My Acne Story
This is my first post on this forum!
I'm writing this to share my personal experience with adolescent and adult acne, as well as the treatments and lifestyle changes that I've found to be most effective for managing the condition. I hope its insightful, and helps anyone on here who is struggling with it as well. I've separated the post into a few subcategories, each pertaining to skin history, treatments, dermatological advice, as well as products and dietary changes. 
1. Dealing with acne from a young age
I've had acne since the age of 14. By that, I don't mean acne conglobata. It started out as a concentrated cluster of spots on my forehead. They weren't red or inflamed, but they were difficult to conceal because they were raised. I effectively treated it with an over the counter salicylic acid wash. I faithfully cleansed my skin twice a day until I had a trip to the dermatologist's office to have a forehead spot removed. I was afraid to put soap anywhere near my open wound, so I went without it for a few days until my incision healed a little more. When I went back to using the wash, it wasn't as effective. Perhaps my break from treatment resulted in a resistance to the product. My acne proceeded too get worse, but at 14, you just learn to deal with it. I just powdered my forehead and hoped the spots would go away with time. Eventually, however, the spotty situation got out of hand. What was once on my forehead spread to the rest of my face. My skin became oily when I hit puberty later than the rest of my friends. I was so shiny, not powder could absorb the shine for more than a hour r so. My sister's face was also greasy, so I assumed it was just genetic. At the time, my parents didn't take me to a dermatologist because they didn't have the money, and we also didn't have insurance for a while. The soonest clinical treatment I was received came from my pediatrician's office. A product called Benzaclin was prescribed to me. It worked pretty well! A combination of benzoyl peroxide and another active cleared my skin quickly. It felt great to go without makeup and my skin tone was even. I was adamant about wearing sunscreen(always have been)so I didn't experience any terrible symptoms like sunburn. I would say my skin was clear for about a year or so. When spots started forming(due to ever fluctuating hormone and stress levels)I turned to Benzaclin again. Looking back, the formula may have changed, because i developed a terrible allergic reaction to it. My skin was red, peeling, and dry. Every product i put on my skin felt like i was putting liquid acid on my face. I begged my mom for Ponds cold cream, Cetaphil, any heavy cream that would moisturizer my skin. None of it worked! Once I ditched the Benzalcin, eventually the redness and peeling went away. Now, i just had to find another way to get rid of my spots.This was probably an all time low for me. My face was covered in spots at this point. Some were whiteheads, some were blackheads. Some were causing scarring on my left cheek and the rest just wouldn't go away. I overhead my dad telling my mom that he had never seen(in all his 45 years)someone with acne as bad as me. I was heartbroken. Another trip to the pediatricians office resulted in two or more prescriptions. (Btw, I'm not putting pediatricans down. They just aren't skin experts.) I was advised to take pictures on a daily basis to see if my skin was improving with the new medications. (I wasn't about to do that!Who wants to immortalize their acne in a photograph?) So I just applied the lotions and potions and waited to see a change. Although I saw some difference, I never really got the results I was expecting. I briefly visited my first real dermatologist alongside my sister, who also suffered from acne. She rubbed her face over my sister's, feeling the bumps and oiliness that resided on it(without gloves)and then proceeded to examine mine. If this happens to you, run. You deserve a derm who washes their hands before they touch you. She gave us the same prescriptions and told use to layer one on top of the other, if, individually, they proved ineffective. They did. Que a new insurance plan and a dermatologist that claimed to have the experience to solve my acne problems. I had a consultation with an academic dermatological institute that I still remember to this day. He was bright, older, and optimistic. He had a staff of attractive young medical residents that rivaled an episode of Grey's Anatomy. They all had great skin, and claimed that the products in his office had helped them achieve that. Guess what? More creams. My first dose of  antibiotics, which was exciting. What could be more effective than pills?I saw slow but sure results in just a couple of months. Maybe I slacked off the pills because side effects are scary. Maybe the creams weren't potent enough. I stopped seeing the results I wanted so badly. I probably went to more visits with him than I did any other derm in the course