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I'm posting here for the first time (hopefully this is the right place) because I'm absolutely baffled that I have yet to find an answer to my acne. Even dermatologists and doctors are confused at the root cause of this.
First off, I've never had acne other than an occasional pimple once a month or so, up until last summer. In May 2014 I began lifting weights at home and started using Whey Protein as a supplement. I also increased the amount of protein in my diet. During the summer vacation I noticed a greater frequency in breakouts, now about once a week. However, these were small and went away in a few days. Suddenly, around early September, in a matter of weeks I had cystic acne that covered a great deal of my face. Drawing the correlation between Whey and acne I dropped the Whey from my regimen, and eventually abandoned exercising completely, thinking that a stabilization in testosterone may help. I even dropped dairy completely. I began to try different diets, everything from Paleo to Low GI to vegetarian. Nothing worked. Even before last summer I ate generally very healthily, never drinking soda, eating ice cream, etc. And yet my acne still continued to break out. And my face is incredibly oily. I can visibly see a stream of oil from each pore after a mere hour after washing my face. (sorry, it sounds kinda gross). Sure I'm SE Asian, but I've never seen so much oil on my face before.
As you can see in the pictures below I have a lot of hyperpigmentation. I am half-Filipino, have a slightly darker complexion, and I scar easily. I have been to many dermatologists, some of whom have suggested I get on Accutane. I am living out of state for school and my insurance will not cover the medicine or doctor visits unless I'm getting them from my home state so Accutane is out of the question. However, when visiting my parents for Christmas break I saw a dermatologist who believed Accutane is not the course I should take. She told me acne wasn't really a problem with me, so much as hyperpigmentation. Nonetheless she gave me Clyndamicin and Retin-A, which I have been using religiously. When I was visiting my home state of California, my breakouts were minimal, even though I ate red meat and cheese, as well as occasional fast food and instant noodles (all of which I hadn't had in months). Since I have been back to my college state I have continued to break out. While it may be easy to say its my college state that's causing acne, I've been living here for almost five years, albeit a much hotter and humid environment than what I'm used to, but only last summer did I begin to have cystic acne. Also, I've been living in the same apartment for two and a half years.
Does anyone have any idea what could be causing this? So far I have marked out diet, bad air (I live in a small town with little pollution, keep the windows open at night, even bought an air purifier), and water (I started drinking exclusively bottled water, which changed nothing). I wash my face in lukewarm distilled water and sensitive-skin Dove soap. I started using dermatologist-recommended sunscreen when I go outside. I avoid the sun as much as possible. I no longer exercise, but I am skinny, have a fast metabolism, and walk a lot at my job. I eat quasi-vegetarian diet. What can be causing my acne and oily skin?
If you can find the source I'll forever sign hymns of praise to you. Oh, and I'll buy you a lobster. As much lobster as you want.
Your skin actually doesn't look like it has too many active pimples which is good.
A few questions...
What do you eat on a typical day now?
Can you list all the things you apply on your face on a daily basis?
Do you used retin-a gel or cream? Was your skin oily before the retin-a? Did you notice an increase in oil production from the retin-a?
Does the shower where you live for school have very hard water or soft water?
Breakfast: Plain low-sugar high-fiber cereal with almond milk
Lunch: fruit + either Veggie burger, soup, leftover dinner, sweet potato, chicken, turkey sausage, sandwich, Udon or Soba noodles
Dinner: Either Asian-style dishes involving rice and plenty of vegetables, baked chicken, occasional turkey-spaghetti, scrambled eggs, soup, stir-fry. Salad every night.
Beverages: Water and ALOT of it. I drink green tea once in awhile and only one cup of coffee a day (I cut down from 2-6 cups/day). And I usually have one beer or glass of wine with dinner. (I've gone weeks without alcohol with no change)
I generally avoid greasy preparation methods, dairy, red meat, and fast food (if I eat out its usually Greek/Mediterranean food or Japanese)
I apply Retin-A every other night (any more makes my face red), as well as Clyndamicin on active spots every morning and off-night. Since this started last summer, I've tried Benzoyl Peroxide, PanOxyl, Bentonite Clay, ProActive, Tea Tree Oil, Apple Cider Vinegar, all to no avail. Currently Retin-A and Clyndamicin are the only things I use.
And I can't say I noticed a difference in sebum levels since I started Retin-A. For one, I usually don't apply it on my forehead or nose, the oiliest parts of my face, since coincidentally I break out the least in these two places.
I live in an old apartment complex that probably uses hard water, which I shower in. A month ago I started using distilled water, as opposed to sink tap water, just to wash my face, but have noticed no change.
And as some extra information, I'm currently twenty-two and while some relatives on my mom's side have very mild acne, no one has cystic acne. Acne is nonexistent on my dad's side. Also, this started in summer when it was really hot, but since the weather has gotten cold (highs in 40s and 50s, lows in 10s and 20s), there has been no significant change. New spots still show up regardless.
Your diet doesn't look bad at all. Maybe you could try an elimination diet to see if you're sensitive to something you're eating?
So you only use retin-a and clindamycin on your face? No cleanser, moisturizer, shaving cream, etc. ? I have found that for whatever reason my skin is super sensitive to most ingredients in cleansers and shaving creams. If I use the regularly like most people, I get cysts... I like cleansing and moisturizing with just a plain oil. If I stick to just that I don't get cysts.
Other than that I'm not sure what else to suggest.. If you're using the cream retin-a maybe try the gel. Or maybe you should try an entirely different retinoid like tazorac.