hey guys,

after following your conversation for some time i decided to also tell my story, what helped me and what didnt.

it started in winter 2020/21 (i was 20 years back then) during lockdown, i always dealt with moderate acne, but back then i developed these white filled pustules around my mouth and nose. i thought it would be normal acne, so i went deeper into skincare and signed up on a website where you can get your own formula to treat your skin. (formelskin in germany, i guess curulogy is the name in the US)

my formula consisted of tretinoin, niacinamide and clindamycin (antibiotic). my skin healed and until october 2021 i was pustule free. nowadays i suspect the clindamycin to have stoped working, also in fall i started to lift again and so i ate more and my bodyfat went up slightly (from very lean to normal). since then i havent been able to stop those pustules totally, i have weeks and months when it is better, but some mornings i wake up with a lot of them

i am eating a vegan diet for almost a year, basically no sugar, just whole food and i also try to incorporate a lot of antioxidants and antiinflammatory food.

since 5 month i try to decolonize my nose (chlorhexidine, colloidal silver and neosporin), but it didnt work so far. that was also the first time i realized that it isnt normal acne and i found your thread and the r/staphacne reddit.

im still in late puberty, my beard isnt fully grown yet, so i hope its just due late puberty hormone inbalances

if anybody of you is interested in finding a reason for that type of skin condition and maybe also a solution, i would be down to work together on it. 🙂 im really sure it is something bacterial, because clindamycin kept me clear for almost 9 month and it also gets better in summer. i just dont get the triggers, my diet is as clean as you can eat (i do lift and do a lot of sports, so i need to eat in a caloric surplus and cannot cut out carbs) and also my digestion is very good. i had bloodwork done in last december and it came back all perfect, even though im vegan lol. i do have oily skin.

Posted by: @joo00nas

hey guys,

after following your conversation for some time i decided to also tell my story, what helped me and what didnt.

it started in winter 2020/21 (i was 20 years back then) during lockdown, i always dealt with moderate acne, but back then i developed these white filled pustules around my mouth and nose. i thought it would be normal acne, so i went deeper into skincare and signed up on a website where you can get your own formula to treat your skin. (formelskin in germany, i guess curulogy is the name in the US)

my formula consisted of tretinoin, niacinamide and clindamycin (antibiotic). my skin healed and until october 2021 i was pustule free. nowadays i suspect the clindamycin to have stoped working, also in fall i started to lift again and so i ate more and my bodyfat went up slightly (from very lean to normal). since then i havent been able to stop those pustules totally, i have weeks and months when it is better, but some mornings i wake up with a lot of them

i am eating a vegan diet for almost a year, basically no sugar, just whole food and i also try to incorporate a lot of antioxidants and antiinflammatory food.

since 5 month i try to decolonize my nose (chlorhexidine, colloidal silver and neosporin), but it didnt work so far. that was also the first time i realized that it isnt normal acne and i found your thread and the r/staphacne reddit.

im still in late puberty, my beard isnt fully grown yet, so i hope its just due late puberty hormone inbalances

if anybody of you is interested in finding a reason for that type of skin condition and maybe also a solution, i would be down to work together on it. 🙂 im really sure it is something bacterial, because clindamycin kept me clear for almost 9 month and it also gets better in summer. i just dont get the triggers, my diet is as clean as you can eat (i do lift and do a lot of sports, so i need to eat in a caloric surplus and cannot cut out carbs) and also my digestion is very good. i had bloodwork done in last december and it came back all perfect, even though im vegan lol. i do have oily skin.

Hey man, I'm the same age as you and my pustules started at the same time as yours.

To be honest I don't and wouldn't mess with any medication at all. Also the pustules aren't linked to any other condition or gut imbalance. It's really just a bacterial manifestation on the face that thrives on certain conditions. Oily skin+ disrupted skin barrier+ androgens cause the bacteria to infect the follicles and then the pustules to form. As I mentioned a million times, sugar and quick carbs are one of the worst triggers. Keto works very well. If you want to be vegan than be careful with fruit. Fruit contains simple sugars, therefore cause pustules.

