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Roisin75

Tetralysal and Differin

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I thought that I would start keeping a log - somewhat late in the day - but I thought it might be useful for others, and give me somewhere to spout all the stuff that's going on. If no-one reads, then so be it. But any advice , thoughts, shared experiences etc would be so, so gratefully received!

First of all, I am 35, female. I have mild to moderate acne. My problems started about 2.5 - 3 years ago. A year ago I had my hormones tested and they came back as normal.

So my acne was mild and not bothering me too much until about a year and a half ago. We moved house - and towns and it was an extremely stressful time. Wanting to look my best because I was meeting new people, I started wearing foundation on a daily basis. I don't know what it was - stress or the foundation, but my skin went crazy. Every since then, things have got progressively worse. About a year ago, I switched from the Chanel foundation I was using to Clinique Anti-Blemish. I have tried giving up foundation on a couple of occasions, most recently was between January and March - I found it very upsetting and depressing. Unfortunately, when I gave up the foundation I made the mistake of giving up Differin and Duac (this was my first attempt at using them between October and January) at the same time and my skin went crazy from having the retinoids etc removed so suddenly. I really shot myself in the foot! After 2 months of extreme depression and watching my skin become steadily worse, I went back on to the Clinique foundation and started the Tetralysal. 6 weeks later I started up on the Differin again. From today, I am going to start wearing Laura Mercier Mineral Powder SPF15 instead of the Clinique - or no makeup, if I can manage it.

I previously tried the combination of Differin with Duac between October 2010 and January 2011. During this time I experienced soreness and redness and continued acne - I gave up both after 12 weeks, believing the Differin to be causing the discomfort. I know now through trial and error that it was the Duac that caused the irritation and not the Differin. I also realise that I did not give Differin enough of a chance to work. I feel quite frustrated that my GP did not stress how long it takes for these things to work - when pressed, she muttered something about 6-8 weeks, which is rubbish. I had to go off and do my own research (mainly on this site) to find that 3 months is really the minimum for most acne 'cures'. Having done my research, I realised that I needed to give retinoids another really good go. I finally understood that I needed to do it for the long-term and that I would have to keep going. So I decided to go back on to the Differin, but this time without the Duac. I have posted below a list of the products I am currently using.

I am on week 14 Tetralysal - This is the one thing I am most unsure about. I have not really seen any visible improvement apart from possibly, a slight decrease in the inflammation of my acne. My plan is to give the Differin 6 months and then come off the antibiotics slowly.

I am on week 8 of Differin. About 3 weeks in I had an AWFUL initial breakout - spots all over my chin and jawline. It has slowly decreased and now my skin texture seems to be improving dramatically - very soft and smooth in certain areas. I do however, have a lot of congestion and I seem to have a lot of papules and comedones still springing up. I don't know if this is normal at this stage and I am beginning to wonder if I should be on a stronger retinoid.

I am starting Week 2 Paula's Choice 2 % Salicylic Acid Toner. Seems to make my skin softer but leaves a very oily looking film on my skin, which is frustrating because I wear it during the day - so I am walking around with a very shiny face! Would love to know if anyone has any experiences of this product and if they found it effective in the long run.

So, today the state of my skin. I have a row of 6 red, inflamed papules on the left side of my mouth (nice). On the right cheek there are 2 papules and a spot that is now going down. On my forhead there are some bumps and 3 small red papules. There is hyper-pigmentation on both cheeks and my chin and few shallow scars here and there. What is really worrying me is that I have spotted lots of new bumps and comedones around my chin and cheek area - and we all know what they will turn into - more inflamed acne. I had thought that by now the Differin would be preventing new congestion. I don't know if this is my skin's initial reaction to the salicylic acid? Strangely enough, my overall skin tone is quite even and it feels very soft and almost glowing. I really hope that this is the Differin starting to work.

Sorry for the long post. Hopefully the following ones will be a lot shorter!

Edited by Roisin75

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The top half of both my cheeks is looking great - really smooth and glowing. I have spotted what looks like the beginning of an inflamed pore up there though, so will have to see how that progresses. The apples of the cheeks are always the worst for scarring - so that would not be good.

The papules on my left are possibly coming down slightly. A couple of the spots on my right have flaked/been 'dealt with' and are going down now - lots of redness though. One really nasty papule there is just sitting there - horrible.

