Hi everyone,

I've read so many posts on acne.org over the years - a decade maybe? - and this is my first posting. I need help. Like so many of you, I've struggled with acne since I was in high school, and I'm 37 now. Tonight I'm sobbing and at the end of my rope.

My skin the last few years has been ok. Small, 1-2 cystic breakouts every few weeks - annoying but I could handle it. Nothing that left my skin with red marks overall. I started on 1% retinol about 3 months ago because I was getting self-conscious about my laugh lines. Oh, to have those worries back again! The retinol caused me to break out with bad cystic acne. (Same thing happened when I tried Retin-A.) I saw a dermatologist a week after I started the retinol (for an unrelated issue), and he immediately suggested spironolactone. I wasn't even seeing the derm for acne, and had only one small zit on my chin at the time - but I took him up on the offer of a prescription.

I started the spironolactone almost 2 months ago - 50mg 1x per day. It reduced my super excessive oil almost immediately. But over the last 2 months, I've slowly gotten worse and worse acne. I have cystic bumps on my cheeks - several where I would normally not break out. They show up and just STAY. I have about 7 eraser-size or dime-size cystic lumps on my face tonight, plus at least as many smaller zits, and many more red spots from fading zits (too many to count - they run together!). It is devastating to me right now. I have a first date tomorrow!

I don't know what to do at this point. This is just so hard. I'm looking for support and advice on what to do next with my meds/topicals. Maybe call my doctor on Monday to check in. I'm not really prone to scarring (other than my chin) but I don't know if this round will change that.

Here is my timeline, for those of you who are kind enough to listen to this level of detail:

June 2014: Tried retin-A for a 3-4 months for fine lines, while still using BP and salicyclic acid. Face broke out like CRAZY the whole time. Finally stopped in early Oct. Face healed fairly fast after stopping Retin-A (within 2-4 weeks?).

July 13, 2015: Started retinol for fine lines (even though I'm a former scientist and know retinol is related to Retin-A). I STOP BP in hopes it will help me tolerate retinol (what a bad idea!). Had been on BP + salicylic acid regimen for years before - mostly successful but still getting regular small, cystic breakouts for last 2-3 years.

July 20, 2015: Saw dermatologist for unrelated issue. Had one small cyst on my chin at the time. He suggests 50mg spironolactone for acne even though I didn't mention acne. (I'm relieved and also thinking, Is it that bad?)

July 29, 2015: Face is really starting to break-out from retinol, and I decide to start 50mg spironolactone per day. Oil decreases immediately. I used to run through LOTS of oil blotting papers every day. Down to 1 blotting per day almost immediately.

August 1, 2015: Yikes, I start BP again, 2x per day.

August 1-Sept. 14: Acne DOES NOT get better - and in fact gets worse and worse. My acne is always cystic/lumpy. I develop small lumps/cysts under the skin that do not go away. Mostly on my cheeks. They're different from old cysts, which would eventually come to a head and go away (sometimes over 2-3 weeks, ugh). But these lumps just keep popping up - some are VERY visible and some I can feel when I press on my skin.

Sept. 14: Switch from 2% salicyclic action lotion (using whole time) to 2% salicylic acid liquid (Paula's Choice). Hope this will dissolve the stubborn cysts but no luck so far.

TODAY: Face looks awful What do I do? HELP.