained it.  If I don't do all the steps then my acne comes roaring back and I am 60 years old...I know - hard to believe someone can have acne this long but I did.  

I sincerely worry when I see others searching for the one thing they can do to control their acne, especially when they have painful cystic acne.  I worry because there is no one thing that will control this...it takes a multi-prong approach (above) that also includes diet and lifestyle.  It is like any other inflammatory disease.

Hope this helps.  And I agree with the others you are very pretty so hang on to that.  I too have been called attractive and yet I had to deal with awful cystic acne forever.  I just kept on trying to deal with it.  Now I have skin that looks at least 10-15 years younger than my peers (...due to all the topicals?...) and I still have my "looks".  

Never lose hope!

And when you get clearer your life will come back as before --- even better!  Life can continue while flaring with cystic acne but it is hard to keep going.  I agree with another poster above that a good man will stick by you.  My husband did and I love him all the more for it.

I agree with all of the above and do all of the above but I also know that for some of us, we have to do more than just change our diet and our thinking.  I have to do some mainstream meds if I want to have healthy clear skin.  The goal is just topicals but I'm not quite there yet.  I hope this is supportive to the poster above who is still breaking out despite diet, etc.

Thanks all    I will follow your advice and up the probiotics and taper off.  Unfortunately I didn't know I was going to be facing this issue until all I had left was 6 capsules but I'll space them out and see if that helps!  I've been taking a probiotic for awhile and added a really good soy yogurt that has lots of live culture in it so that should help.  And I added Quercetain with Bromelain which also acts as an anti-inflammatory and anti-histamine.

That's very interesting about Oracea's having antimicrobial activity.  I'll just have to hope that my topical antibacterial lotion. Cleocin-T, that I apply in the morning is sufficient.  I probably have the world's most resistant case of acne.  It came back after two rounds of accutane and has lasted decades (I'm now 61).  The only thing it responded to was full strength oral antibiotics and when I was actually on the accutane.  Nothing else worked.

However, my current derm (who I also saw in my 30's before moving away) looked through my charts and noted that I had never tried a topical antibiotic.  So this is what he put me on, along with the regime below.  Sort of a multi-prong approach.  Plus I got allergy testing and avoid foods I'm sensitive too.  The whole thing resulted in clear skin.  A miracle really so you can see why it is scary for me.  No way do I want to return to what I've suffered with through the years!!!

But I think that what is really keeping my skin clear is a combo of the BP cleanser + Cleocin-T + monthly microdermabrasions.  That and allergy diet (and probiotics).  This was a new kind of regime for me and it seems to be working so I hope that the Oracea just isn't that big a part of it...since as I shared above, I had tried it before and it never did much.

Again thanks for the support.

If you have rosacea then you will see a reaction within a day or two.  Even quicker sometimes.  The red bumps will come out and be inflamed.  You may get a rash of them in one area and often they itch.  They last for a long time.  Check out the rosacea sites for foods to avoid.  If this is indeed part of the problem then you'll be able to figure out what foods make you flare up.  Usually it works out that you don't have to avoid all the foods...just the ones your system responds to.  Also, you may want to get a professional allergy blood test done.  I found out I am sensitive to certain foods that cause inflammation to my system when I eat them.  Avoiding those foods has helped my whole body feel better in addition to my skin.

I hope this helps.  It just sounds like this is what you may be dealing with.

What about people that avoid all dairy and sugar but still break out?

In my experience with resistant chronic acne, diet is just one piece to the puzzle.  Acne is much like other chronic inflammatory skin diseases (eczema, psoriasis, etc.) in that a non-inflammatory diet helps but you also have to sometimes take oral meds and apply topical meds to keep the condition from flaming up.  Allergies can mimic the symptoms of acne so it doesn't hurt to try avoiding common triggers --- you'll know pretty quickly if that's the culprit.  If it's acne then you have to do more.  Also avoiding common hormone triggers like dairy helps.  It's all about doing everything you can to help the body manage the condition.  And this means avoiding things that are inflammatory to the body (sugars, caffeine, alcohol, hard to digest foods - junk foods, cheap oils, dairy).  You can experiment with avoiding things for 2 months and then adding them back in.  It's very interesting!

