Week 8 wrap-up: Back to another bad week for my acne. That potentially nodular pimple from my last post has since developed into a full blown cyst, and four other cysts emerged: one on my left cheekbone, one on the left side of my chin, and two along my jawline. All in all, I currently have seven active cystic-nodular pimples, and a whole bunch of red spots and PIH on my face. Looking at my face in the mirror is a bit depressing, since I went from a relatively clear complex just a few months ago to having a face covered with acne marks. I really hope that this is all part of the initial breakout and it will subside in a few weeks.

Week 9 wrap-up: This was a relatively good week for my skin. A lot of my pimples came to a head, including five cysts, two whiteheads and one clogged pore. I popped them, extracting lots of pore plugs and sebum, which has allowed them to flatten. I still have two active cysts on my face and two just below my jawline, as well as two whiteheads that just emerged along my hairline. As a whole, however, my skin looks much better than last week, and the overall texture is smoother. I still have a few weeks before I hit the 3-month mark, which is the point at which most studies show that there are significant reductions in acne lesions.

For reference, here is my updated regimen:

Mornings
Rinse face with water, shave, wash face with Cetaphil Gentle Skin Cleanser
Apply thin layer of CeraVe Moisturizing Lotion
Workout at gym, shower, dry face with clean towel
Apply AcneFree Sensitive Skin Alcohol-Free Toner
Spot treat with topical clindamycin and/or buffering lotion
Moisturize with Alaffia Neem & Shea Butter Skin Recovery Facial Cream
Apply Biore Perfect Milk UV SPF 50+ Sunscreen

Evenings
Remove sunscreen with Kirkland Daily Facial Towel Wipe
Wash face with Cetaphil Gentle Skin Cleanser
Apply thin layer of CeraVe PM Facial Moisturizing Lotion
Spot treat with topical clindamycin and/or buffering lotion
Before sleeping: Apply pea-sized amount of either Retin-A 0.05% cream or Ziana gel

I also take 100 mg of doxycyline and 1 teaspoon of fermented cod liver oil daily. Additionally, I have been trying to clean up my diet. I limit myself to one cup of coffee every morning, and I have switched from black tea to green tea during the day. I try to drink at least 8 cups of water daily, and I've cut down on fried foods, sweets, junk food, gluten products and dairy, while increasing my vegetable/fiber intake. And, as noted above, I try to get at least 30 minutes of exercise every day, including some moderate-intensity cardio 4-5 times per week. Not sure if these things really help with my acne, but they keep me healthier.

Week 10 wrap-up: This was another good week for my skin. My two remaining cystic pimples came to a head, flattening out and leaving just dark spots. My only other new pimple was a whitehead on my chin, which also came to a head and is now healing. Overall, though, my skin is looking much brighter than before. I still have a few clogged pores near my eyes, but my cheeks are otherwise smooth and free of active blemishes. The only problem is all the post-inflammatory hyperpigmentation, which will hopefully fade in the coming months.

I just visited my dermatologist and picked up another two-month supply of doxycyline and a tube of Skinoren cream (azelaic acid 20%). I've heard so many good things about azelaic acid and its ability to kill acne bacteria and reduce hyperpigmentation. I'm a little hesitant to add it to my tretinoin regimen since it can cause itchiness and irritation, but it would be nice to have something to address all of the acne dark spots.

Week 11 wrap-up: A third good week in a row for my skin. This week, I got three very small whiteheads around my chin/mouth, one of which quickly came to a head and two of which just sort of flaked off and disappeared after a few days. My one lingering jawline cyst also came to an ugly head yesterday and is now in the tender but healing stage. My overall skin continues to look bright and smooth; I don't have any active acne at the moment, and the dark spots are slowly starting to fade. It's hard to put my finger on the reason why my skin has taken a turn for the better, since I've been trying so many things in combination, including the tretinoin, topical clindamycin, oral doxycycline, and holistic changes to diet and exercise. I suspect (and hope!), though, that the initial breakout from the tretinoin is finally subsiding after eight weeks.