Quite a lot of bumps on my forhead - some of them are slightly inflamed but not 'angry'.

Still eyeing the congestion bumps on my chin warily - I really hope the bha will have some effect on them.

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The 'inflamed pores' are really freaking me out. I have had them before - not quite a papule or cyst - it is literally the skin around one or two pores that has become raised and inflamed. Sometimes they stay that way and just fade away - other times they progress into a full blown angry spot. Where there was one, I now have 3, all in the same area - the part of my cheek that I was so pleased with. It is really depressing - because if you had asked me two days ago I would have told you that it was the one area of my face that wasn't congested. Where do these things come from?! It's not like there were any bumps or anything there.

I have shelved the Laura Mercier Mineral Powder - it is shiny and on top of my shiny bha face makes me look like an oil slick! Also not enough coverage. I am ashamed to say that I am back on the Clinique Anti-Blemish foundation - I just feel so depressed if I don't wear it.

If anyone does this read this log - I would really appreciate any comments on the regimen I have going at the moment. If there are ways I could make it more effective etc.

Edited by Roisin75

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Sounds like you've got a lot going on... SA, BP, and Differin. That could be why you're getting irritation. The prescribing info for tretinoin at least says to use SA with extreme caution while on it. I've heard BP can deactivate retinoids too, so maybe don't wash with the BP in the evenings before you use the Differin?

Also Clinique Dramatically Different Moisturizing Gel broke me out something fierce when I try it, but everyone is different :)

Best of luck!

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I would take the SA out. You are on 2 prescriptions and I'm sure if it's not interfering already, it will. Best of luck. Hope your skin gets better soon!

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I had wondered about the Clinique Gel - got good reviews on Makupalley but might be worth trying something new.

I don't use the bp wash in the evening - only in the morning. It is one of the things that remained in my routine as it evolved - I don't think it has been particularly effective - maybe I should phase it out. I wouldn't say the general state of my skin is irritated exactly (apart from the spots themselves), there is no redness or flaking, if anything it feels quite soft.

I had understood that it was ok to use retinoids with SA - especially if one is used am and one pm.

I read the following on the Paula's Choice website and have read other similar opinions elsewhere:

RETINOIDS: Aside from exfoliation, prescription options for improving the shape of the pore include Retin-A (tretinoin), Differin (adapalene), and Tazorac (tazarotene). There is an immense amount of research showing these to be effective in the treatment of acne (Source: Journal of the American Medical Association, August 11, 2004, pages 726-735). Depending on your skin type, you can use these up to twice a day. You can also use these only at night in combination with using a BHA or AHA during the day. As an alternative, some dermatologists recommend applying the BHA or AHA first then applying Retin-A, Differin, or Tazorac. The thought is that the BHA or AHA boosts the effectiveness by aiding penetration of the other products.'

...but then other sources seem to be saying it is NOT ok. Very confusing. I came to the conclusion that it meant to excercise caution due to possible irritation?

I posted about this previously but nobody replied. I have an appointment with my doctor in a week so I will check then. If anyone has any experiences or opinions on this I would be very interested.

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Still very confused about the whoe bha thing. There are numerous posters on this site who combine bha and retinoids.

I have decided to cut out the BP wash - it is definitely overkill. I didn't use it this morning and I am wondering if it would be ok to just stop using it or if I should phase out gradually.

My skin feels good today! Soft and smooth - tone is good and the pores look nice and small. The inflamed pores I was worrying about seem to be subsiding. The line of papules on my left cheek seems to be going down. The spots on my right have all flaked or burst and are now healing. I have one inflamed spot by my mouth and the bumps plus a couple of redish bumps on my forhead.

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Week 9 Differin

Week 15 Tetralysal

Week 3 Salicylic Acid

Overall skin texture - soft and very smooth, it really does feel like it is glowing. The tone is very even and pores seem much smaller. I really hope that the Differin is effective because there is none of the soreness or redness that people talk about - I would hate to have to switch to something harsher.

No massive change to the congestion and papules, as one spot dies down, another inevitably pops up. I seem to be getting a lot of black heads surfacing - many of which literally just flake off or pop out. The inflamed pores died down luckily and the area on my right cheek seems to be healing up now.

I have not been using the bp wash - I hope that stopping this suddenly won't have any bad effects - but knowing my skin, it probably will!

