I'm gonna try to put the TL;DR version at the top for people who don't necessarily want all the background information, but I'm still adding it because I guess I wanna be as detailed as possible for anyone else who may be considering this treatment or has already gone through it to see if it lines up with their experience. So at the top, photos, basic info, and the regimen.
Basic Info: Female, American, 21 years old, on low-dosage oral birth control (Loestrin 24 Fe with a recent switch to Microgestin 1/20 Fe) for almost 3 years, mild to moderate acne within the last 2 years, skin normal to dry (not oily), medium tan skin, not very sun-sensitive, facial acne only (no body acne)
My Prescribed Process:
Morning: warm water wash with Cetaphil Gentle Skin Cleanser, apply thin layer of Aczone gel 5%, then over top of it I use Aveeno "Positively Radiant" Daily Moisturizer SPF 30 if I'm going outside a lot that day (since it's summertime), otherwise CeraVe Facial Moisturizer which is much lighter
Noon-ish: Doryx (Doxycycline) 150 mg (with food, so usually at lunch)
Before bed: warm water wash with Cetaphil Cleanser again, apply thin layer of Differin .3% gel
Progress Photos:
This album shows me from the front and sides the day I started the treatment: http://imgur.com/a/6oDnf#0
This album shows me today, at 1 week in: http://imgur.com/a/QBzON#0
I don't have the best camera, but I'm taking them in the same place with the same lighting with the same stuff on - in the photos it is right after the application of Aczone and the moisturizer, no other makeup or creams. I haven't had significant acne on my forehead in a while (the occasional zit but nothing like my cheeks) so I'm not taking photos of it though I am applying a small dab of the creams up there, as the derm recommended it.
Background: Acne in my early 20s has been especially frustrating for me because I never really had acne in the pubescent years or in high school, and it's annoying for your face to be the only thing that doesn't agree with you looking like a real adult. I definitely got the occasional painful zit, but it would go away after a week or two, usually without treatment (only use of a mild drugstore face wash, or salicylic acid spot treatment when I was panicking about a social event coming up). Very normal, never more than two at a time or so on my face.
I'm not sure exactly when the switch occurred, but I know that the first time I noticed that I no longer had the occasional zit, but instead a constant rotation of pimples in different patches on my face, was around late 2010, when I was 19 going on 20. I don't think there was any particular "cause" - I'd already been on birth control for about a year at that point, but maybe it took a while to have a hormonal effect, not sure. So, birth control definitely did not improve my acne situation, though I can't really say it caused it either. This is also when I realized I had some scarring and weird red coloration that never went away either in the same spots on my face, and that this spots were also the focal points of the breakouts I did get. I started paying more attention to face washes, sticking with "regimens" of moisturizer and over-the-counter treatment for several weeks at a time before realizing they didn't really do anything. This is also the first time I felt self conscious enough to begin purchasing concealer - before this I never wore face makeup. Notable "gentle" products I used for a while include Burt's Bees, Origins Checks and Balances facial wash in combination with their Perfect World Moisturizer (SPF 15), or with Ponds Dry Skin Cream, Lush Greased Lightning and Aquamarina gentle cleansing roll, etc. All of these things had gotten rave reviews from some of my friends or from reviewers online for helping with clear skin and breakouts, and none of them really seemed to have adverse effects on me (heightened breakouts or irritation, etc.) but they definitely didn't make it any better. A lot of the washes would make my pores feel really "tight" but also dry it out, and I already have skin that tends try. I have never done any of the more intense over-the-counter kits or packages like Proactiv or Clinique or whatever, 'cause I'm a broke college kid, haha.
I have also taken great pains to combat any environmental/lifestyle issues that might have been causing it - either changed my pillowcases every few nights or put a towel or t-shirt over them, only pat my face dry with towels instead of rubbing, etc. My exercise and activity has actually increased greatly in the last couple of months since it's been summer vacation - I go to a gym regularly now - but I was always at least lightly or moderately active in the last couple of years on a regular basis (walking and dancing). My diet was occasionally as crappy as a college student's is likely to be during crunch times, haha, but those were always slip-ups and I ate and still eat plenty of greens, drink tons of water, and I'm addicted to fruits of every variety. I don't drink soda or other sugary beverages, and even while at school I drink alcohol at most once a week, and not a lot of it. I've been monitoring my diet much more closely in the past couple of months as I prepared to seek medical treatment for a problem I was becoming increasingly depressed about solving on my own. Even though I don't sunburn, I apply SPF moisturizers religiously whenever I'm going to go out; my acne doesn't appear to get any worse when I've spent time in the sun. I have only begun wearing facial makeup relatively regularly in the past year or so in an effort to cover up acne - I used a Neutrogena "Micro-clearing" powder compact and occasionally Stila stick concealer for particularly red bumps, I've never worn liquid or heavy coverage foundation (mostly because I don't know how to put it on well).