@eevs have you ever heard about mastix gum? i came across a balm which states to block a specific enzyme, which transfers testosteron into DHT (the active form of testosterone). it might be worth a try, if you wanna read further into it, just look up mastix gum

Posted by: @joo00nas

@eevs have you ever heard about mastix gum? i came across a balm which states to block a specific enzyme, which transfers testosteron into DHT (the active form of testosterone). it might be worth a try, if you wanna read further into it, just look up mastix gum

I chew natural mastic gum for jaw gains haha. But that probably doesnt have an effect. I'll look into it!

Posted by: @Scorpy

Had my derm appointment last week and was prescribed doxy (but a low subantimicrobial dose) and benzaclin (benzoyl peroxide/clindamycin gel)

my skin is dry as hell (whereas it's normally super oily), but the pustules went away immediately, I haven't had a new one for 3-4 days, we'll see if it lasts

 

EDIT 5/1 - So far so good, my skin is no longer dry/peeling and is back to it's normal level of moisture, still not a single pustule since my last post

Also, a side note, I'm not sure if this is making a difference (as I started doing this at the same time I started the doxy/benzaclin), but someone earlier in this thread said that they saw good results using both azelaic acid and BP, when BP alone stopped working. My current routine is:

Azelaic Acid + Moisturizer in the morning

Benzaclin + Moisturizer at night

When it comes time to get off of the antibiotics, I will try transitioning to this routine with just 2.5% BP Gel to replace the benzaclin and see if I have any luck maintaining my clear skin

Hey I also got prescribed Oracea and have been using it together with sulfur and azelaic acid. Same as you all pustules and inflammation disappeared in a couple days. Miraculous stuff!

I am 99% sure now that I have been dealing with rosacea that mimics gram-negative or staph folliculitis. BP is effective for rosacea and has served me well in the past, but long-term it damages the skin barrier so it's not a perfect solution. Whilst on the benzoyl peroxide regimen I would still get flareups from rosacea triggers like spicy food, stress and too much sunlight.

Supposedly you can take low-dose doxy "indefinitely" as it doesn't impact the microbiome, it only has an anti-inflammatory effect, but still probably want to wean off at some point.

I will update in a couple months if I can keep the rosacea in remission with just topical azelaic acid and sulfur whilst weaning off Oracea.

This is coming from someone with 10 years of white pustules and exhausting nearly all treatments, save for Accutane.

*Disclaimer: I am sure that some people here are dealing with GNF and not rosacea, but I think at least trying to treat the condition as rosacea could be worth a shot.

I also think that we may be having different conditions that result in similar pustules, be it rosacea, GNF, staph folliculitis or perioral dermatitis. I've personaly been diagnosed with all of those conditions by different dermatologists

For me BP, azelaic acid and doxicycline did not help. But for others it may help (seen multiple posts in this thread about BP and azelaic acid).

I've also ended treatment of H. Pyllori bacteria in my gut, but it didn't have effect on the pustules. So, no success yet. We'll try to address SIBO or something else on my next appointment with gastroenterologist.

Posted by: @Husky124

I also think that we may be having different conditions that result in similar pustules, be it rosacea, GNF, staph folliculitis or perioral dermatitis. I've personaly been diagnosed with all of those conditions by different dermatologists

For me BP, azelaic acid and doxicycline did not help. But for others it may help (seen multiple posts in this thread about BP and azelaic acid).

 

I've also ended treatment of H. Pyllori bacteria in my gut, but it didn't have effect on the pustules. So, no success yet. We'll try to address SIBO or something else on my next appointment with gastroenterologist.

 

Hey sorry to hear the H. pylori treatment didn't work for you.

I truly believe that the root cause of this (whatever this is) has something to do with the gut, probably SIBO and bacterial toxins translocating out into systemic circulation. However I have had this condition for so long, as mentioned more than 10 years at this point, and done so many treatments to "fix" my gut/SIBO and never saw any relief, so it's a bit of a mystery really.