I have resigned myself to quietly getting on with it for now. I am not expecting any miracles - but I do comfort myself with the fact that I am 2 months in on the Differin and hopefully past the worst from the IB.

Edited by Roisin75

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Week 10 Differin

Week 16 Tetralysal

Week 4 Salicylic acid

I had my appointment with the derm today. He took one look at me and told me I should take Roaccutane. He says that my acne is 'very red and inflammatory' - he also said that I am beginning to scar and he wants to prevent any more scarring.

I had been noticing an improvement in the the texture of my skin - but he is right, the overall acne situation IS a mess. The derm didn't seem interested when I said that that I felt I hadn't given retinoids enough of a chance - he basically said 'yes, but Roaccuatane will work and it is time to take some serious action.' He got me to take a pregnancy test and blood tests, gave me a prescription for Roaccutane - said he would call me in a couple of days to confirm the blood test results and that I would probably be able to start it on Friday.

I feel totally shell shocked and don't know what to think. I had completely got myself geared up for the long haul for retinoids. I had imagined that he would give me loads of advice on how retinoids work and maybe change me to something like Retin-A. When I spoke to him I was very tearful and he was extremely sympathetic - he was in no way dismissive but at the same time I am so shocked by his decisive response. I hadn't thought it was THAT bad - I have a lot of papules and pustules, one cyst (I think that's what it is) and a lot of what I had thought was HIP. I thought that it was severe cystic acne that they generally prescribe 'tane for?

I think I am going to take the prescription but I am very worried about the side-effects- especially the long-term facial flushing which seems very common.

I feel totally dazed.

Edited by Roisin75

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Had a second conversation with my derm yesterday morning. I have posted about this elsewhere so I don't want to repeat myself too much.

The long and short of it is - he thinks my acne is moderate and that because it is upsetting me so much I would benefit from Roaccutane. The scars are light at present. He thinks that Differin will help but won't be completely effective in shifting my acne.

I have come through 10 weeks of Differin and had been feeling very positive about it all. I would really like to continue - if I thought it would work. I have seen a lot of success stories/logs on Differin 0.3 and Retin-A - but I don't think I have read a single one for Differin 0.1. I am beginning to wonder if there are any success stories for 0.1 out there?

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Week 11 Differin

Week 17 Tetralysal

Week 5 Salicylic Acid

I've decided not to take Roaccutane yet. I can't face a summer of feeling unwell/down. My children break up for the summer holidays in July and I will have them full-time for 6 weeks - it wouldn't be fair on them. Maybe, come October when I have given Differin 6 months, if it's not working I will take it.

I am going to carry on as I am for now. I kind of wish that two months ago my GP had put me on a stronger retinoid - but now I am 11 weeks down the line with Differin and I think I should probably keep going.

My skin does seem quite a bit calmer. I have 3 or 4 active spots at the moment - a couple of which are more like reddish bumps' than spots. I do seem to have a lot of congestion still - the white bumps that often turn into proper spots, so I don't know what wil happen to those. The HIP really gets me down. Every time I get a new spot my heart sinks because I know how long I will have the red mark for.

About a week ago I started using the BP wash again. It doesn't cause me irritation and it makes my skin feel cleaner and softer if I use it.

Generally I still have that glowing soft feeling that seems to come with Differin.

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I am considering giving up the salicylic acid. I am sick of my face looking like an oil slick. I am also beginning to wonder if it might have something to do with all the little bumps under the surface of my skin.

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Hi

Everyone's skin is different, so all you can really do, is try things out and see how it goes. Change one thing at a time, give your skin a fair bit of time to adjust and se if it gets better.

You might want to try SA wash instead of BP one, the you could also drop the SA gel. In my experience, the best SA washes are: superdrug one (and it's cheap!) or garnier (blue bottle, white ones are also okay but really pricey :P ).

I am week 5 on differin (or something like that) and I think that differing made my skin reallyoily. I am hoping that this is just a temporary thing that will change after a while.

And yeah, all retinoids will make it so much more easy to get redmarks. There's one rule how to avoid it - do not pick. I've never really managed to do that ;) If you want your redmarks to heal quicker, some put sudocream on them at nights, you might want to give it a shot.

Hope it helps!