As for regimen changes, I started trying out the Skinoren cream this week. On Wednesday, I put a small amount on my neck and did not experience any reaction. On Thursday and Friday, I put some on my forehead during the day and also did not experience any reaction. So yesterday morning, I applied a thin layer all over my face, especially my cheeks. It wasn't painful, but it did sting/tingle a bit for the first 2-3 minutes, although not nearly as bad as glycolic acid. The bigger reaction is that it made my face feel dry. Not flaky or peeling dry, but just dry and tight, even after moisturizing. It was a bit uncomfortable for about half an hour or so, but then I didn't really notice it for the rest of the day. If this works out, I'll add it to my long-term regimen to combat acne and hyperpigmentation.

Week 12 wrap-up: This is finally the three-month mark, and I can definitely see improvement from weeks 2-8. I still have some breakouts this week, but overall my skin continues to look okay. I had one clogged pore that finally emerged, and two other small pimples that popped up, quickly came to a head, and are now healing. There are still some lingering clogged pores and a few irritated patches that look like they might turn cystic at some future point, but nothing too bad at the moment. I don't have any active inflammation or cystic pimples, so things are looking much better than last month.

In terms of regimen, I've incorporated the Skinoren cream into my morning routine, right between toning and moisturizing. It causes some mild stinging/tingling upon application, but the sensation is bearable and subsides after about half an hour. No noticeable effects yet, but hopefully the azaleic acid fades the dark spots over time. One other change: for the past week, I've only been using Retin-A 0.05% cream, rather than alternating with Ziana. Since Ziana is only available in the US, I'm trying to see whether I can get by with just the cream or if it's too comedogenic for my skin. So far, I haven't noticed any extra clogged pores or oiliness, but I'll give it another 1-2 weeks.

Week 13 wrap-up: Great week for my skin. I have absolutely no active breakouts at the moment. I did have a very, very small whitehead that emerged on my cheek two days ago, but it dried up and flaked off in a matter of hours, without leaving a trace. All of the dark spots are fading, and while a few of the marks from the cystic acne are still noticeable, nothing looks that bad. In fact, just this week, someone was lamenting to me that the pollution and humidity in Hong Kong causes acne, and when I agreed with her, she told me very straight-faced, "But you don't have acne problems." If only she could have seen me a month ago, when my face was covered with cystic acne...

My regimen remains mostly the same, except that I've started experimenting with using Retin-Abeforemoisturizer a few days a week. It's hard not to moisturize right after washing since my face gets very dry, but the tretinoin cream is emollient enough that it's not a problem once I apply it. I can even get by without moisturizing after using the tretinoin cream. The few times I've done this, however, have made me realize that buffering with moisturizer makes a big difference. When I apply Retin-A cream on bare skin, I end up getting slight flaking the next day, especially along my lower cheeks and jawline. My skin also gets more sensitive, so there have been a few days this week that I've dropped down to Retin-A 0.025% cream to manage the irritation. This might also be because I shave with an electric razor every morning, which causes further skin irritation in that area.

In terms of contemplated changes, I am thinking of asking my US dermatologist for Retin-A Micro next time I see him. RAM isn't readily available in Asia, and I found a Valeant Access coupon that brings the 0.08% 50 g pump bottle price to $75 without insurance. It's much pricier than the $6 that I pay for a 20 g tube of Retin-A cream, but it's a stronger concentration and possibly more effective. I am also debating whether to add a Vitamin C serum back into my regimen. It would be helpful for fading dark spots and rebuilding collagen, but the last time I tried it, my skin felt like it was burning for half an hour. I will have to see if there is somewhere in my routine that I can slot it in without disrupting the rest of my treatments.

Week 14 wrap-up: This was an okay week for my skin. No huge cystic pimples, but I had a whitehead form just below my nose and an inflamed clogged pore at my upper lip that has left a small dark spot. These are both in spots where I don't usually apply tretinoin, which might explain why I'm still breaking out in those areas. Additionally,I'm traveling at the moment and I've been much more lax about my diet and exercise regimen, so this may result in a bit of a reversion over the next few weeks. I am hoping, however, that the initial breakout is over, so even if I get some new acne, it won't be that bad.

As for regimen changes, I've gone back to alternating between Ziana gel and the Retin-A 0.05% cream. I feel like I've used the tretinoin cream long enough to determine that it won't clog my pores, and I have several small sample tubes of Ziana that I need to use up soon before they expire.