The low-dose doxy/sulfur/azelaic acid combo had such a remarkable effect that I had to post about it, but I recognize that not everyone will respond the same to treatments. I'm keeping my fingers crossed that you have more success with the SIBO treatment!

I'm also taking s boulardii, lactoferrin, riboflavin, mastic gum and avoid gluten. However I have been doing those before and didn't see the same results as when introducing Oracea, maybe there's some synergistic effect.

Posted by: @GrumpyPainter

Posted by: @Scorpy

Had my derm appointment last week and was prescribed doxy (but a low subantimicrobial dose) and benzaclin (benzoyl peroxide/clindamycin gel)

my skin is dry as hell (whereas it's normally super oily), but the pustules went away immediately, I haven't had a new one for 3-4 days, we'll see if it lasts

 

EDIT 5/1 - So far so good, my skin is no longer dry/peeling and is back to it's normal level of moisture, still not a single pustule since my last post

Also, a side note, I'm not sure if this is making a difference (as I started doing this at the same time I started the doxy/benzaclin), but someone earlier in this thread said that they saw good results using both azelaic acid and BP, when BP alone stopped working. My current routine is:

Azelaic Acid + Moisturizer in the morning

Benzaclin + Moisturizer at night

When it comes time to get off of the antibiotics, I will try transitioning to this routine with just 2.5% BP Gel to replace the benzaclin and see if I have any luck maintaining my clear skin

Hey I also got prescribed Oracea and have been using it together with sulfur and azelaic acid. Same as you all pustules and inflammation disappeared in a couple days. Miraculous stuff!

I am 99% sure now that I have been dealing with rosacea that mimics gram-negative or staph folliculitis. BP is effective for rosacea and has served me well in the past, but long-term it damages the skin barrier so it's not a perfect solution. Whilst on the benzoyl peroxide regimen I would still get flareups from rosacea triggers like spicy food, stress and too much sunlight.

Supposedly you can take low-dose doxy "indefinitely" as it doesn't impact the microbiome, it only has an anti-inflammatory effect, but still probably want to wean off at some point.

I will update in a couple months if I can keep the rosacea in remission with just topical azelaic acid and sulfur whilst weaning off Oracea.

This is coming from someone with 10 years of white pustules and exhausting nearly all treatments, save for Accutane.

*Disclaimer: I am sure that some people here are dealing with GNF and not rosacea, but I think at least trying to treat the condition as rosacea could be worth a shot.

I haven't been diagnosed with rosacea yet, but this is what I've been suspecting in my case as well. It would certainly explain the stubbornness of the condition and limited response to conventional treatments

My follow up appointment is next week. So far I'm still completely free of pustules.

i believe i had rosacea in the past as i used to flush after eating, but now you mention it my cheeks and nose can get some redness to them still but i dont get how it would explain chin pustules

once again, sea and sun has cleared my skin 90% - only because my forehead was so bad it did not fully heal but has improved so much in such a short amount of time. everywhere else my skin is glowing with 0 pustules & 0 oilyness

its literally like i have a C02 laser when i do this, come out the sea and air dry skin in the sun and you can actually feel something happening to your skin. just make sure you dont burn.

seb derm root cause for me imo becasue i also get it on scalp, or some sort of skin shedding issue where the dead skin sticks to the skin rather than just naturally coming off which easily clogs pores/ hair follicles. the sun seems to fix this becasue it naturally sheds the skin

SA also helps but never combine with sun, AA did nothing for me, low dose doxy looks like it could be very effective. first i have heard of that but i am now trying to move to the coast, even in winter you can collect seawater and use as a toner and combine with red light therapy

i also think regardless of diagnosis root cause is gut health, no free test from your gp will pick up anything unless severe but it doesnt mean everything is gucci. ive used mastic gum in the past and i did notice it helped with bloating after eating but it costs a fortune to use daily long term.

