It's normal to have an initial breakout or purge with retin-a, spironolactone, etc. Spiro will take months before you see results. For me, I wasn't clear until 6 months.

I had pretty severe cystic acne and bactrim did nothing for me. However, I also didn't "purge" or get a breakout from it. If the testosterone pellet is what caused the acne, I doubt an antibiotic will do much good since it's a hormonal problem.

3 months ago I had a testosterone pellet put in my hip. I have had acne ever since. A month ago I was put on doxycycline and spironolactone along with topical retin a and clindamycin/benzoyle peroxide. Within days my face got increasingly worse until my cheeks and jaw line were covered in cysts and pimples. I figured my skin was purging. After a month I felt the doxycycline was not working at all so I went back to deem who prescribed Bactrim ds. This was yesterday and I am terrified to take it!!! Will my face purge again?????????? I leave for vacation in 2 weeks. Anyone experienced purging when starting bactrim????

I do not find Retin-A or any derivative (Differin, Duac, Epiduo, Taozorac, Tretinoin) helpful with acne. Retin A thickens the skin near the follicle which makes sebum plugs more likely. Retin A does wonderful stuff for anti-aging, but I have found it disastrous for acne skin.

I would continue the spironolactone. Also the Bactrim if you feel you need it. I did not notice any real purging with oral antibiotics. There is a little bit of a purge with spironolactone, but it does go away, unlike Retin A which basically just makes you purge forever.

Doxycycline was one of the least helpful antibiotic pills for acne, so I am not surprised it is not doing much for your skin.

Thank you for your responses..... I have read so much about retin a helping everyone, never thought that was possibly the cause of the breakouts. Do u think I should stop using it for awhile. I just started doing it every other night and the clindamycin benzoyle every other night. It was to hard to put makeup over the clin/Benz in the mornings and my face was incredibly dry!!! I started the Bactrim this morning but on 1/2 a pill. Thought if I did 1/2 a pill everyday for a week, the 1 pill and eventually 2 per day it'd be safer (all the allergic reactions I read about scared the crap out of me). Any thoughts on that?

Btw.... I am continuing the spiro.....

Thank you for your responses..... I have read so much about retin a helping everyone, never thought that was possibly the cause of the breakouts. Do u think I should stop using it for awhile. I just started doing it every other night and the clindamycin benzoyle every other night. It was to hard to put makeup over the clin/Benz in the mornings and my face was incredibly dry!!! I started the Bactrim this morning but on 1/2 a pill. Thought if I did 1/2 a pill everyday for a week, the 1 pill and eventually 2 per day it'd be safer (all the allergic reactions I read about scared the crap out of me). Any thoughts on that?

Btw.... I am continuing the spiro.....

No, you should use the Bactrim at the prescribed dose if you are going to use it all. You can actually encourage bacterial resistance (where the bacteria have time to become immune to the antibiotic, you give them just enough that they can "learn" from it without all of them dying, then they mutate to become resistant) by taking a smaller dose, skipping doses, or by not finishing the entire course.

For the topical clindamyacin/Benzoyle, if your face dries out too much, you can reduce how much you apply it. When I was on that combo, I could only use it once every 3 days.

What antibiotic finally helped you?

Thank you for your responses..... I have read so much about retin a helping everyone, never thought that was possibly the cause of the breakouts. Do u think I should stop using it for awhile. I just started doing it every other night and the clindamycin benzoyle every other night. It was to hard to put makeup over the clin/Benz in the mornings and my face was incredibly dry!!! I started the Bactrim this morning but on 1/2 a pill. Thought if I did 1/2 a pill everyday for a week, the 1 pill and eventually 2 per day it'd be safer (all the allergic reactions I read about scared the crap out of me). Any thoughts on that?

Btw.... I am continuing the spiro.....

Unlike the poster above, I did not notice any purge from spiro. From what I understand, "IB's" or "Purges" only occur with retinoids (topical or oral). Any increase in acne due to another drug is more likely an allergic reaction to the drug or a coincidence. Spiro greatly improved the acne on my body and my chin (body is completely clear, chin is much better) but did nothing for my cheeks. I've been on it for over 6 months now. I was put on Bactrim before I was put on spiro, and I (sorry if this is graphic) got an AWFUL Candida infection. It was, absolutely, one of the most painful experiences of my life, to the point that for weeks after, any weird itch or pain gave me a panic attack. This is not an exaggeration, and I am not trying to be funny. It. was. awful.

Now, with that being said, I did notice some clearing before I stopped taking the bactrim. And, of course, I don't know if the severity of my experience is a very common one.

What antibiotic finally helped you?

Antibiotics didn't finally help me. I have been on every antibiotic there is. Spiro alone is what finally changed my skin.

What antibiotic finally helped you?

Antibiotics didn't finally help me. I have been on every antibiotic there is. Spiro alone is what finally changed my skin.

Today was good, no new ones and the others seem to be drying up. Haven't used retin a in 2 days and spot treating with clindamycin benzoyle at night and morning. Taking 400 mg of bactrim........ Fingers crossed!!!!!

What antibiotic finally helped you?

Antibiotics didn't finally help me. I have been on every antibiotic there is. Spiro alone is what finally changed my skin.

Do you mind me asking your age? I ask because I'm 42 and although I've always had small breakouts (around my period), this is ridiculous!!!! I'm now taking the full dose bactrim and spiro. Hoping it will work!!! My fear is that when Im done with bactrim will my face breakout again? The testosterone should be out of my system by no later than February. Also, how long have you been on spirolactone ?

What antibiotic finally helped you?

Antibiotics didn't finally help me. I have been on every antibiotic there is. Spiro alone is what finally changed my skin.

Do you mind me asking your age? I ask because I'm 42 and although I've always had small breakouts (around my period), this is ridiculous!!!! I'm now taking the full dose bactrim and spiro. Hoping it will work!!! My fear is that when Im done with bactrim will my face breakout again? The testosterone should be out of my system by no later than February. Also, how long have you been on spirolactone ?

There are similarities between us hormonally, although I'm male. My t levels are high and I generally have been able to maintain my acne in the mild category after trying virtually everything. Doxy and bactrim did nothing for me (including many other things).

At the moment i am experiencing a breakout because I have ignored my advise over the holidays. I have been eating all the wrong food.

Try not eating anything except meat, fruit vegetables. It's very hard to follow. If you can do this for several weeks, your acne will likely improve and once improved, you can cheat on the weekends.

If you are like me, when the testosterone dose drops, the acne won't clear for a while. Testosterone converts to dht and estradiol. Dht causes body hair and male pattern baldness. Estrogen will offset some of the side effects of elevated testosterone that causes increased sebum production. So, when testosterone drops, so does estrogen and it's neutralizing effects.

This is only my hypothesis, however in my case it's true. When testosterone is high and drops, I loose the neutralizing effects of estradiol, however increased sebum production seems to drag on for a while.

I know it sucks, is painful and requires a huge amount of planning to implement, however your best for an improvement without extreme pharmaceutical interventions like accutane or birth control might be following my diet suggestion.

Good luck.