By the middle of last year I felt really bad about my acne even though it was still pretty mild, was convinced it was showing up in every photo, and was embarrassed to like stand close to people while talking to them in case they'd be looking at it. I'll admit it hasn't stopped me psychologically from doing most things, but I just want to get it over with. I want to not be nervous about how I look in photos, and I want to not be embarrassed when my boyfriend kisses me on the cheek.
I visited my GP about three and a half weeks ago now to talk about acne, and he gave me a referral to a dermatologist (who was able to see me within two weeks) and in the meantime gave me Amoxicillin to take 3 times a day. I was on that for two weeks without any visible effect (for better or for worse), but I was also told to expect this since antibiotic regimens usually take much longer to work. The dermatologist, when I did see her, told me to stop the Amoxicillin since it's not a good idea to take it for longer than the two weeks, and she prescribed a different antibiotic and two topical creams, Doryx, Aczone 5%, and Differin .3%, and a daily process for application.
The dermatologist recommended that I apply both creams not just to affected areas but over the whole face, so I'm doing that, and I'm sticking very very carefully to the "pea-sized amount" prescription, even though it's super tempting to use more in the face of minimal results! But it's only been a week, I'm doing my best to be very patient. She said that Differin often dries people out a lot, and that I'd probably want to put a moisturizer on over that at night, but Differin actually hasn't caused any drying or flaking, while Aczone has, so I don't have a moisturizer on at night, just during the day.
So far:
I've been doing this treatment for exactly a week today, and nothing appears to have really happened, which I expected. No sign of any "initial breakout" phase yet either, but I'm bracing myself just in case. I haven't had any gastro problems or discomfort from the Doryx, and neither of the creams is irritating/itchy/causing redness. The Aczone is drying but not in an uncomfortable way, and the daily moisturizer takes care of that as far as I can tell. I've only worn face makeup twice since I started the treatment - I'm restricting it to going out and special occasions, and for that the dermatologist recommended I switch to loose powder or mineral makeup instead of pressed powder. So I'm using Clinique Super-Balanced Powder Makeup, and for the bumps that are quite red I touch on a non-comodegenic cover-up stick (used to be Stila, now Almay).
I realize there won't necessarily be a lot of replies to these things, but it's going to be really helpful for me to have somewhere to post pictures and keep track of progress objectively, because I have a tendency to get discouraged in a day where I imagine more redness or get overly excited about the disappearance of a couple of pimples when really it could just be coincidence. The other treatment logs on here have been encouraging so I figured I'd give it a shot, as embarrassing and hard as it is for me to show my face without makeup. Any suggestions (moisturizers and cleansers and makeups especially?) or encouragement would be really welcome from anyone else who has done this process.
PHOTOS because okay, it's officially 1 week + day, and I'm already seeing some changes. It's crazy how the shifts appear to happen like clockwork - reading some other people's posts here and elsewhere on the net report changes (IB or clearing up or whatever else) like at exactly two weeks or exactly 9 days. Yay modern medicine. (But maybe I'm reading too much into these and these aren't the IB just yet, who knows.)
Anyway, photos of the changes are in this album here: http://imgur.com/a/UPUvV#0
Couple of bumps forming near my hairline on the right side of my face, they're the tender/sore kind. Then a large whitehead sprang aggressively from an already mostly healed bump on my left jawline. Also, yeah, there's a little bit of cleanser suds in my hair, I cleaned it out, don't worry!
In general if I had to say I noticed anything, it's that left cheek is slightly less red/inflamed than when I started treatment (here it is at start, here it is at 1 week yesterday), and right cheek appears to have accumulated more bumps. But really, all shifts so far are pretty negligible except for the ones in the album in this post. Blah. Btw if you disagree and do see something let me know, part of the reason I'm doing this is because I find it difficult to be view any changes in my own face objectively and it's hard even with the photos for me! Of course even if no one else reads this I'm still gonna do it. 
Thanks for the words of encouragement! I'm trying to prepare myself for the worst. 
More photos from yesterday (day 10) of the treatment because the aforementioned hairline bumps that just sprang up are still there, but no longer painful to touch, and the whitehead along my left jawline already calmed down a lot just a day. No big changes otherwise. Pictures, as usual, taken right after application of Aczone and moisturizer in the morning. I've been applying both retinoids to my forehead as well, even though I didn't have bumps there; so far none have popped up.