I think you are again going to far with possible explanations. I believe that there is a dysbiosis in the nose flora and the gram negative bacteria travels down from there, infecting the hair follicles and feeds on sebum. Every infected hair follicle causes an immune response which results in the body/skin trying to capture the bacteria by creating a pus filled bubble. So far there is no guaranteed cure for this condition except two possible cures: accutane and zero contact therapy or basically doing nothing hoping the body heals itself which is totally possible.

I believe everyone with this condition should to minimal contact all the time, just wash your face very gently with water, ideally soft water, once or twice a day and don't use any creams, exfoliants whatsoever. If dead skin builds up on the perioral area, leave it there for some time and when its super easy to get off, just by rubbing with your fingertip very gently, do it.

I highly suggest eating a ketogenic diet as this results in less inflammation and sebum production+ stable hormones overall, so that the bacteria has no/less chance surviving in our follicles, therefore wont infect them. I speak from personal experience, one week of keto and all the pustules are gone without new ones appearing for as long as I cheat more than 3 days. One cheat day a week on keto is possible without pustules appearing.

I never took antibiotics, neither tried accutane and I still got this disease- I believe by a weakened skin barrier through benzoyl peroxide in combination with drinking spoiled raw milk and getting sick- raw milk is known to carry klebsiella bacteria which is the one causing the pustules.

@eevs i agree with everything except letting the dead skin build up as the pustules can only develop in anaerobic conditions. i also dont agree with keto even though i agree it works

it also depends on the severity, i get slight buildup daily on parts of my t zone only and find it much easier to gently wipe it away with a wet cotton pad each morning/ eod. i have left it in the past and did not get the pustules but the skin loses its radiance, no topicals will work and you wont be able to absourb all the wavelegths from the sun optimally. it also stops the pores clogging, mine used to be quite visible as they were always clogged but they are getting better all the time, as long as you dont aggressively strip the skin, which i imagine everyone here has done in the past.

sun alone will make my skin more oily and could make it worse, especially if you are going through a spreading phase... but sun plus salt from sea is the best thing for this condition, at least for me...it also has many other health benefits and 0 negatives...but obviously its hard to just get up and move, thats even if you can find somewhere to rent/buy

if you use creams, you need to check every single ingredient to make sure it is fungal acne safe, you can run it through websites but 99% of creams are not. you def dont want silicones...ive just been using thermal spring water if i feel my skin is dry but if you have oily skin it will rarely feel dry and most creams will just mix with sebum and cause more problems.

UPDATE: salt water is seriously transforming my skin, I am now making my own toner just pure water and salt and apply it morning and night to clean skin.

sun and salt in theory will fight any issue you have; the sun is a immunosuppressant and it will cure any autoimmune issue you have, that includes any of the skin flaking ones. the salt will go into the pores and kill bacteria while absourbing any excess oil. i can also see in my beard theres no dead skin

i would suggest anyone still here tries it, 0 side effects...derms will try to gaslight you that salt is bad for the skin

Hello everyone, Im presently on a long term low dose accutane course to treat my GNF. However I saw on a recent Reddit post that someone had success treating their GNF with alum block. I plan on trying it if my GNF comes back after my course but wanted to share the tip here in case it helps anyone. Its pretty cheap and easy to use so its worth a try. Good luck

i started getting some pustules around chin/ mouth again, that was where i was prone before. maybe the salt is not the fix. the salt helps clear the pustules quickly though

if you have seb derm, the salt will really make a big difference, my skin feels very smooth and does not get buildup like before. after doing a bit more research there a lots of people who report the same online. i still dont know the best dosage, i purchased some dead sea salt and made concentrated solution and it felt like my skin was burning, though it does not go red like bp. so now i have diluted it more to the point i get a little sting but not like before. also using on my scalp now. i do not think it damages the skin barrier, actually lots report it enhances it

im looking into parasites now, they do not show on testing unless severe and cause skin issues.

Just wanna say that I am still 100% free from pustules using low dose doxy (20mg twice daily) and Soolantra cream. All the redness gone from my skin as well, just healthy looking normal skin tone.

