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Leopold

Antibiotic resistance

Hello, all.

I'm a 26 year-old male who's been suffering from mild/moderate acne since I was 15. About two years ago I began a course of erythromycin, which cleared my skin up for several months until I seemed to have an allergic reaction. I was completely spot-free, but I was getting large, fast-forming blisters on my face which pulsed red and white and faded away quickly to leave a long-lasting red mark. Yeah, the stuff that was preventing my acne caused massive red blisters on my face. Oh, the irony.

I switched to minocycline and the problem persisted, until I stopped taking antibiotics altogether. After I couldn't take any more of pimply skin, I started taking the antibiotics again, finding that I could take the antibiotics until the blisters started, stop taking them until the acne started, and then taking them again. It wasn't ideal, but I could live with it.

Over the months I've noticed that the antibiotics have become less and less effective. I wasn't getting the allergic reaction any more, but spots started creeping back in slowly. About a month ago, they were almost as bad as they've ever been.

I live in China now, teaching English, so acne is the last thing I need. Unfortunately, living here also makes getting medical advice and assistance especially difficult. I had a box of doxycycline that I'd never used, and didn't want to risk taking them in case they had expired, so I took it to the doctors and asked, through my translator, if I could switch to doxycycline. In typical Chinese doctor fashion she ignored the question, told me to eat less spicy food (the Chinese cure for everything up to and including AIDS) and gave me some Chinese medicine which has done absolutely nothing to help. I couldn't tell you what medicine it is, since the label and leaflet are completely in Chinese.

Anyway, my question is: assuming I've developed a resistance to minocycline, does this mean that I'm also resistant to doxycycline, or can I switch to this? Is there also any chance that the resistance to minocycline will decrease?

Regarding my acne: it used to affect everywhere on my face apart from the cheeks, which are still more or less clear. This meant my forehead, nose, upper lip, nostrils and chin often had large spots. Now, it's almost exclusively restricted to my lower lip and chin area. I'm getting 1-2 new spots every day, some small, some fairly large. A number of them are large and tender, but almost invisible. None of them seem to be as red as before I started the antibiotics. I'm also using BP 5% once a day, in the morning.

The minocycline is the only thing that has ever done anything to help me. I'm frankly disillusioned with acne medication and I'm sick of reading mutually contradictory "facts" on the internet ("diet influences acne"/"diet doesn't influence acne" being the most recurring one).

Anyone else who suffers with adult acne knows how psychologically debilitating it is. I can't stress how much this is affecting my confidence and self-esteem. As I said I'm a teacher and I love my job, but I never would have come to China if it hadn't been for the fact that the antibiotics had me with clear skin and a new sense of confidence. I really don't want to quit this job, but I simply can't deal with not knowing how bad my skin is going to be when I wake up in the morning. I'm so tired of living my life according to the whims of this condition.

I will really appreciate any advice you can give me. Thanks in advance.

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It is probable that your body has built up a tolerance to the antibiotics and if it has, then switching types isn't going to really matter since they're all "broad range". I imagine the climate there is not helping matters any either. It is more humid, yes? Ugh. Seriously, the only thing I can think of to aid with that is to drink as much water as you possibly can. If the doctor is against prescribing another antibiotic, do you think you could coax her into giving you a topical tretinoin like retin-a for increased exfoliation? I'm at a loss. I can only imagine your frustration.

I think there are so many conflicting claims regarding acne because there are so many different reasons as to why people are afflicted. I know there's someone on this board whose acne is triggered by citrus. For some, it's dairy products. For some, it's nicotine. For some, it's too much oil production. For others, it's stress. Etcetera. Etcetera.

I sincerely hope you get more cooperation out of the medical staff while you're there. What a neat opportunity you have though. Do you foresee yourself becoming fluent in Chinese? How long are you there? Perhaps you can end up having your own one on one "discussion" with this doctor and make her see things your way? ;)

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I was planning to stay longer but with this resurgence of acne, I don't know if I can do it. Hence my utter frustation. I will have to leave something I love and go back to a country I don't care for and a job I will most likely hate, but where I won't have to deal with people face-to-face all day. I have two choices- find something else that works for my acne, or learn to live with it and not let it affect my confidence. Both are easier said than done.