of a year. I felt like I was just another customer to him, and my parents probably felt the same way. I remember the card ride home on my last visit to his office. I cried and asked my mom, "what am I supposed to do?I can't live like this." It probably wasn't emapthetic of her to say, "well, I'll call the pediatrician. . .to get a referral to a pediatric dermatologist." I angrily insisted that it wouldn't make a difference. All dermatologists are the same. Why bother? One week later, and I was sitting in her office surrounded my porcelain skinned children much younger than me. Enter an fifty-something Asian woman with a kind expression on her face. Looking back,  I really appreciate the approach that she took that day. Medical history, products I liked and disliked, what was effective for me. We went over oral options including birth control and Accutane, and decided that a low dose tetracycline and topicals were best to start with. She also cared about my skin as a whole. She was interested in my history of pre-cancerous skin lesions(something other derms had ignored)and checked me for suspicious spots. For the first time, I felt like someone cared about my skin, and not just the skin on my face. I achieved great results with her(albeit, my poor, teenage dietary habits held me back a bit)because we stuck to a process that eliminated the ineffective and focused on treating the issue from every angle. She encouraged me to exercise, stay healthy, and maintain good hygiene. (Finally!A derm that encouraged positive lifestyle habits.) My skin was great for a couple years, but I struggled to keep it that way. My skin was always oily, and I still had problems areas on my face, although I'll admit that my acne was about 70% better. I finally decided to go on Accutane.
I did not go on Accutane because my spots came back full force. My acne was just persistent. If I skipped a day of treatment, she could tell. She said we had reached the "status quo" with my skin using only topicals because my skin was just so oily. I know a lot of people will say that this drug is harmful, both short term and long term. However, I had just turned 18, and before I was that, my mother was hesitant to allow me to go on it. I consented because the accutane prescription was low dose, and because I trusted my derm's opinion.
I am currently about 7-8 months post-accutane. I was on 60 mg a day(30 am/30 pm)which is pretty low. I didn't take birth control because I didn't want my body to go crazy with all that medication. Instead, I signed an abstinence pledge(which is an option)and consented to monthly blood tests with an initial urine test to ensure that I wasn't already pregnant. I didn't experience any terrible symptoms other than dry lips. I may have experienced a little fatigue. I've always had sinus problems, and my nasal passages are a little more dry than before. However, I always have eye drops and nasal spray on hand. To be honest, the process wasn't all that hard. One pill twice a day, taken with food high in healthy fats, as well as a monthly blood test and trip to the dermatologist. It's been over 6 months, and I haven't had any symptoms and the acne isn't nearly as bad as before. If your doctor recommends it, I would try one course, if your acne is severe enough. Personally, I don't think I would do a second round of therapy, just because I'd feel guilty doing that to my body again. However, a single course proved to be enough for me, and I haven't had a severe breakout since the initial accutane purge.*
(Just a quick note. Some people ask if they can take vitamins/herbal supplements to help speed the accutane process along. Don't do this! Any other
oral supplements can mess with the medicaiton's effectiveness. My derm even warned me against taking vitamin c(for my immune system)
because accutane is basically large amounts of vitamin a. Encourage your body to heal and defend itself during accutane by eating a well rounded diet including fruits and vegetables. 
(*In the first couple months of accutane, the skin "purges" any acne sitting under the skin.)
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2. Bad Advice. . .
Everyone has received bad advice at some point. Here are some things that dermatologists have told me over the years. Guess how long I stayed in their offices?
"You have the same skin as your sister.So, all products will work the same for both of you."
                                 -Bad Dermatologist #1
Say, what? Sorry, but I'm pretty sure my sister(who is two years older than me)is not my twin. Even if we were twins, we would not have the same fingerprints.
She inherited my dad's Italian genes, and while I am also Italian, my skin is fairer and more sensitive. For a doctor to sit me down in a chair next to my 
sister and tell us to use the same products is just a testament to her lack of knowledge. Same family, different people, DIFFERENT SKIN. What works for your
skin could send your sister the emergency room. 