No side effects at all, in fact I feel better overall from taking doxy (overall reduced inflammation).

I may or may not check back here, hope everyone can get rid of this stupid condition. I feel like I have so much catching up to do in life because I have mostly been hiding at home. Cheers everyone.

Posted by: @GrumpyPainter

 

it seems to be the winning combo, i spoke to my gp and tried to get low dose doxy but they refused and only offered a normal 1 week dose of something else (cant remember the name) which i declined.

@scorpy are you also still 100% clear?

Posted by: @Fxckfolly

Posted by: @GrumpyPainter

 

it seems to be the winning combo, i spoke to my gp and tried to get low dose doxy but they refused and only offered a normal 1 week dose of something else (cant remember the name) which i declined.

@scorpy are you also still 100% clear?

My dermatologist took me off of the doxy, but I'm still using the benzaclin for now. So far, so good. He said I can go back on the doxy if start getting unmanageable breakouts again.

Posted by: @Fxckfolly

Posted by: @GrumpyPainter

 

it seems to be the winning combo, i spoke to my gp and tried to get low dose doxy but they refused and only offered a normal 1 week dose of something else (cant remember the name) which i declined.

@scorpy are you also still 100% clear?

Hmm, what if you suggest to your doctor that you may be dealing with rosacea/perioral dermatitis? Doxy is the go-to drug for those conditions.

If your gp refuses to give you the doxy, another option is to consult with a telemedicine provider and say you need doxycycline for malaria prophylaxis. Or somehow convince them that you have chlamydia.

Same as you @scorpy I plan to taper down to 20 mg and then quit in a few months to see how my skin does. Can always jump back on to calm down flareups.

Well, I certainly don't want to take any medication, and super certainly no antibiotics.

I will just do lifelong ketogenic diet. 0 sugar and 0 carbs in general. Works for this condition just perfectly. I'll do a cheat day sometimes, I'll just make sure to not do it more than once a week or maybe even no more than once a month. One cheat day doesn't cause pustules at all as I found out.

Hi,

so regarding the antibiotics treatment, I'm afraid this is just like the worst option since it only works while you're taking it and most likely the zits are gonna come back shortly afterwards even worse, since the bacteria will develop resistance and you already got rid of a lot good bacteria. Every single person here who went on the same path described the same result, we are not supposed to take antibiotics for a prolonged period of time for a reason.

Regarding the keto diet solution, I tried it couple of times, it works, but simply it's not sustainable for me, I think for 99% of people it's not, so good luck to people who plan to stick with it for the rest of their lives.

So it's interesting, by accident I discovered that our issue could be connected to low stomach acid, among other things. Since I was a kid I was getting heartburn each time I would eat pastry from the bakery and I used sodium bicarbonate(baking soda) to neutralize the stomach acid going up and causing the pain. Recently, I've been taking it immediately after each meal for a period of like 2-3 weeks and noticed that my face is like 95% clean, only one zit showed up which was great, for a few days it was 100% clean. It appears that it definitely is affecting this condition, but we need more time to, like 60 days for a better conclusion. It's great that it is cheap, like $2 for a pound/0.5kg bag.

However, I'm saving baking soda option for a plan B, since I made arrangements with a clinic to do an FMT next month which can hopefully address this issue directly in the gut.

Posted by: @Lollipopsalesman

Hi,

so regarding the antibiotics treatment, I'm afraid this is just like the worst option since it only works while you're taking it and most likely the zits are gonna come back shortly afterwards even worse, since the bacteria will develop resistance and you already got rid of a lot good bacteria. Every single person here who went on the same path described the same result, we are not supposed to take antibiotics for a prolonged period of time for a reason.

Regarding the keto diet solution, I tried it couple of times, it works, but simply it's not sustainable for me, I think for 99% of people it's not, so good luck to people who plan to stick with it for the rest of their lives.