The climate here is not especially humid- I'm in central China. It gets hot in the summer, but not really humid.

I really am at my wit's end. I can't stop thinking about how deeply unfair it is to still have this crappy condition in my mid-20's, when all of my colleagues have perfect skin.

EDIT- just took some pictures. I should take pictures more often instead of looking in the mirror- it doesn't look anywhere near as bad this way. I should stress that all of the spots, with the exception of the one in the corner of my mouth, have already peaked and are disappearing. I'm interested to ask- what kind of spots are these? Are they cystic? I ask because I've been looking around the forums and have never suffered from the small papules or whiteheads at all, only yellowhead spots or large, red bumps.

Edit edit- Gah, won't directly link. I'll just post the link instead.

http://i103.photobucket.com/albums/m138/Ji...um/HPIM0281.jpg

http://s103.photobucket.com/albums/m138/Ji...nt=HPIM0280.jpg

http://i103.photobucket.com/albums/m138/Ji...um/HPIM0277.jpg

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the good thing is you don't have scars. thats what my acne looks like too i dontreally know what it is but i know the frustration you feel. i can't even go to the job interview of my dreams that they called me about because i'm so flared up. it makes me feel more adolescent. have you tried any topicals besides bp?

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I have had similar experience to yours--antibiotics helped a bit then my body became "acclimated" to them and the meds effectiveness decreased. I think success over acne with antibiotics is short lived.

I've had success with taking zinc(no more than 100mg a day or it is toxic to your body), a multi-mineral supplement(to aid the zinc you need copper and maganese), alpha lipoic acid, and omega 3/6...the zinc especially helps. I don't know how much access you have to these supplements but you can order them online or try to include more foods in your diet that contain these vitamins/minerals...

but everyone is different--sometimes dietary changes really help folks(often due to allergies) others not..experiement and see what happens.

good luck.

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The problem is that since I'm in China, I don't have access to a lot of treatments that I would in the west. I don't even know if I can get hold of vitamin supplements and the like, and explaining it would be a nightmare.

Shaved this morning and took some more pictures. It's even worse today...

http://i103.photobucket.com/albums/m138/Ji...um/HPIM0284.jpg

http://i103.photobucket.com/albums/m138/Ji...um/HPIM0283.jpg

There MUST be a reason why it's affecting my chin and mouth only. It's driving me crazy. The rest of my skin is virtually flawless.

Can anyone confirm that this is cystic acne? The spots tend to be fairly large and tender, although I do get smaller yellowheads too.

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Hmm...it does appear to be cystic, but I'm no expert. Honestly, I was expecting worse, but I'm sure you don't want to hear that. You just want to make it better which is totally understandable.

Are they quite holistic over there in China? I wonder if there are some things you could try by working with an herbalist or something, you know? For instance, drying oils or masks; some people swear by aspirin masks. Surely you can get aspirin (I hope!).

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Do you touch your face a lot? That's the only explanation I could think of for why only your chin is breaking out...then again it could be stress related.

Honestly I think you need to be resourceful and creative to find a solution...I lived in Thailand and Vienna for several months in both places and learned quickly to befriend bilingual folks who were familiar with the area. You could also have a friend or family member mail them to you...most zinc supplements are relatively cheap and lightweight to mail. I don't know how rural the area is but if you have access to email/internet than I'm sure you can figure out a remedy. For now I would pay attention to your diet, stress levels, and how often you touch your face...to see if there is any connection.

good luck...keep us posted.

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Honestly, looking at the pictures, your acne doesn't look all that bad. I know that not having a clear complexion can be depressing, but it could be a whole lot worse.

I am speaking as a mom. I also, want you to be aware of the devastating side effects that minocyline can have. My healthy 18 year old daughter developed a disease called drug-induced autoimmune hepatitis as a result of taking minocycline for acne. I also now know that minocycline can cause drug-induced lupus.