Album of day 10 here: http://imgur.com/a/gexNj#0
Pictures (I feel like the right cheek changes in amount of inflammation from morning to night): http://imgur.com/a/0Xpb3#0
Day 12 going into Day 13 of treatment. Right cheek definitely has more bumps/breakouts than it did at the beginning of treatment, and is overall redder. Especially, the big bump that's started to stick out a lot in the middle of my check. Left cheek remains comparatively pretty clear, and my forehead still hasn't developed anything new. I wouldn't really describe anything that's happened as a major "Initial Breakout" though (what do you guys think of my face now versus the albums at the start? am I just not seeing it?). Some bumps have gone away and a couple have popped up at about the rate that these sorts of things usually happen on my face. So I'm still bracing myself.
I'm going out of town for a few days, which will be interesting - I'll have to keep up the regimen even while likely staying out late, and I'll probably be wearing makeup for a few days consecutively, so I guess that'll be more potential stress on my skin than it's hard since I've started the treatment. The Clinique powder I'm using for makeup is full coverage, but I think the bumps are too many (or I'm not skilled enough) to actually make the skin look smooth without liquid, so I'm more going for reducing redness out of the blush zone and covering obviously red pimples/scars. Won't be able to keep up exercising during that time either since I'm away from the gym, but I'll do my best to make sure there are still greens in my diet and everything.
A note about hair: I do have long hair and bangs, but since they haven't been cut in a while and it's humid outside, I've taken to pinning off my forehead or braiding them to the side for quite a few weeks now, unless I'm going somewhere nice and my hair is straightened, and I always pin the bangs back and tie my hair back at night. There is usually some kind of product in my hair, but I've never had breakouts on my forehead where they would lie so I'm pretty sure they're not the problem, and I've got no plans to cut them. Even so, I'm still keeping them off my face as much as possible, which I've always done as a general policy and am doing with special care during the treatment.
Ok, back, from out of town. Here's the treatment today (right, left, and front views), at 2 weeks plus one day:
PICTURES: http://imgur.com/a/0HrRC#0
I think it actually looks pretty different from just a few days ago, especially considering I wore makeup every day I was gone. I was pretty good about the treatment schedule though. Here's my right cheek Monday, four days ago and here it is today; I think those are the most drastic changes though left cheek looks pretty good too. Overall both cheeks are much less bumpy and the red appears to have decreased today. The inflamed whiteheads that popped up along my hairline and in the middle of my right cheek and along my jawline early last week are all just red and kind of faded now.
The loose powder makeup was definitely the right choice to go on over the moisturizer, and it washes off very easily without any need for hard rubbing with the Cetaphil cleanser.
Another update - haven't been around in a while, was out of town traveling, but here are some picture updates since today is officially week 4 since starting the treatment.
PICTURES: [/b] http://imgur.com/a/BHQra#0
Since the last set of photos I posted, which were just after two weeks (and after another trip out of town), my skin went through a few ups and downs. Nothing particularly horrendous, but there were a few days where it seemed like redness was increasing a lot, and other days where some whiteheads actually itched. I've never intentionally popped a pimple so I normally don't feel compelled to touch my face during the treatment, but one whitehead flared up in the middle of my cheek (and a day before I was reunited with my boyfriend, ugh) that itched really badly. I resisted though!
So I suppose this period is the closet thing to the "Initial Breakout" that I've experienced so far, but the whiteheads that come up all come down again within a day or two at the most. Overall redness doesn't appear to have improved a whole lot, but I guess fighting scars isn't the point of this treatment. Also, I might be getting bad at keeping track, but none of the bumps that have appeared since treatment appear to be new ones, they're all former red spots that became raised or something and then sort of die away. Right cheek appears to have a generally worse time than the left. I got a small bump on my forehead for the first time the other day but it's long gone.
If people want more pictures with a super side-by-side comparison over the last two weeks, look right here:
Right cheek at 2 weeks: 
Right cheek at 19 days: http://imgur.com/a/tYusi#0
Right cheek today at 4 weeks: http://imgur.com/a/BHQra#1
Ups and downs, ups and downs. Obviously diet and exercise pretty much go out the window when I'm traveling, but they don't appear to have had huge effects on anything and I stuck to treatment pretty religiously.
Today is week 5, and the breaking out is definitely worse - my left cheek has a lot of bumps, nearly as many as when I started. Right cheek has stayed comfortably smooth since the last photo update though. Nothing is particularly red or inflamed though; I guess I give credit to the Doryx for handling that. Trying not to get discouraged; it's not that this is particularly bad, it's just annoying to have been using for 5 weeks and not see much of an overall improvement if you compare today with the day I started. There definitely is an improvement in the weeks between though, but it almost makes me wonder whether my face would have simply gone through this cycle anyway without expensive topical medications...I'm seeing the dermatologist in 3 weeks though, so I'm definitely going to keep using until then and see what she says.