So it's interesting, by accident I discovered that our issue could be connected to low stomach acid, among other things. Since I was a kid I was getting heartburn each time I would eat pastry from the bakery and I used sodium bicarbonate(baking soda) to neutralize the stomach acid going up and causing the pain. Recently, I've been taking it immediately after each meal for a period of like 2-3 weeks and noticed that my face is like 95% clean, only one zit showed up which was great, for a few days it was 100% clean. It appears that it definitely is affecting this condition, but we need more time to, like 60 days for a better conclusion. It's great that it is cheap, like $2 for a pound/0.5kg bag.

However, I'm saving baking soda option for a plan B, since I made arrangements with a clinic to do an FMT next month which can hopefully address this issue directly in the gut.

How is Keto not sustainable? Just eat a bunch of starch free vegetables both raw and cooked and then meats, fats, eggs and cheeses...

Throw in some berries whenever you crave them and you are good to go.

It's actually quite similar to the diet humans would eat in nature, despite they would also eat honey which is a huge pustule trigger.

I remember going through long streaks of keto and not a single pustule showing up. Then I added sugar free carbs such as whole grains and still no pustules until I added fruit back for more than a few days. I think sugar is the culprit but in order to reset your skin, a long streak of Keto might be necessary.

I'm currently always having 2-3 pustules around the mouth but I wasn't strict with keto..

Will go fully keto again and update in 2 weeks.

Posted by: @Eevs

Posted by: @Lollipopsalesman

Hi,

so regarding the antibiotics treatment, I'm afraid this is just like the worst option since it only works while you're taking it and most likely the zits are gonna come back shortly afterwards even worse, since the bacteria will develop resistance and you already got rid of a lot good bacteria. Every single person here who went on the same path described the same result, we are not supposed to take antibiotics for a prolonged period of time for a reason.

Regarding the keto diet solution, I tried it couple of times, it works, but simply it's not sustainable for me, I think for 99% of people it's not, so good luck to people who plan to stick with it for the rest of their lives.

So it's interesting, by accident I discovered that our issue could be connected to low stomach acid, among other things. Since I was a kid I was getting heartburn each time I would eat pastry from the bakery and I used sodium bicarbonate(baking soda) to neutralize the stomach acid going up and causing the pain. Recently, I've been taking it immediately after each meal for a period of like 2-3 weeks and noticed that my face is like 95% clean, only one zit showed up which was great, for a few days it was 100% clean. It appears that it definitely is affecting this condition, but we need more time to, like 60 days for a better conclusion. It's great that it is cheap, like $2 for a pound/0.5kg bag.

However, I'm saving baking soda option for a plan B, since I made arrangements with a clinic to do an FMT next month which can hopefully address this issue directly in the gut.

How is Keto not sustainable?

I wrote it is not sustainable for me, but most likely it is not for majority just by looking at the amount of people that gave up on it.
For myself, it's not sustainable because after 2-3 months, I start craving all the food that I loved that now I can't eat, and then slowly become depressed. So when I break keto, it is extremely hard to go back on it immediately, like 10 times harder for some reason, my body simply craves too much carbs and that makes it very difficult.

Alright, so I changed my mind since I have experimented a lot and came to this exact conclusion. May it help as many people as possible and may it help you as it helped me.

Our condition is controlled and eventually maybe even could be cured completely by the following three things:

1. minimal skincare

2. a diet low in sugar, NOT in carbs in general

3. low stress

Concerning point number 1:

The bacteria that causes the pustules can only infect the follicles if the skin barrier is not fully intact and there is not enough "good" bacteria, in our case gram positive bacteria, to fight the "bad" bacteria, in our case gram negative bacteria, or at least create balance between them.

Many of us have experienced that less and less pustules appear the less you clean your skin which makes total sense since the skin is capable of repairing itself and recreating symbiosis. It just has a hard time to do so if you constantly clean and exfoliate, let alone use harsh products.

