Hi GIna, thanks for your message.

I've had a quick scan of your log, and it's helpful to know you've tried all the natural approaches (sorry they didn't work for you), as I keep thinking - how long do I keep trying natural before I give up and go medical? Would hanging on another month or so make the difference? I would like to believe that on a healthy diet with the usual triggers eliminated that things would eventually sort themselves out, but I guess that isn't always the case.

I don't know why I had my (almost) 2 clear weeks, it could have been a hormonal fluke and nothing to do with my diet after all.

I know I'm miserable now, but that's more due to my skin than anything else, and frustrated with my diet. My daughter is underweight (and a fussy eater) so she's supposed to be eating lots of carbs and dairy products, while I'm trying to do the opposite, so mealtimes can be quite a faff, having to do 2 different meals with completely different ingredients.

I thought about eating lots of vitamin A rich foods and supplementing to try and keep it more natural, but from what I've seen on here, vitamin A supplements are more toxic than roaccutane, so presumably the side effects would be worse.

I need to do more thinking. Presumably if I started roaccutane and the symptoms were too much I could just stop? I haven't seen anything about that yet. I would hate to find out that if you stop before the whole course it comes back worse, like with antibiotics.

Thanks.

Yes --- I'm following your posts, Emily. You sound so much like me many years ago. I was terrified to take accutane but like the post above...never had any of the awful side-effects other than dry skin and lips which was remedied by using lotions and lip balm. I loved accutane. It was about the only time I had crystal clear skin other than what I am doing now. And I agree that you can't necessarily go by what the drug inserts say because they have to list any reaction cited by anyone and it can be from when they did the drug testing or early on when very large doses were given. And, too, patients weren't as well screened for other health problems back then which added to the side-effects that had to be listed. Now, after decades of using this drug, doctors know what to screen for and are very careful to decide who can use the drug. Don't worry. As for birth control...why can't you use the pill? (sorry if I missed earlier posts on this...) IUD devices are difficult to use anyway. Or could you have one of the inserted devices under the skin that would only stay in for while you are taking accutane?

I have some other thoughts too. Why can't you try Spironolactone first? It is often used along with oral birth control and has really high success rates. It really sounds like your cystic acne is hormonal...well all acne is but the cystic kind responds to drugs that target hormones.

From what I've read and observed and experienced myself, the natural remedies help but don't control cystic acne...it is just too hormonal and deep. It never hurts to eat healthy and give the body a fighting chance though.

I am so glad you finally were able to see a dermatologist Emily. If I were you, I would try the accutane. When I finally followed through with what my derm wanted me to do and didn't try to modify things or ask for something else I cleared up. It was hard to trust him after so many years of failure. But I also had to admit that I had always fudged around with my treatment routines or demanded we try other things instead of just doing what was recommended. This mainly came from a desire to go as natural as possible.

The truth is that really controlling chronic cystic acne takes a certain kind of regime that is strong to start and then slowly tapers down to just topicals. Strong at the beginning means taking accutane to change how the pores function (allows meds to work better later), antibiotics to cut down bacteria, hormonal drugs like BP and/or Spiro to help the body cope with androgens, topicals to help the skin shed better, etc. It often takes using a multiple drug approach. Again, this is just for a couple of years and then the derm tries to taper things off to a maintenance regime. Everything is so individual.

Take a copy of my post in to your derm and ask if this is how it works. Many posters on this site are very young and as yet don't realize how complicated treatment regimes need to be sometimes to get things under control. They seek the "magic bullet"...the one drug or topical what will clear them up. I did this too and kept on trying until I got much older and gave up. It was then that I decided to just do what the derm recommended...exactly as prescribed.

Consider Dan's Regimen. It works very well for most cases of acne as long as it's followed very closely. http://www.acne.org/regimen

Thanks cvd.

Yesterday I decided I didn't want to do roaccutane, due to already having thinning hair, joint pains etc, but now I am wondering again after reading your post. Maybe I could be lucky on it too. There's so many horror stories out there that it has scared me, it seems almost no-one gets away without it being truly awful at some stage.

I can't do hormonal birth control because it gives me acne (it's what started this latest outbreak off) and severe migraines (so I am at higher risk of having a stroke). I'm just too reactive to hormones to use them.

I was going to ask my derm about spiro, but when I got in there and he very quickly said that roaccutane was the only thing that would work for me due to the cysts, I forgot! (doh) . Maybe I could phone up and ask, or perhaps I should just try roaccutane and then if it gets too much ask for spiro then.

I don't know if spiro would be ruled out by my inability to take hormonal treatments? I'm not really sure how it works.