It is important to be aware of the possible side effects that drugs can have and to weigh the risk versus the outcome. For my daughter, the minocycline provided only minimal improvement in her acne. What it did for her was to give her a possibly lifelong disease. We are hoping that because it is drug-induced, it won't be lifelong, but we won't know for a very long time. She now has to take prednisone for the inflammation in her liver and has had one liver biopsy and will have another in June. All a result of an acne drug.

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:( I certainly don't want to screw myself up for life, but the minocycline (and before it, ehrythromycin) was the only thing that kept the spots off completely.

I know it doesn't look all that bad outside of my head, but it really knocks my confidence, and the kids I teach certainly notice, which undermines my confidence in the classroom as well. I just want it to stop.

I'm researching the hell out of this on the internet. I've heard that a low-GI diet can be good for acne, so I'm going to give that a go and see how it pans out. Thanks for your support, it's really appreciated.

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Unfortunately I don't really have any advice for you, but I just wanted to let you know I'm basically in the same situation as you are. I moved to Japan last year (from Canada) to start teaching English, and about a month after I came here my skin started to get worse and worse, and it hasn't improved at all since then :( I love my job, and I love being here but this has completely destroyed my confidence, and somedays I consider leaving everything I have here (including a great boyfriend) to go back home so I don't have to face people everyday. :( Like how lame is that?!! I wish you the best of luck, and hope we can both find a way to beat this!

Shaara :)

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Sounds like we're both in the same sucky situation. Best of luck, I hope you beat the urge to pack it all in over your skin. I'm trying to do the exact same thing.

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How are you doing today, Leopold? Did the past week result in any improvement? Just checkin' up on ya.

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Hey Leopold,

Just wanted to say that I know what you're going through. I always had moderate acne but 6-7 months ago it flared up into large painful cysts all across my cheeks and forehead, which was quite embarrassing considering I had to go to work and knew that people were probably wondering what the hell was wrong with me.

I know you probably hate hearing it, but your current breakout really does not look that bad. In fact your cheeks and forehead seem pretty clear to me and thats what people notice the most. My advice to you is to simply wash VERY GENTLY twice a day with a very mild cleanser...maybe its just me but I would avoid trying to put too much stuff on it or take a bunch of different supplements, for me it doesn't help and often makes things worst.

Your work seems to be an amazing opportunity and it would be a shame to throw it all away for something that may appear worst to you but not to others (you even mentioned yourself that it does not look as bad in pictures). My advice to you is try to stay away from the mirrors, anything that reminds you of it only adds unnecessary stress. Try to remember that the rest of your face is quite clear (a luxury that some...including myself...do not have) and that pimples around the chin and mouth are quite common and many people get them, therefore people are least likely to pay much attention to them. Focus on the positive things you bring to your work and also how lucky you are to discover an exciting country (in five years when your chin is all cleared up, you won't want to remember this experience as a depressing one).

But whatever you do hang in there. As crazy as it sounds acne can make you stronger and even more confident. When you look back and say to yourself "I still showed up for work everyday even though I was embarrassed, and I still looked everyone in the eyes even though I felt uncomfortable doing so" then you'll realize how strong you are.

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antibiotic resistance builds up because some bacteria will have ab resistance genes and what happens when you take abs is you kill off all the ones who do which then shifts the balance in the favour of the ab resistant ones which then multiply and...you get the idea (selective pressure)

different abs have different modes of actions which means that bacteria which are resistant to some abs may not be resistant to others depending on their genetic constitution so yes if you switch to an ab with a different mode of action then it should work for a while at least (in theory)

A good way to avoid or at least minimise the extent of resistance is to never stay on an ab for too long. There are specific guidelines for each antibiotic which I am not too clear on and unfortunately many GPs do not seem to be aware of them either. Usually the drug companies will publish guidelines based on their own clinical trials and experimental observations. Its worth searching on the internet but make sure you look at medical sources not just random net blogs or something.

ab resistance is a scary problem. Its realistic to expect that in a couple of decades we will be in the same position (in terms of life expectancy and consequences of infection) as we were before penicillin was discovered because we have overused abs so much that it gets to the point where 90% of bacteria is resistant.

p.s not that this will make any difference because it never does when people say it to me either - but apart from the odd pimple your skin is quite lovely especially for a boy. You have a very nice skin tone

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