PICTURES: http://imgur.com/a/FZuZk#0
Thanks for the encouragement. I like the Aczone alright! It dries my face out much more than the Differin does, even though it was the Differin I was warned about, but that's easily solved with a thin layer of moisturizer in the morning. Using these two creams in combination will make it kind of impossible for me to tell which one actually did/does the trick though!
I'm hanging in there, now at 6 weeks. I'll try to post pictures tomorrow, but not much has changed. I'm starting to realize I might have to talk the dermatologist about treatment for scars when I go back too since they now account for much of the discoloration/redness I have as opposed to actual raised pimples.
Haven't updated in a bit because there's not much new to report. I hit 7 weeks on the treatment yesterday. Have a couple of big ugly pimples (pink, not whiteheads) on the left side of my face that haven't gone away in about six days; that's pretty unusual because usually ugly things pop up and then are gone very quickly. Still sticking very resolutely to the pea-sized amount prescription, as hard as it is. Overall I feel like my face is better in terms of bumps than when I started, but also redder (all the big bumps that showed up went away but left scars/red discoloration), and right at this exact moment it's worse than it was around, say, the 3 or 4 week mark. All of which is to be expected I suppose.
I just want things to even out; I don't really know how to hide things only using powder makeup anymore, even if I only wear makeup once or twice a week (when I know I'll be going out or when photos will be taken). I hate feeling embarrassed to have my face close to my boyfriend's sans makeup. I haven't renewed my gym membership and therefore haven't been in three and a half weeks or so, so maybe that has something to do with it, but I don't really want the state of my acne to rely on whether I can afford expensive workout regimens in my life, haha. Just want to get back to the dermatologist.
ALRIGHT, finally an update with pictures. I hit 2 months today (9 weeks of treatment) and I'm overall in a pretty good mood. Very grateful to have pictures to look back over to remind myself that serious progress has been made. Anyone reading this or any other treatment logs: photos are a good idea if you're super self-critical, which I think all of us with acne are.
Pictures: http://imgur.com/a/cmsT3#0
Unfortunately the camera is just my phone camera now since the Nikon broke, so you're stuck with slightly worse quality I'm afraid, but I think you can still see what's important. Honestly it's much better even than it was just a couple of weeks ago. I visited the dermatologist again today for a treatment follow-up assessment and she seemed pretty pleased with the remarks; pointed out that there's no active acne on my face right now at all (even though occasionally a zit can flare up for a day or two, they haven't been big or in noticeable areas for a while).
I wanted to talk to her because my biggest worry now is some of the discoloration/scarring, but she said most of the red marks on my face are just that - marks - and on most patients fade within one or two months. I have a couple of scars that are kind of pockmarked indentations but she said those are best dealt with after the other marks fade and I'm weaning off of treatment.
So at two months, she also advised me to only go through one more refill of the Doryx and stop taking it at three months, but to keep using the retinoids. She warned that after that runs out, some people experience a flare-up on their face when going off the antibiotics, so it's important to keep resolutely at the retinoids without the doxycycline to ensure my skin becomes accustomed to it. Honestly I'm mostly relieved that she thinks the red marks are going to fade, and also very hopeful that I'm one of the typical patients she's talking about, lol.
Overall I feel much better about my face at the moment - clearly I'm in a better mood than my last post - and I am wearing makeup once a week tops. I was in some photos last week not wearing makeup and you can barely see the red marks even. When I do put makeup on though, the loose powder is much much better now that it doesn't have any bumps to contend with; it's just great for evening out my coloring and hiding some of the red.
Month Four PICTURES: http://imgur.com/a/RsHdU#0
(Sorry the pictures are so small, phone camera is still all I've got)
WOW haven't updated in quite a while, but I wanted to just check in again. I'm still using the Aczone/Differin regimen and the same Aveeno moisturizer, though I've now been off the Doryx since November 3rd. There was no flare-up when going off the antibiotics, fortunately (she warned that some people experience brief flare-ups of small cysts for a couple of weeks, but my face remained pretty constant). I've also, for unrelated reasons, been off of birth control (Microgestin) for about two and a half weeks now with no apparent difference to my face in that time, which has never happened before. I'll be going back on it on a different brand within the next couple of weeks I guess, but I don't expect to see much of a difference while I'm still using the retinoids.
