Hi everyone! I found myself spending a lot of time reading the forums and decided it was about time I joined/shared my current acne journey. I had mild acne as a teenager, but nothing like what I am experiencing now as a 30-year old (frequent clogged pores, occasional whitehead, frequent hyperpigmentation). I am an acne and acne treatment novice, so any help is so very appreciated (Please also see the questions sections)! (* ' 3 ')

Background:

I have frustratingly sensitive, oily skin but was essentially acne up until 1 year ago exactly when all hell broke loose on my face. I got a new, somewhat high stress job (that I really love) and had a couple of mild health issues that may have further thrown my hormones out of whack. The acne seemed to be at its worse a few days before my cycle, so that strengethened my belief in the latter.

First, there were small raised bumps, no pus. I figured I needed to cut back on my use of EVOO, so I did that, but the small bumps persisted. So I tried toothpaste (horrible idea). Then, I got some Neutrogena cream acne wash with salcylic acid. That seemed to help somewhat, but the acne got worse until every pimple was now pus-filled and left a dark mark, regardless of whether or not I picked at it (which I did initially).

Medical Interventions:

Gynecologist - I heard that birth control pills can help with acne so I get some. I had taken different types before and they have never GIVEN me acne, so I was hopeful. I took the pills; they helped a little...until I got to the placebo pills. Then my acne went into rage mode on my face. More hyperpigmentation... NEXT!

Dermatologist - Found a dermatologist who seemed nice and got good reviews. She prescribed tretinoin cream 0.05% and Claris Claryfing Wash (my insurance gave me Acella BP Cleansing Wash instead). The dermatologist also recommended I use a hydroquinone 2% cream on the dark spots, so I got a Palmer's brand for oily skin.

Purges, reactions, and sunscreen, oh my!:

Went through a short purge phase (lots of whiteheads), had an allergic reaction to the hydroquinone cream that lead to a melasma-like darkness around my mouth (fun!), had another reaction to the sample of Neutrogena moisturizer/SPF cream my dermatologist gave me, celebrated the fading of some dark spots and wept at the beginning of new ones. The clogged pores that turned into red and painful acne (and then dark spots) continued, so I stopped using the hydroquinone, in fear it was adding to the problem. Then I started to suspect the tretinoin cream, especially since I have naturally oily skin and after applying the cream at night, I would wake up in the morning practically coated in a sheen of oil, with very large and open pores. In fact, I was getting acne in places on my face I had never gotten acne before. My dermatologist then recommended I NOT moisturize in the morning, and to instead just wash my face and apply my sunscreen (Cotz Sensitive Skin 40 SPF). My skin looked so ashen, tight, and dehydrated in a few days that I had to nix that idea. Now I am waiting for her to write me a prescription for tretinoin gel or Tazorac.

Current status: 1. Ordered Vi Derm Clear HQ Free skin brightener to replace the hydroquinone, because I don't need exogenous ochronosis in my life 2. Stopped using the tretinoin cream 2 days ago (and may not use the gel, either. Still ambivalent about the risks/benefits - extra large, clogged pores? No thanks! ).

AM routine: Deciding between Trader Joe's Nourish All-In-One Cleanser (it's super gentle) and the Neutrogena Oil-free cream acne wash with 2% salicylic acid followed by the Vi Derm HQ free cream and/or Trader Joe's Oil Free Antioxidant Facial Moisturizer (the bottle does not say non-comedogenic, but it's very light and I used to use it before my acne problem) and then my sunscreen (20% zinc oxide). Any suggestions?

PM routine: Double-cleansing with grape seed oil (to get rid of the multiple layers of sunscreen), followed by Trader Joe's Nourish All-In-One Cleanser or the Acella BP Cleansing Wash (haven't started to use it again, yet as it's mildly irritating) followed by the Vi Derm HQ free cream, and then bed! Any suggestions?

I am starting a PhD program in a few weeks, another high-stress environment. I would like to feel like I at least have my skin under control so I can focus on other important things.

Questions from a newbie:

1. Should I avoid double-cleansing? If so, can someone recommend a facial wash for sensitive skin to remove zinc oxide sunscreen?

2. IS it safe to exfoliate while on retinoids? I've read mixed reviews (e.g. "retin- a is like a mini-peel") but I wonder if the dead skin/debris is further clogged my skin (I also have small bumps that contain those hard-seed like pus/substance). I have a Clinique facial scrub I bought when my acne was in it's infancy but have been too afraid to use.

3. Tretinoin gel - any luck for people with sensitive, oily skin?

4. Do I need to wear sunscreen even when I am staying indoors all day?

5. Any reviews on Vi Derm HQ free from current/previous forum members?

6. How long have you been dealing with adult acne?

7. Has anyone NOT gone broke trying to fix their acne issue?

I feel like my face is one big experiment and it's driving me crazy. It started so suddenly I am wondering will it stopped, and if I will have to use topical ointments indefinitely. Thanks, all!