Oh god, I'm so sorry to hear what you're going through. I have cystic acne and it's horrible.

OK, well I don't know too much about spiro but it does seem late to be having an initial breakout. Some of the other girls here will be able to chime in with more knowledge, though. I did take spiro myself, but only for a few weeks because it almost immediately made me break out in numerous cysts and I couldn't bear to wait it out because I scar pretty easily.

Has ANYTHING been different the past few weeks? Diet, stress...? Changes like that can take a few weeks to show anything on your face so think back to anything that might have been slightly out of the ordinary. I spent the first few weeks of January guzzling fruit smoothies to be "healthy" and suddenly near the end of the month, I broke out in the biggest nodule I have EVER had and a handful of cysts. I haven't had nodules/cysts in two years since being on Diane 35. I immediately stopped the smoothies and have had no new cysts since then. I had no idea my acne was triggered by insulin spikes until now and I've had this type of acne for about 8 years. Any chance you've been eating anything different or changed your habits recently?

This isn't getting to the root of the problem, but will your derm give you cortisone shots for some of the worst ones you have now?

Thanks for the response.

I think-- THINK (don't want to hex it!) that my breakout is subsiding. I still seriously look like I have chicken pox because I have little scabs all over, but it has been about 24 hours since new cysts have erupted (which is a big deal, because that has not happened in 5 days). I am hoping and praying that this breakout is over.

If this is a delayed IB, I would love to stay on the Spiro. It has worked great minus this. But honestly, I don't know if I could weather another one of these. My poor hubby has been through the wringer this week with my crying and depression. This is the first morning that I woke up hopeful in a week.

I have been spritzing my face with apple cider vinegar, but I'm not sure if that's done anything or not. I also ordered DIM and would like to take it (although I'm not sure how it would interact with BC and Spiro... anyone know?)

I eat a pretty healthy diet and have eaten gluten free/low carb in the past, but it doesn't seem to help or hinder my acne. I FEEL better when I'm low carb, so I should get back on that-- but even when I did it for a year, I still had cysts (although nothing like this).

wow that is just so crazy that your face went nuts like that in such a short amount of time. hopefully this is the last of it! when my cystic acne was really bad i asked for keflex and it cleared me up within 5 days. that stuff is heavy duty but it really cleared me up quick because at that time i was really desperate. also the derm told me if the cysts got any worse (i was going to start accutane in the next month but never did due to the keflex/spiro working) that they could give me a shot of prednisone to just calm everything down so that is always an option too. i would also look into going back on the retin-a if your skin can tolerate it and if not add some sort of AHA/BHA to your regimen and that should help you out a bit.

i can feel your pain cystic acne is like the worst thing ever and seeing your skin like that really just pushes you over the edge. nobody can possibly understand it unless they have gone through it themselves. try to stay positive and know it will get better!

I'm sorry you're going through this. I was on Spiro for 3 years; even at its best, my skin looked horrible (acne marks and bruises) and it didn't help with the cysts I'd get that time of the month. I feel like it took at least 6 months to "work" and I still got multiple cysts from week to week.

Are you on new supplements? That usually caused the effects for me that you're describing; never mattered what acne drug I was on.

Doxycycline failed to work for me as a teen but in my 20s (current age) it helped. You might want to try something else.

I started taking Spironolactone in 2011 and I'm dropping it now in 2014, as it didn't work. I can't say that I ever had an initial breakout on that particular medication. And in 5 1/2 months, you ought to be over that hump. Have you considered asking for Accutane? You can continue to use birth control and Spironolactone while on it. It's a very aggressive treatment, and I've seen it work wonders on even the most stubborn acne. Mine included!

Hello, everyone-- I'm new here. I am hoping that someone can help me as I am going through a very, very tough time right now.

I've had acne cysts here and there since I was about 15 years old. Usually just one or two at a time, every few months. It was annoying, but not debilitating. During my teens and early 20s, I tried things like Retin-A and antibiotics, but the cysts were always coming back here and there. Again, though, not so much that it wasn't manageable.

After a particularly bad breakout last fall, I decided to see a dermatologist. I have PCOS and hypothyroid (Hashimoto's), so she quickly recognized the hormonal acne pattern (along my chin, behind my ears and on my upper neck). Starting in September 2013, I was put on 100mg of Spironolactone (50mg to start, but I was up to 100mg by just two weeks later) daily. I was also put on Doryx (extended release doxycycline) and Aczone topical gel.

I initially decided I didn't want to take the Doryx, both because I hate long term antibiotics and because it was like $450 a month (before my deductible was met). My skin was improving just using the Spiro and Aczone. In fact, over three months, I had about one cyst and that was it. At my two month dermo follow up, I told the doc I wasn't taking the Doryx, so she prescribed me another topical antibiotic-- Acanya-- to use as needed. I had a bad reaction to the Acanya initially, so I didn't use it much. Also, I had ZERO breakouts for the next 4 months.

Forward to five days ago. One cyst popped up. No biggie-- I just figured I was due for one. Then another. Then another. Within a matter of 24 hours, I had cysts EVERYWHERE. On my forehead, in my eyebrows, eyelids, around my mouth, all over my neck, on my nose and on my cheeks. At last count I had 51 of them on my face and neck. 51. I have NEVER had more than 5 or 6 on a bad breakout. This is, hands down, the WORST breakout I have EVER had in my life. I am absolutely broken. I refuse to leave the house. It's so bad I look like I have chicken pox.

I saw my dermo after the breakout began on Tuesday morning. She told me to just continue what I was doing, but to go ahead and start taking the Doryx (antibiotic) again. I have been taking that since Monday (I actually took one before I went in in the hopes I would nip it off at the bud). Today the breakout is still flaring, I still have new cysts forming, and my entire. Face. Hurts.

I have spent several hours just crying and sobbing because I went from being 100% clear to looking like a case for Accutane in about 24 hours flat. What in the sam heck happened?! Is the Spiro CAUSING the breakout?!

I should add that I am also on birth control (Apri-- which I have been taking forever and it has never been a problem).

Could this be a Spiro "initial breakout" even though it has been 5.5 months since I started Spiro? Or is it something else? And how the heck do I make it go away? Thank god I work from home, because if I didn't, I would have lost my job. I refuse to even run to the supermarket looking like i do.

Please, please help me.

Gram-negative folliculitis can cause an acne-like rash. It's associated with long-term antibiotics. You could have another disease that's mimicking acne, such as rosacea fulminans. Yes, rosacea fulminans/pyoderma faciale does appear out of nowhere.

If it's one of those, the best treatment is Accutane. I would definitely get those cysts checked out. It's likely you'll have to go on Accutane and/or steroids.