Another way to think about it is that acne is like the outside appearance of how an inflamed digestive system would look like...think ulcers, inflammation, swollen areas, etc.  What do we do for an inflamed digestive system?  We eat simple clean foods, drink lots of water, sometimes have to take antibiotics, use probiotics, and avoid alcohol, spicy foods, etc.  We do things that calm the system (walk, yoga, deep breathing, eating well but simply, etc.).

Now add to this image the fact that on the skin, especially the face, we may be genetically sensitive to androgens and our pores may not shed well.  So if we suffer from acne we have to do things that help the skin be buffered from androgens and to keep our pores open.  Women can take Spironolactone for the androgens, guys can't but they can do everything possible to avoid foods that trigger hormones.  Everyone can use cleansers and topicals that help keep the pores open (BP, retin-a, etc.)

So you see for the skin it is much more complicated...lots of things to think about...

You probably had clearer skin because you weren't eating dairy products!  Our diet here (processed junk foods and fast foods) is loaded with dairy and sugar.  Dairy has natural hormones that can aggravate acne and sugary foods cause insulin spikes which in turn affects hormones...a vicious cycle that acne prone people should avoid.

Some people keep on getting acne.  I was one of them...never outgrew it.  If you have this kind of acne then you have to keep on treating it even when you get clear.  It means you either are really sensitive to androgens within your skin and/or to the acne bacteria.  Or your skin in certain areas may not shed as well as it should so pores clog up.  This could just be genetic.  Diet changes help but if you have really resistant acne then it won't solve the problem.  Dan's treatment method is good.  You need to experiment to find out what will actually control the acne so you have clear skin.  Your derm can help with this process.  Try what he says.  Keep a log.  I had really chronic resistant cystic acne...did accutane twice and still had it...but the regime below keeps me clear.  As you can see it is complicated but it works.  Hopefully something more simple will work for you!

I take Spiro 100 mg/day...all in the morning.  Works better since it's a diuretic so pee alot in the am and not so much in pm.  I think it really helps.  I have (had) really resistant chronic cystic acne in t-zone.  Spiro normalized things to the point that the other meds had a chance.  You can also try Oracea along with it --- a low dose sustained release doxy.  It doesn't mess with your GI tract like other antibiotics since it works as an anti-inflammatory and not an antibiotic.  Another thing that has really helped me and I think has what finally made my skin clear is a combo of monthly microdermabrasions + BP cleanser + Cleocin-T (a topical antibiotic).  These three together along with the Spiro have done the trick.  I'd like to say diet alone helped me but it didn't.  My overall health was better but it just didn't stop the acne.  I've always eaten health food but recently was diagnosed with food allergies so follow a special diet that is gluten-free.  I think it helps but only along with the other meds.  Of course I had really deep cystic acne so maybe diet alone would work for people with more superficial acne....don't know...

I hope you can go natural and that it works!  It never worked for me and I tried everything...sorry!  I was told by my derm that some people, especially women, are very sensitive to androgens.  Upsetting hormones (stopping BC, etc.) can trigger even more sensitivity.  But that said you may just be sensitive in general.  This means that it helps for you to take something that blocks androgens.  Spiro is really good for this without affecting hormones in other ways.  It is a really old drug, is relatively simple in design (gentle diuretic) and safe to use longterm.  I really like the regime I'm on (below).  A key element of it is monthly microdermabrasions.  I think they make a huge difference in my pores staying open.

Hope this helps!

I have been on Spiro for 10 years.  It is one of those meds you can take forever.  It is considered a very mild medication and works by blocking androgen receptors so it isn't even mucking up hormones...just blocking androgens from getting to the skin where they cause acne.  It takes several months for Spiro to kick in.