"It's like that board game. We've tried a lot of products, but we need to use some together. There are a million different combinations, we'll just have to try them all."
          -Bad Derm #2
Needless to say, that was discouraging. Some derms focus so much on different combinations of topicals that they lose sight of what works for 
each person individually. Just because a gel doesn't work on it's own doesn't mean that adding a gel on top of it will transform my skin. This comment actually came from a dermatologist WITH a criminal record. He was giving bovine injections to patients under the counter as a cheaper alternative to botox. All so he could make a few extra bucks. He represented everything a dermatologist shouldn't be.

Me: "I have a lot of moles on my face. Can I prevent this kind of sun damage with sunscreen?"
Derm: "No. It's genetic. Sunscreen does nothing. It's genetic."
        -Worst. Derm. Ever.
Do I even have to explain the idiocy behind this one?

3. Products!
I've always enjoyed using products. I've always loved taking care of my skin, regardless of the condition it was in. 
I have pretty sensitive skin that tends to be reactive, so there are ingredients I've learned to avoid. I suffer from sensitive skin that reacts to fragrances and harsh detergents, as well as topical dermatitis when I use too many products Here are some of the products I use to maintain good skin. Basically, I like to keep it as simple as possible. I follow the basic cleanse(am/pm) moisturize/protect from sun. Plus, it's easier on the wallet. 
Full routine broken down:
AM Routine
-CeraVe Foaming Cleanser
-Skinceuticals Sheer Physical Fusion(SPF 50)
 *is moisturizing enough for my skin
 *safe enough for post procedure skin. I used it when I was on accutane, and I didn't have any problems. It is a physical sunscreen, which I prefer.
-Clinique Moisture Surge Gel(the pink one. Doesn't break me out. Love! I buy the smaller tubes because they're most cost friendly and come in hygienic packaging.)
Hair care is also important. I tend to get a lot of breakouts on my forehead/hairline. It took me a while to realize that it was my shampoos/
conditioners/sprays that were giving my breakouts. Think about it! All those fragrances and silicones are on your scalp and getting really close to your forehead.
I opt for fragrance-free shampoo/conditioners, and start washing at the nape of my neck, keeping the shampoo away from my hairline/forehead.
I like to wash my hair every other day, and use dry shampoo(fragrance free)in between. It's better for your mane anyway. Be sure to apply conditioner from mid shaft to ends. Conditioner can clog pores if it reaches your scalp or face.
-I'll either wash my hair or add a few spritzes of dry shampoo to absorb oil. 
Midday:
 My lips are dryer after accutane. I reapply balm pretty consistently throughout the day. Sometimes, I have blotting sheets on hand, as my face can still get slightly shiny. My hg of lip balms is lypsyl. It's from the drugstore, and it always heals my lips.I used it when i was on accutane and it was a godsend
I also have paula's choice lip and body balm(which I've heard good things about)and I've always loved Fresh Sugar Lip Balm SPF 15(untinted.) It's expensive, but sometimes I treat myself.  
Evening:
-CeraVe Foaming Cleanser
-If I have a spot treatment on hand, I'll dab it on larger spots.
    I have epiduo, which I prefer for all over.It's also a retina. I also have onexton, which is very strong.
-If I'm washing my hair at night, a no scent shampoo. Philip Kingsley makes a good no-scent shampoo. It is expensive, BUT it is very
difficult to find a shampoo without a stitch of fragrance, whether it be natural or artificial. Natural ones claim to be fragrance free, but 
contain essential oils. More mainstream shampoos contain detergents that can strip the hair. (Some people wonder if sulfates can cause scalp acne. I don't always find this to be the case. Be sure to use sodium LAURETH sulfate and not LAURYL sulfate. Surprisingly, a lot of shampoos that advertise
their "natural" ingredients contain the latter detergent. It strips to scalp and can make your hair produce more oil.)
Other things:
-Toothpaste!
 Not for spots, though. I've noticed that spots can pop up around my mouth if i use toothpaste high in fluoride and sls. I was experimenting with natural
toothpastes, which I liked, but they can irritate my lips sometimes. More often than not, I use colgate gel whitening. it works well and doesn't cause breakouts around my mouth.
-Makeup:
Although I've tried things like bareminerals and clinique, having bad skin has turned me off to base makeup entirely. I don't just like things sitting on my face all day if i can help it! Instead, I invest my money is quality skin care. Why bother buying a $30 bottle of liquid foundation?My sunscreen is tinted anyway.
-Dry shampoo
(It can be hard to find a fragrance free one, but make sure to find one that has fragrance listed as one of the last ingredients. Some absorb oil with the help of denatured alcohol, but I like the ones that don't contain alcohol. It's less irritating on my scalp.)
I think that's about it! In the end, it's all about finding the things that work for you, and that takes a little time for testing. i'll probably always be confined to fragrance free, gentle skin care. Also, little things like hair care and oral hygiene can play a role in the overall appearance of your skin. 

*I cannot guarantee that the products I listed will work for everyone. I recommend ding a patch test for every product you add to your routine. Ask for samples when you can!

4. Diet/Lifestyle
I'm always surprised when people with acne comment that the foods they eat aren't the cause of their breakouts. While that may be true,
certain foods exacerabate the spots I already have. For example, a spot on my chin can turn into a cyst if I consume inorganic meat
or dairy. I've narrowed down my triggers to a few things:
 *Dairy and Meats(I can eat these organically in moderation, but my skin is always better when I abstain from them.)
 *Sugar
   some people say that powdered sugar and honey are the same once broken down both broken down in your body. Personally, I tolerate natural sugars(fruit    agave, honey, organic cane sugar.) I have an inflammatory response to baked goods and white grains. If you love these as much as I do, try slowly cutting back  and adding more whole grains instead. You probably won't be able to do it all at once. 
  *Processed Foods:
  I avoid too many processed foods. When in doubt, I make sure to read the ingredient list. Keep it to less than 15 ingredient to start with, then 10, etc. Think of it this way. The less hands/machinery your food has passed through, the better. Your body has to work hard to break down all those additives, and that can mess with your skin.
I can't avoid sounding clique here. . .exercise and drink water!These two things hydrate and get your heart working. More oxygen to your extremities also means healthier, happier skin. I get a glow when I exercise, especially when I stick to a cardio routine and sweat things out. It's also good for stress levels. 

My advice: What I know to be true is that there are no quick fixes for acne. Get a dermatologist when the problems STARTS. Find one that you like, BUT remember to trust your own instincts. If it comes to taking something as heavy duty as accutane, treat your body as best as you possibly can while you're on it. Modify not just your skin care, but your lifestyle. Try to pinpoint allergies and avoid them. But, most importantly, don't let it distract you from your daily life. Take care of your skin, but your body is important, so do the things that make you feel good. Your skin is your largest organ. Who knows it better than you?