I think I will make an appointment with my usual GP and say I'm not prepared to use the coil due to already having heavy/painful periods and see if they will accept something like diaphragm and condoms instead.

Glad to hear you are clear now, I hope that's the end of it for you!

Thanks Brandy. I started with Dan's, and still have some of the products. I thought I would bin my nicotinamide, which hasn't helped at all and go back to using BP, incase it helps at all while I dither about whether to take the accutane a bit longer!

Hi Emily, I actually came on here initially to just post my regime as after suffering with acne for 15 years or so I've finally seemed to have got on top of mine, I'm 29 now and have been clear for 3 months (fingers crossed). Anyway I got to reading your forum diary and felt I should at least share my experiences of adult acne in case they help.

I'm not sure how much this you can relate to, I'm a 29 year old guy who had mild/medium acne but who knows

First of all I would probably describe my skin a dry/sensitive, probably more sensitive than anything else and my acne I believe is/was caused by both hormonal imbalance in my body and finding products that my sensitive skin would accept and help. My acne tended to flare up around my nose, around my mouth and chin area.

A few things I found out during the last 5-10 years most of which you'll probably be familiar with:

1) Diet definitely does have an effect on acne, most doctors and forum posts by "medical" experts waffle on about there being no evidence but that's garbage in my opinion as most of the people on these forums will also attest to. For me sugar is a real issue, I have to watch how much I eat as too much sugar in my diet always caused a few spots at random places on my face. I don't tend to eat much sugary food anyway but I agree with everyone on here that you should keep up the good diet and try to keep away from sugary stuff. For me I play a lot of sport so this is never too much of an issue as I'm always trying to stay in shape anyway. I can't say much about the gluten stuff as I don't have that but I have no reason to doubt all the other people who say it can be a big issue.

2) One thing I stumbled on when I was 25 was that I my skin, which at that time was still breaking out but nothing more than what you'd call mild/moderate, started to get a lot lot worse right after I moved from a quiet town in the north to a city center (due to my job) and during this time whilst on exactly the same regime it probably got twice as bad as it had ever been. I eventually moved out of the city to the suburbs after 6 months and my skin went back to "normal". I think this was partly due to me having dry/sensitive skin and perhaps it just couldn't deal with city life, the fumes and pollution etc and also I don't think I had the kind of moisturizer/protection to keep it

in check. What I did find helped towards the end of that 6 month stint is running and exercise in the country helped, I think in reality it was just the "clean" air

3) Exercise as well as the good diet is definitely something I would do, I try to go running a few times a week, not only does it help with blood circulation but if your finding life stressful then I find a punishing exercise routine always helps my relieve stress and tension.

4) Another one to help with the stress and stuff that I do is I drink a cup of Pukka Cleanse tea in the morning, its basically got nettle, fennel and peppermint in it. I'm not sure about the whole "cleanse" thing but it certainly puts me in a decent mood and I always start on this before I get into my normal tea regime!! I don't tend to drink coffee as I also found in the past this caused me to breakout.

Ok now my regime, as I said above this is something I only really stumbled on a few months ago and so far its working really well for me.

Morning/Night: I cleanse with st ives apricot scrub, its pretty decent and does the job I feel of setting a decent platform on my face. I've never really found the "cleanse" part to do anything other than setup a platform for the creams you then put on.

In the morning only and only 2-3 times a week I will put on Kate Somerville anti bac lotion, this is a 5% BP. I know its a BP and some people don't like to use a regime that is gonna have this long term and for a while I was the same, firstly that's why I only use this in the morning and I'll only tend to use it 2 or 3 times a week. It also seems to be a really good BP, I've had issues with BP in the past because of my dry/sensitive skin and those were 2.5% ones, I was very nervous about trying this but a mate in the USA said to give it a go as Kate Somerville stuff is really populate over there. Anyway my skin takes it really well..what a surprise for me! It's probably the best BP I've ever used.

Morning/Night: My final step in terms of creams and stuff is to apply goat milk moisturizing cream from natural-skin-care.com. I know goat milk!! but WAW did this stuff work, in all my years of searching for a moisturizer that my sensitive/dry skin would accept AND would help with my acne this is it. I don't know how I didn't find this before, anyway its really good for people with dry/sensitive skin and things like eczema, they site has lots and lots of different natural skin care products and it's worth having a look.

