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Adult Female Acne: Dan's Regimen after Roaccutane?

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Hello everyone,

I've been using this forum as a source of information and emotional support for a long time, but recently I decided to become an active member.

This is my acne story: I am a 31-year old female and will shortly finish my (hopefully last) roaccutane treatment. I had cystic acne, never a lot at a time, but sometimes very exceptionally deep, and which sometimes took months to heal, in my face and on my back. I used to never have much success with topicals, but birth control pills cleared me up pretty much completely, and I took Dianette from age 15 until 27, until my chloasma (brown discoloration often seen in pregnant women) got so bad that I decided to go off the pill. Slowly but surely the acne came back, but I also realized that my general physical wellbeing improved greatly once I stopped taking Dianette. Gradually, after about two years, I began to see the surfacing of some deep cysts, the way I had them only as a teenager.

In January 2009 (aged 30), I finally started treatment with roaccutane for six months (my acne had been a real problem by then for a year, and, needless to say, antibiotics were completely useless): Month 1 30 mg, months 2-3 45 mg, months 3-6 50mg. My face generally cleared up nicely within the first month, with the exception of one absolutely horrible cyst on my forehead, which took more than 4 months to heal. It was unlike anything either myself or my dermatologist had ever seen. The content was completely hardened and had spread into the deepest layers of the skin, as if it had been there for years and years. An injection would have been pointless, because the inflammation was caused not by an acute infection, but by this stuff slowly being softened by roaccutane and penetrating to the surface. Fierce. There was a time when I thought it was never ever going to heal. It did eventually, but over the last two years I've had to deal with deep cysts on my back and sometimes on my forehead, which slowly, one by one, here and there, came to the surface.

At the end of the first 6-months roaccutane treatment my back was not fully clear (I had four active cysts on my back which had only surfaced in the last month, and, like the one on my forehead, they surfaced very slowly, bit by bit), but I was advised to take a break anyway, since things might still improve afterwards. And, indeed, my back cleared completely within 3 months, but once I was ready to celebrate that the battle with those cysts was definitely over another one of those acne fossils, if much smaller than the first, surfaced on my forehead! I'm now 3 weeks into my second round of roaccutane (60mg a day), and the cyst is nearly resolved, but still looks ugly and red, and will continue to do so, I would say, for another two weeks. I had no breakout this time when I started roaccutane again, and I can see that the dryness (which never really went to the extent of being a problem in my case, but got very noticeable towards the end of the first treatment) has set in earlier.

Anyway, I am hopeful and absolutely determined not to let the acne continue to eat away from my life's happiness anymore, but I also hope that I can avoid taking hormones again, as I feel that they mess things up even more and I would like to give my body a chance to make friends with itself - and stay friends - after all these years. I'm wondering if any of you who might have a similar kind of acne - deep, cystic (severe in appearance but not necessarily in terms of frequency at any given time) - have used the Regimen successfully for maintenance? I want to be able to live a normal life again, and if taking hormones is the only way I will do that, but I really don't think it should be necessary.

I was malnourished and very unfit as a teenager. There was not much body awareness where I grew up, and my family, I think, had no way of coping with my acne. My mother and one of my sisters had it too, but not as severe as I did, and it was something that was never talked about. They maybe thought that if they pretended it wasn't there it would somehow go away. The effect that had on me was that I started to totally internalize the problem, thinking it was somehow in my head, or certainly my fault. I felt huge shame and guilt about suffering from that condition. Even though I was in treatment with a dermatologist (sent by one of my classmates at school, since it didn't occur to my family that that might be a good idea) from age 13-18 approximately (I was reasonably clear by then and stopped using topicals, using just birth control pills for maintenance), I was ashamed even to trust the dermatologist with my problem, and I avoided showing him my body acne, for example. And since he wasn't even aware of the extent of the problem, we didn't really have a basis on which to discuss more rigorous treatments, such as roaccutane, which, I think now, would really have been the treatment of choice for me then. So, no good relationship with my body as a teenager, but in early adulthood I started to change that. I have never lived a healthier life than now. I know I have some endocrinological imbalances, I have hypothyroidism, for which I have been taking tablets for about 10 years, but all my lab results always come back normal these days, even last week, 2 weeks into roaccutane, everything was absolutely perfect, including cholesterol, which sometimes tends to be a bit high. I eat a healthy diet, I exercise regularly, do yoga regularly when I'm not on roaccutane (I can't at the moment due to joint stiffness from the medication).

Most of the time I'm optimistic, thinking that I am on the right path and that I will soon be able to normalize my relationship to my body again and live a (relatively) normal life, but there are days when I lose faith, simply because this has been going on for such a long time now. So, if any of you have any thoughts or advice, that would be most welcome.

Good luck to everyone on this forum with their journey.

Edited by Mara78
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I don't really have any advice for you; I just wanted to say good luck.

I've been told to take hormonal birth control for acne, and don't want to partially because of your reasons (and the risk of depression), so thanks for your story.

Edited by Addie
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Thanks, Addie, for your encouragement.

You are right to be skeptical about the use of birth control pills for acne. I've spent quite a bit of time researching this and checking other people's stories, and I've come to the realization that hormonal contraceptives only camouflage the problem. It catches up with you when you stop taking them. And they cause a lot of other problems, including depression. Looking back I would say that I was definitely depressed while on the pill, or, rather, it took away from my natural agility.

Some of the typical stories you find are of women who have been on the pill for 10, 15 years, and when they eventually want to get pregnant they can't because their bodies are so alienated from their own hormones. They need more hormones then to induce pregnancy, and are then a mess when entering perimenopause and all that stuff, for which, of course, they need more hormones.

Good luck to you as well.

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