You seem to be only focusing on the blood sugar leading to inflammation aspect. What about food allergies or sensitivities? Do you think everyone could tolerate a normal amount of grains in their natural form, or do you think some people would still break out because of food sensitivities that cause inflammation?
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I think allergies or sensitivities happen regardless.  The problem is that allergies and sensitivities are activated much more now because our diet is so restricted and tends to be foods that are inflammatory when eaten in excess (wheat, corn, dairy, sugars, etc.).  Most of us in Western society only eat processed wheat products, dairy from cows fed industrial feed (corn), beef and chicken fed on corn and farmed fish fed ground up fish pellets.  Think about it...when was the last time anyone served you wild turkey, wild rice, barley, spelt, grass fed lamb, wild bird, fresh caught trout, soup made from wild picked mustard, dandelion, hazelnuts, etc etc.

Ancient cultures had a much more varied diet than we do today and the animals they ate also ate a much more varied diet.  For example they ate a much greater variety of grains (spelt, quinoa, wild rice, barley, etc.) wild birds, wild fish and wild animals that had eaten insects, other wild animals, and wild grasses.  Do you see where I am going with this?  From the bottom of the food chain to the top there was tremendous variety in what was eaten.  This helps the body from becoming overloaded with one form of protein...it is the proteins in foods that cause allergies and sensitivities which in turn causes inflammation.  And concentrated sugars cause inflammation.

Unfortunately in our world today we eat foods that are both restricted in type of protein (hence concentrated in that type of protein) and concentrated in sugars.  Our bodies can't deal with it and get inflammed...we need more variety in our diet.  This is why dieticians recommend a rotation diet.

The poster above talks about his Mongolian roots and how they eat mainly meat and dairy.  However the animals they eat and get their milk from have been grazing on wild grains.  Some of the animals (chickens?) may also be eating insects.  This creates diversity and lowers the likelihood of allergies, etc.  Plus the human body is very adaptable to a point and the nomadic Mongolian people adapted to a rather harsh environment.  In addition, I would venture to say that there are less toxins in that environment and less stress all of which help the body have less inflammation.

Here is another example.  My husband is a fish biologist and used to work at a fish hatchery where the fish were kept in crowded pens and fed a diet of pellets made from ground up farmed fish (FYI --- fish normally eat insects, worms, other fish, etc.).  The fish had to be fed a constant diet of antibiotics or they would get inflammatory skin lesions and other diseases.

Does this sound familiar?  Just like farmed fish, more and more people today are suffering from inflammatory skin problems and diseases requiring antibiotics.

We need wild foods and a variety of wild foods eaten in their natural state to be healthy.  This is really the issue.

Unfortunately even if you or I begin to eat exactly like our ancient ancestors we will still suffer from the harm already done to our bodies from the recent generations before us who ate a very restricted diet.  Our bodies have become crippled by an overactive inflammatory response.  That said, it definately helps to return to an all natural and varied diet.  And we will see a difference.  I know I have.  But it takes time for the body to heal...maybe more than our lives to reap the full benefits.  We need to feed our children this way from the beginning.

I've been searching forever for a sunscreen that doesn't cause acne and doesn't look oily.  And I think I've finally found it...De Vita Solar Protective Moisturizer SPF 30+

I waited a month to post this to make sure my skin didn't react.  With other sunscreens I knew almost right away...they were too oily or my skin was bumpy within a week.

So I'm really happy to share this and hope it helps others.  I can buy this at my local health food store but it is also sold online.  It was developed by a woman who suffered with cystic acne and developed a cosmetic line specifically for adult acne sufferers.  I now also use her cleanser and will be buying her Aloe Vera facial scrub.  Her products are a godsend for those of us with sensitive skin.

Just thought I'd pass this on

Grrrr --- I wish primary docs would stick to what they know best and refer people when needed.  I'm sorry you are having to battle with your GP to see a derm.  But if you are an adult with chronic acne that is getting worse then this is beyond what your GP can help with and he/she may make it worse by trying to use treatments designed for teenage acne.  You need to see a derm to rule out rosacea or other things similar to acne.  Treatments vary according to what is actually happening and only a derm can know this.

Demand to see a derm.  Where do you live (US or Europe)?  If you are in the US and have insurance then call the insurance company and see if you can go to a derm without a referral.  If not, then continue to haggle with your GP.  Call everyday and see another GP if needed.  Some GP's get kickbacks for not referring.  This is awful but it happens.  Others are just ignorant about adult acne.