The best routine for us is:

Only wash your face once a day with very gentle hand motions, ideally before going to bed. Use water only (if you live in an area with soft water) or a selfmade natural facial cleansing lotion (if you live in an area with hard water). The point of washing the face is to get rid of excess oil and actual dead skincells without actually trying to do so. You will notice that your skin will become smooth and hydrated just by this simple routine. If your face is full of dead skin cells and you feel like you have to rub, do it with most gentle care on a dry face by just using your fingertips before washing your face. This should be done no more than once a week.

By this routine you ensure that your skin will be healthier and stronger than ever and pustule causing bacteria won't be able to enter the pores and/or cause an infection. Stick to this routine!

Concerning point number 2:

Sugar is the culprit. It is not fat, it is certainly not protein and it is not carbs in general. Feel free to eat what you want to eat as long as it is low in sugar. Oats, whole grains and regular potatoes are great carb sources that won't trigger pustules. Keep fruit intake low, do not eat honey, white sugar etc. at all!

Eat a balanced diet and don't think too much about it. Your stress level will decrease significantly.

I'd maybe also don't eat too much fat since I noticed more oiliness the more fat I ate. More oil means more bacteria thriving ground.

Eat balanced. Avoid sugar. Thats it.

Concerning point number 3:

Negative stress is terrible for everything, also for our skins ability to fight infections. Always try being positive about your life and everything about it. You are alive, so make the best out of it. We are not dead, but we will be dead one day. The time to be happy and relaxed is now. Pustules won't make us sad since we know the way to heal them now. Be humble. Not just towards others, also towards yourself and your skin. And you will notice everything gets better then. Just not fall in the trap and take it all for granted then once you are happy and relaxed.

Combining these three points is the key to clear skin. Not just for gram negative folliculitis sufferers but for regular acne sufferers too. And ultimately also the key to being more relaxed and happy. Following this protocol also isn't stressful or anything, it is more about not doing too much which we all thought we had to do in order to fight the condition.

My skin is clear now. My mind is free.

Hey everyone, I've been dealing with this kind of inflamed, pustular acne for at least a decade. Just like many here it shows up under my nose and my chin. Over the past few months I read this thread front-to-back three times. I want to say thanks to everyone in here for all the work and information put in to figure this out.

I'm not in the clear yet, but here are some things that I have noticed for me. The diet-acne connection is undeniable in my case. The culprit being carbohydrates-- specifically sugar -- like so many of you have mentioned. I've changed up my diet a few times this year to figure it out and noticed big differences. One period of time I was eating 6-8 pieces of fruit a day and experiencing huge pustules. I cut fruit and it got better, but not good enough. Now I am sticking to a keto diet with <50g net carbs. Specifically, low sugar. I'm talking 20g or less of natural sugars a day.

My biggest tip to readers would be to download a food log app on your phone and enter in what you eat. There are a good, free ones there that will calculte your macro and micro nutrients. It's much easier than writing everything out by hand. The main benefit of logging your food is looking back on days of a flare up to see where your nutrition may have gone wrong. Find the pattern in the numbers. For me it is high sugar/high carbs.

In addition I've taken up intermittent fasting to help monitor blood sugar spikes, another strategy I learned from this forum. I feel better during the day by skipping breakfast and just eating breakfast and lunch at the same time. My hunger doesn't activate until I eat that first meal, so another benefit is I'm not craving lunch a few hours beforehand.

Ultimately though I believe this strategy of dieting is a treatment and not a cure. I'm still not sure what the permanent solution would be, where I can enjoy carbs and sugars without reprisal. Maybe its just genetic. Truth be told I did this to myself. I messed up my hormones from a decade of Marijuana use. Yeah I know Marijuana is perfect and harmless -- most people have no problems with it. I do. I developed adverse reactions and still used it anyway. Specifically, I couldn't hold any food in my gut when using it. I'd have to head to the bathroom everytime, and it wouldn't be solid waste. Apologies for being graphic, but everyone that's read this far knows the gut-acne connection.

Again, thank you to everyone in this thread for pouring your heart and soul into this. Every time I read this I have hope. It takes time, but time heals.