Amazingly, using only the small pea-sized amounts recommended, I'm still on the original tubes of Differin and Aczone at 4 months of this regimen. My face is clearer than ever and people have been commenting on it since about the two month mark - when I saw friends I hadn't seen since early in the treatment or since before I started, they immediately said my skin looks amazing. Lots of the red marks have also faded over the last two months, so if you're worried about scarring even while you're doing a regimen, keep in mind that lots of the marks are just that and will go away! The next thing I'll want to address are the kind of indented pockmark scars, of which I have a few. I'll want to go back to the dermatologist maybe in another month to talk to her about that and to ask if I'm just supposed to keep taking this stuff forever or if I wean off of it, lol.
New update: revisited the dermatologist, this past week I hit seven months of treatment. At about the three-four month mark, I began having pretty much no acne and have enjoyed a face almost entirely free of new acne since then, still with just some red marks from old acne. About two weeks ago, though, new cysts began popping up along my hairline, and a couple along my jawline, where they used to flare up with some frequency. I kept constant with the retinoids and didn't try anything differently, and they have all but faded, but I figured I should go back to the dermatologist since I hadn't for almost five months. I figured that perhaps the reaction was because it was time to stop weaning off of Differin/Aczone or that I had been taking it for too long.
Instead, she told me what I was now seeing were the effects of the "Initial Breakout" period I'd never had. During the first three months of treatment, the IB had been suppressed successfully by the Doryx, and when I stopped taking it, it had taken a while for the antibiotics to be completely removed from my system. Something like this:
August: treatment start, daily Doryx + Aczone + Differin
October: positive results of treatment very visible, derm tells me to only take one more month of Doryx and keep using retinoids
November: I stop Doryx, daily Aczone + Differin
late February: anti-inflammatory effects of Doryx finally wear off, mild IB period begins
So she's prescribed another month of Doryx to keep the retinoids in check, and to keep an eye out this time for signs of gastrointestinal discomfort, which I didn't have any trouble with last time.
New update: revisited the dermatologist, this past week I hit seven months of treatment. At about the three-four month mark, I began having pretty much no acne and have enjoyed a face almost entirely free of new acne since then, still with just some red marks from old acne. About two weeks ago, though, new cysts began popping up along my hairline, and a couple along my jawline, where they used to flare up with some frequency. I kept constant with the retinoids and didn't try anything differently, and they have all but faded, but I figured I should go back to the dermatologist since I hadn't for almost five months. I figured that perhaps the reaction was because it was time to stop weaning off of Differin/Aczone or that I had been taking it for too long.
Instead, she told me what I was now seeing were the effects of the "Initial Breakout" period I'd never had. During the first three months of treatment, the IB had been suppressed successfully by the Doryx, and when I stopped taking it, it had taken a while for the antibiotics to be completely removed from my system. Something like this:
August: treatment start, daily Doryx + Aczone + Differin
October: positive results of treatment very visible, derm tells me to only take one more month of Doryx and keep using retinoids
November: I stop Doryx, daily Aczone + Differin
late February: anti-inflammatory effects of Doryx finally wear off, mild IB period begins
So she's prescribed another month of Doryx to keep the retinoids in check, and to keep an eye out this time for signs of gastrointestinal discomfort, which I didn't have any trouble with last time.
Your skin cleared up a lot good for you 
Question, how long did it take for doxy to start working? & what's your diet like?
Your skin cleared up a lot good for you
Thank you! The doxycyline worked pretty much immediately I guess, since I started taking it as soon as I started using the retinoids, never without, and I never had the dreaded "initial breakout" period until I stopped using it. Since my last post, when I was told to start taking doryx again, I've only taken it a couple of times since it was causing a bit of gastrointestinal discomfort for the first time, and the delayed Differin IB reaction cleared up on its own within about a week anyway. So I'm using only retinoids.
My diet isn't super carefully controlled, but is generally pretty healthy. I don't drink soda or coffee, nor eat most salty junk food and I probably eat at least 4 servings of fruits/vegetables a day. Totally guilty of dessert every day though, and I don't go out of my way to control starch/grains. When I have time, I exercise about three times a week. I will say that I never saw any difference in my skin whether I was exercising regularly or not (occasionally I didn't get to do it for as long as a few weeks) and diet also doesn't appear to play a huge role - sometimes I eat a bunch of chips and sometimes I am eating like four cups of spinach a day and it doesn't seem to have caused breakouts. Before I started the retinoids I even took wheatgrass for about a month to no avail. The creams/medicine are definitely what's doing it and not lifestyle, which makes sense since the dermatologist says it's hormonal in my case.