Be assertive and ask your GP why he/she won't refer you.  Get answers.  Heck...we're adults and deserve to be treated with respect.  Adult acne is not like teenage acne.  We scar easier and the emotional toll is greater because of societies expectations and bias towards clear skin.  We deserve to get adequate treatment so that we can function in this world!

I'm going on a rant here but it just makes me so angry that adult acne sufferers are not treated with the same respect as say people suffering from psoriasis, etc.  They get referred without a problem.  Why is acne different???

Hi Jenn

I've also suffered with acne for decades.  Several things totally cleared me up...and I am totally clear now.  Accutane kept me clear while I was on it and for several years after.  Full strength antibiotics kept me clear but I can't and don't wish to take them forever!  Nothing else by itself kept me clear.  BP stopped the cysts but I still broke out in pustules.  Salicylic acid broke me out more.  Going totally natural kept down inflammation but I still broke out in cysts.  Allergy diet and anti-acne diets helped keep down inflammation but I still broke out.  And I followed these things faithfully.  I tried using only natural products but still broke out.  I must emphasize that I am diligent about my skin so I feel that I have given these options a fair try.

What is working for me is the following regime.  It is complicated but I have a very resistant and chronic case of acne (I'm 61).  First off seeing a well known and respected derm has made a huge difference.  All the other derms I have seen treated my acne as if I was a teenager which did not work with my aging skin.

Here is my regime.  I have to do all the parts of it to maintain clear skin.  I now have 100% clear skin.

1. Allergy Diet --- I got formal testing.  If you are older this is a must since trial and error may not pick up what you are really allergic to.  This is the mistake I made when trying to eliminate foods on my own.  Taking a really excellent high dose probiotic is important too.  I take specific suppliments that compliment my allergy diet and include 30mg of zinc picolate for my skin.

2. Monthly Microdermabrasion --- Opens the pores and prepares the skin to accept medications.  People with resistant chronic acne have pores that clog up easily and stay plugged up despite cleansers, etc.  This is well worth the money...plus less wrinkles!

3. BP Cleanser --- (A.M. routine) This is easier on the skin that a BP topical and works just as well if the right brand (see below).  Plus there is little if any bleaching of fabrics.

4. Cleocin-T Solution --- (A.M. routine) This is like a toner but has antibiotic in it that kills acne bacteria.  This really works...I am amazed.  You use a bit extra of it on any remaining zits to heal them up quicker.  It feels cooling on my skin.  I love it.

5. De Vita Solar Protective Moisturizer SPF 30+ --- I have searched forever for a sunscreen that doesn't break me out.  This is the only one.  The 19% Zinc Oxide is very soothing to my skin and seems to heal it.  It is specially formulated for skin prone to breakouts and goes on matte, not oily or shiny.  I use this morning and night.  Research is showing that using it at night helps build up the zinc in the skin to help protect it better during the day.

6. Cetaphil Antibacterial Bar --- (P.M. routine) This is very gentle and prepares my skin for the tretinoin cream.

7. Generic Tretinoin Cream .1% --- (P.M. routine)  This helps restructure the pores and also takes care of wrinkles!

8. Spironolactone 100 mg --- This helps block androgen receptors in the skin so that androgens are not available to inflame things.  I will be reducing this dose next fall.  The ultimate goal is to not take oral drugs and only use topicals but this takes a lot of experimenting to get just the right mix of topicals, etc.  My derms thinks we can do this by maintaining the monthly microdermabrasion + BP cleanser + Cleocin-T Solution.  We will start eliminating the oral drugs later this year.

9. Oracea --- This helps reduce inflammation.  It is a low dose doxy that is not an antibiotic but only an anti-inflammatory so it doesn't upset natural gut enzymes and flora.  I could probably stop taking this now but my derm wants me to wait till Fall.  He has a whole protocol for dealing with chronic acne...it is slow but he says it works...just takes patience and time.

Doing the above routine has been hard...so much to remember...but it is working and my skin is clear.  It is as clear as it was on accutane which is a miracle.  Hope this helps!