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Hi Helios! Thanks for the advice - interesting what you said about the Differin and the oiliness. My skin has been really oily - to the point where I haven't needed a moisuriser (unusual for me), and I thought it was down to the SA. I haven't used the SA for a couple of days and my face is still pretty oily. However, I have found that most of the under the surface bumps on my forhead have disappeared since I stopped the SA - which must mean that they were irritation bumps from the SA. We will see - I am going to stay off it for a while!

Are you going to start a log on your Differin/Tetralysal experience?

Edited by Roisin75

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I feel tired and depressed today. More spots, more bumps under the skin.

Every night I wash the makeup off my face - look at my awful skin and think 'sod this, I'm going to take the Roaccutane after all'. Every morning, I wake up and think 'no, I'll keep going for a bit longer'. I am so sick and tired of all this.

Last night my husband told me he thought I am spending too much time on this site. I know he's right - but I feel so helpless and it is my only way of coping with all this. I feel like I am stuck in the middle of a nightmare.

Crap day.

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Hi

I am sorry that you're having a crap day. Treat yourself to something nice. Or just play your favourite song aloud and dance to it. Anything that makes you feel better. Tomorrow's going to be a new day and it will get better.

I decided not to log my experience. Over the years, I've taken antibiotics, retinoids etc so many times that, well, there's not much point logging every single thing I do :P Haha, it probably sounds like my skin is terribly bad. It's not, over last few years it's always alright. With good days and bad days. I took accutane just because my skin is a bit, what's the word.. stubborn.

Here's what I would suggest for you to do - try not to change your regimen too much. Your skins has to adapt to every single change you do and it will take longer for you to see a benefit. Give oral antibiotics 6months before you quit or change to a different antibiotic. Give retinoids at least three months. When it comes to face washes, toners etc., give them at least a month. It takes patience, but it is worth it.

As I have probably mentioned before, everyone's skin is different and you have to learn those tips and tricks that work on your skin. It's a steep learning curve, I know. For example, with a skin like mine the obvious thing to do is exfoliate. Many do that and get great results. Including my sister, she doesn't need antibiotics or anything. My skin is different. Any exfoliation starts with really good results and then turns into the worst nightmare ever. The only way I could find this out, was, well, trying to exfoliate.

My point is that you've got fairly complicated regimen already, it is easy to start jumping between different products and your skin will just end up getting worse. Maybe it is worth taking a step back and starting from zero. What is your skin like? What is your acne like? Is there a lot of inflammation? Are there lot's of microcomedones? Is your skin sensitive? Not knowing answers to these questions, it is not going to be easy choosing the right stuff.

I assume your acne can be classed as moderate and inflammatory, right? So the general rule to deal with this is: Oral antibiotic + retinoid, which is what you have. Lymecycline is a great choice for antibiotic because it is easy to take and it is gentle on your tummy. However, in my experience, there are far more effective antibiotics, but they can be a real pain in the a** (excuse me :) ) to take. Differin (adapalene) probably is the best retinoid out there, it's more gentle than others too. So see, it's a good start, you're using all the right drugs.

Having said that, seems like you are struggling and that might be due to your regimen. For example, BP is greatwhen it comes to fighting acne. However, wash is not nearly as effective as cream. But there's a good reason why people don't use it - it can be irritating and it bleaches everything - hair, towels, bed linen, clothes. A complete nightmare. I fear that by using BP wash you are just getting the bad side of BP without getting the benefit. If you feel like BP is worth a shot (it is great when it comes to fighting acne), you might want to consider using it in the mornings instead of the wash (go for quinoderm 5, you don't need a prescription for this).

Face wash - most of them will have SA in them. SA is pretty good, however, it's good for mild acne. When it comes to anything more than that, SA alone is not going to do anything. Now here's the thing - I'd say that SA + BP is too much for skin. SA + retinoid can be quite good because SA actually helps retinoid work better. BP + Differin (doesn't apply to other retinoids) is alright, they work on their own. Also, if you use SA face wash you might want to complement it with SA toner.