Pills/Supplements:

Ok so initially for many years I was taking the clearpores herbal supplements, these were ok but I could never build a regime around them that worked so I stopped about 6 months ago after having used them for 4-5 years as I was getting fed up not being able to sort my acne and went to doctor who gave me some antibiotics, can't remember the name of them but WAW BIG mistake. Initially after 2 weeks my skin went super clear but then after 4 weeks urgh horrible breakouts and my stomach felt a bit funny. I kept on them for 2 months...as I wanted to see them through but no it was a mistake for me. I've been to the doctors a few times and I have to say I love the NHS and all but for me with things like acne and skin problems in the UK our doctors are pretty rubbish, hearing about your issues just to get a Derm sounds like a bad joke and then for him to only spend 10 mins with you. I was speaking with a US friend and I think they have it some much better over there but hey what can we do. I guess you could go private but $$$$$

Anyway back to the pills, I stopped taking antibiotics and my fiend said maybe its not all hormonal and I might have vitamin issues, I found it hard to believe as I eat so well and play so much sport, anyway I ordered Perfectil Platinum to go with my above regime. After 3 weeks..waw...big improvement, I mean not just in terms of acne my skin in general just felt really solid, I've always had issues when I go out and about in town for the day I'll come back and the odd spot with have developed, these pills seemed to really give me some stability. After 3 weeks all I had was the odd 1 or 2 small spots appearing during the week. I could have lived with that but really wanted to kill them of once and for all so decided to add another supplement in (I know always risky it can throw things of) but decided I could always revert of so I added Tejaswini (google it) which my sister saw featured on Marie Claire and they gave it a thumbs up so decided to try it. It sounded similar to clearpores herbal supplement, except the ingredients are mostly different. Anyway started on those about 6 weeks ago... after 2 weeks my skin got bad...and i was getting mega nervous, and my back was also getting bad (I should say my back is never good but this was much worse than normal), after 2.5 weeks I was all ready to bin them but I've had these types of pills before and know they can take a good few weeks to "purge" the system so kept on them and YAY they came through, after 3.5 weeks my skin quickly recovered and for the last 3-4 weeks its been really good and it seems to have kicked those last couple of spots I was getting.

Ok essay over, did you read all that

Really really hope something comes up soon, maybe something in the above will help, I have to be honest it sounds doubly worse for a gal but stick with it and don't lose hope. I'll check back from time to time.

Hi Neil

Must be such a relief after 15 years to be free of it!

I am reining my diet back in again after the chaos of summer - though I did eat a chocolate mousse and mars ice cream after a particularly bad driving lesson today. I'm back into morning smoothie mode, though they are mostly fruit and nut milk based, so I need to get back into the green ones again.

I live in the country and the air quality here is good, so that's a bonus. I go for long walks across the hills when I can, probably every other weekend if the weather's not too bad. I get stressed easily though so I'm sure that doesn't help - I have ongoing problems with my ex, an intense job, am a single parent and loathe my driving lessons, so that probably chucks a whole load of stress toxins into my system. I need to find a way to rebalance all of that.

I drink Pukka Cleanse tea too, but probably only 1 cup a day, so maybe I could add another couple of cups in somewhere.

Thanks for sharing your regime. The BP you are using sounds really strong! I've been using my 2.5% stuff again for a few days and my skin has got to that itchy burning stage, but I'll keep going as I'm sure it will adjust soon.

My derm I saw on the NHS is the same one that works at our local SK:N clinic, but to see him privately there costs 100 (or was it 140, I forget now) a session. I wonder if he prescribes differently to his private patients of if they get the same as the NHS ones?

I haven't tried the products you mentioned, (never heard of the Tejaswini) but will look into them. Glad they have worked for you - and so quickly! - and you haven't had to resort to roaccutane. I really hope you have found your cure.

Not much to report - the BP is starting to have an effect on my face, though my scalp is terrible and sore at the moment, so I know it's only a temporary topical improvement rather than systemic. Still some breakouts happening, and that lovely lizard skin effect of the BP, but not as bad as last week when I had loads of big painful red lumps.

Thought I may as well try Perfectil Platinum and Tejaswini, what have I got to lose? (other than 65?). I did some basic maths and discovered I probably spend over a weeks wages on supplements every month. That's a bit scary, shows what desperation drives people to!

Anyway, the one change I have noticed is in my mood. I usually tend towards depression, have done most of my life, but within a few days of taking noni juice and fish oil capsules my mood has gone right up. Even an awful day at work and row with my partner haven't had any lasting effect. I wake up every day feeling good about life and am not dragging myself through it like normal. Can't say either have affected my skin yet unfortunately, but if I can have bad skin and not feel as dragged down by it as I used to then that's half the battle won in my opinion.

I also started taking Pukka chlorophyll capsules whilst waiting for my juicer to arrive, then I will attempt to make my own wheatgrass juice. I was buzzing with energy last night, couldn't sleep for ages and got up this morning without any difficulty even though it was an early one. Thinking the two might be linked.