Week 16 wrap-up: My skin remains about the same since my last update. I have generally clear skin except for one small whitehead near my eye brow, a handful of clogged pores, and discoloration that is slowly fading. While things are not perfect, I am relatively happy with the current state of things since I've been lax about my regimen in the past two weeks: minimal exercise, plenty of gluten and a bit of dairy every day, and irregular sleeping habits. I've also scaled back the doxycyline to once every other day, with the hopes of weaning myself off oral antibiotics in the next month or so.

Week 18 wrap-up: My skin continues to look pretty good. I stopped the oral doxycyline last week and have continued to be lax with my diet, i.e., consuming moderate quantities of dairy, gluten, etc. The initial breakout seems to be well over and tretinoin appears to have "normalized" my skin. Last week, I had two whiteheads pop up near my mouth, but both of them quickly came to a head and faded within days. Other than that, I don't have any currently active pimples, and the dark spots continue to fade. My skin also seems to be a bit smoother and brighter overall. It's been about four months since I started tretinoin, so hopefully my skin continues to improve over time!

For future reference, here is my updated regimen. Now that I'm using azelaic acid, I've switched back to Thayers witch hazel toner since the AcneFree Toner included a small amount of salicylic acid.

Mornings
Rinse face with water, shave, wash face with Cetaphil Gentle Skin Cleanser
Apply thin layer of CeraVe Moisturizing Lotion
Workout at gym, shower, dry face with clean towel
Apply Thayers Alcohol-Free Witch Hazel Toner
Spot treat with topical clindamycin
Apply Skinoren azelaic acid 20% cream
Moisturize with Alaffia Neem & Shea Butter Skin Recovery Facial Cream
Apply Biore Perfect Milk UV SPF 50+ Sunscreen

Evenings
Remove sunscreen with Kirkland Daily Facial Towel Wipe
Wash face with Cetaphil Gentle Skin Cleanser
Apply thin layer of CeraVe PM Facial Moisturizing Lotion
Before sleeping: Apply pea-sized amount of either Retin-A 0.05% cream or Ziana gel

Week 20 wrap-up: Now that my skin has largely settled down, I don't feel the need to post as often.  In the past two weeks, I haven't had serious acne concerns.  I had two bumps that looks like potential acne but turned out to be inflamed ingrown hairs.  Credit to all the chemical exfoliants in my regimen -- one of the ingrown hairs literally pushed itself out of my skin over the course of a day or two, while the other also came to the surface, allowing me to yank it out with tweezers.  

The photos below show the latest state of my skin: the hyperpigmentation is still visible, but it's much less noticeable than before, and I'm hoping it'll continue to fade with the use of azelaic acid and tretinoin over the coming months.  All of the dark spots below used to be huge, dark cystic spots just 2-3 months ago, so I am really happy with the progress.

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Week 23 wrap-up: I am just a few weeks shy of the six month mark, and my skin remains roughly the same since my last update. The dark spots of hyperpigmentation are still the same, but I don't have any new acne breakouts. Last week, there were a few spots that looked like they might turn into acne, but these quickly faded without breaking out. At the moment, I also don't seem to have any clogged pores or ingrown hairs. I don't know if it's due to the tretinoin, azelaic acid or the topical clindamycin, but my acne problems seem to have subsided. Now, if only I could start seeing the other skin-improving benefits of tretinoin!

Week 27 wrap-up: I'm just past the six month mark. I haven't been diligent about posting here because my skin has continued to remain the same. Still a few hyperpigmentation spots, but overall, my skin is free of clogged pores and I haven't had any acne breakouts in the past month. I still occasionally get the reddish spot that looks like it'll turn into a pimple, but then it fades in a day or two. This must be what it feels like to have "normal" non-acne-prone skin! My current regimen appears to be working, so I haven't made any changes to it, other than scaling back the fermented cod liver oil to half a teaspoon a day. I continue to exercise regularly and drink lots of water and green tea, although I have been much more lax about dairy and gluten.

Week 34 wrap-up: Just a quick update: no significant changes to my skin in the past two months. I still get the occasional inflamed spot or clogged pore, but nothing serious and it usually lasts a few days. The hyperpigmentation has faded slightly; I think, however, that some of the redness and dark spots are just lingering signs of sun damage and aging over time. On a related note, it looks like the tretinoin is finally starting to help with my overall skin texture. My pores are still fairly large, especially along the T-zone, but the fine lines seem to have softened and become a tiny bit less noticeable. I've read that tretinoin can continue to show improvements over the first few years, so hopefully my skin will continue to get better. I've been using the tretinoin 0.05% cream every night (buffered with CeraVe PM), and I don't experience any sensitivity or irritation, but as long as it works, I'll stick with it rather than moving up to a higher concentration.

Week 50 wrap-up: It's been four months since my last post, and approximately 1 year since I started using tretinoin. I'm happy to note that everything remains pretty much the same. My skin is still generally clear, except for the occasional inflamed spot or small pimple - around one or two per month, and each of those usually lasts for just a few days. I still have a few lingering spots of hyperpigmentation, but the texture of my skin is pretty smooth and free of under-the-skin bumps. My skin also feels pretty good. During the day, I experience some itchiness when I apply the azelaic acid, and in the evenings, I sometimes see flakiness and dryness in spots, but as long as I stay moisturized, it's not particularly noticeable. I see the peeling as a sign of constant exfoliation, so it doesn't bother me.

I have been tempted to try all sorts of new skincare products like sheet masks, serums and toners, but so far, I am sticking to the below regimen. It's not too complicated or expensive, and it's been working for the past 8 months, so no need to risk changing things:

Mornings
Shave, wash face with Cetaphil Gentle Skin Cleanser, dry face with clean towel
Apply thin layer of CeraVe Moisturizing Lotion
Workout at gym, shower, dry face with clean towel
Spot treat with topical clindamycin
Apply Skinoren azelaic acid 20% cream
Moisturize with Alaffia Neem & Shea Butter Skin Recovery Facial Cream
Apply Biore Perfect Milk UV SPF 50+ Sunscreen

Evenings
Remove sunscreen with Kirkland Daily Facial Towel Wipe
Wash face with Cetaphil Gentle Skin Cleanser
Spot treat with topical clindamycin
Apply thin layer of CeraVe PM Facial Moisturizing Lotion
Before sleeping: Apply pea-sized amount of Retin-A 0.05% cream

Week 60 wrap-up: I am now more than a year into my tretinoin regimen, and my skin has been great! The hyperpigmentation has faded to the point where it is almost unnoticeable, and my pores seem to be a bit smaller. My complexion overall looks brighter, clearer and smoother than it has in years. I've continued with the above regimen, although I occasionally skip a day or two of tretinoin here and there, especially when traveling. I have returned to consuming dairy, and I've largely stopped the FCLO, but my skin remains pretty much acne-free. I have no plans to make any changes to my regimen, given how well things are going. Hopefully, it'll continue to stay clear going forward.

Week 75 wrap-up: I was washing my face yesterday night when I realized that all of the post-inflammatory hyperpigmentation is finally gone. At this point, I look like I've never had any acne issues at all.

I'm tremendously happy to have discovered this website and have learned about tretinoin. Before starting this regimen, I had so many doubts and concerns. I had read all of the horror stories -- that my face would be red and super sensitive to sunlight; that daily shaving would irritate my skin beyond belief; that using tretinoin cream would be pore clogging; and of course, that there would be a horrific initial breakout.

If you've followed this log, you'll know that I did suffer from a pretty bad initial breakout -- the worst breakout that I've ever had in my life. But after 8 weeks of acne hell, everything became better and my complexion remains great. Sure, I wear sunscreen every day, but I've not noticed any increased sun sensitivity. Daily shaving does bring up some skin flakiness in the morning, but this goes away after I wash my face and moisturize. And happily, my face tolerates tretinoin cream even better than the gel, which I find sticky and disgusting (I used Ziana gel).

For me, tretinoin has been a holy grail miracle treatment: it's so easy to use, it's extremely inexpensive, and itworks. Not only has it addressed my acne problems, it's also left my skin looking clear, healthy and tight. So if you have acne issues and you're thinking about tretinoin, my advice would be to give it a try. It might not work for you, but if it does, it's worth it!