So I'd say that you have to choose between SA and BP. The chances are that BP is going to be more effective, but it also might just be too irritating and, well, you could end up bleaching everything. Anyway the regimen could be like this:

Gentle face wash (am and pm, no BP, no SA) + Quinoderm 5 (am) + Differin (pm) + Lymecycline

Alternative is using face wash (and maybe toner) with SA and not using BP at all. Now, at first this combo will bring out lots of spots, but after a while it should get better and your skin should clear up. You have to give it a good while, though. I think that right now I am in the stage where SA + Differing brings out lots of spots, I am hoping I am going to progress to the clear phase soon :)

Finally, what keeps you off accutane? There's no reason to be scared of it. It just has lots of press (good and bad) and that's it. If you decide to go for it, wait till summer's over because it will make your skin more sensitive to sun. Yes, your lips are going to be dry like never before. Apart from that, it's great :)

Sorry if this is too long. I hope this helps. I hope you're feeling better too. You will be fine, it's just a matter of time. And now - go off acne.org and take your husband to a restaurant or do something else that will take your mind off spots and pimples ;)

Edited by Helios

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btw, duac has BP in it. You can't use it with lymecycline because duac also has an antibiotic in it and two different antibiotics at the same time is a no-no :) But that also means that you've used BP cream in the past. If your skin (and towels and clothes) could take it, I'd suggest trying quinoderm (or you can get that acne.org BP from the states). BP is going to be good for bringing the inflammation (and the bumps underneath the skin) down.

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Hi Helios - thank you so much for taking the time to reply and for giving me so much useful information - it really helps to get other peoples' opinions. I think that you are right about how complicated my regimen is. Once I have started using something I become scared of stopping - just in case I cause even more damage. I kept going with this regimen because I didn't experience any sensitivity and my overall skin feels quite smooth and soft. I tried Duac during my first attempt with Differin at the end of last year (at that point I wasn't on antibiotics), I hated Duac as it made my skin really sore. This put me off using any bp gels - a wash seemed like a good alternative. I don't know about the SA - I stopped using it last week because my skin was so shiny and bumpy - but then I have broken out really badly since I stopped.

My problem is I have been trying to work this all out by myself - my GP only prescribes Differin and antibiotics (she told me that she has never prescribed Retin-A to anyone) and the derm at my local hospital is only interested in prescribing me Roaccutane. So I am officially very confused - trying to work it out has been a frustrating business.

This last week has been a really, really bad week. I am now on week 12 of Differin and I had been fairly confident that things were beginining to improve slowly. However, I have broken out really, really badly. I seem to be going through some kind of second IB - or maybe the Differin is just not strong enough.

The possible side effects (especially the long-term ones) are why Roaccutane scares me. I am especially scared of being left with thin hair and a face that is permanently flushed and red. Howevery, I am so down about it all that I am very close to just getting on with it. I didn't take my antibiotic this morning and I am thinking of taking the first pill this evening.

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Hi

Don't be scared of Roaccutane. There are many horror stories but that's because all the people who have great results with nothing bad happening can't be bothered to share the good news ;)

If for whatever reason you don't start accutane - you can try using Azelaic acid + Differin + Tetralysal. That's what I am doing, my skin too was too irritated by BP. I think this is a good combination as Azelaic acid both kills acne bacteria, changes the skin a bit to reduce the number of comedones and it's good for healing up read marks. You will have to get a prescription. I don't know why though - azelaic acid is waay more gentle and safe than BP, for example. Even though it does so much good, on it's own azelaic acid won't be enough (just in case if you wonder).

But seeing how much you struggle with your acne and seeing that it is hard for you, I'd say talk with your derm about Roaccutane. Make a list of all your concerns and make him/her comment on all of them. I had some side effects while being on accutane, but all of them went away after the course. Only my lips are ever so slightly more dry now, but just very, very slightly. Taking roaccutane was definately worth it. Not only would I do it again, but I would also take a second course, if my skin starts acting up again. Taking antibiotics and having a complicated regimen can get very tiring, especially if you have done it for a long time :)

Keep us updated - I am sure there are plenty people reading your log but just not commenting. Your skin will get better, you just have to hold on in there and keep on fighting. I am keeping my fingers crossed :)

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Week 13 Differin

Week 19 Tetralysal

Week 1 2.5% Panoxyl BP!

First of all Helios - thank you for all your advice - I REALLY appreciate it! This forum is fantastic - I love the way there are so many people out there supporting each other.

The last week has been a rollercoaster - I have been on the verge of taking those damn Roaccutane tablets so many times I have lost count. I have given things a lot of thought and have come to some conclusions. First of all, I am way to scared of Roaccutane to take it right now - but I am not going to rule it out. I have an appointment to see the derm on 18th July and when I see him I will ask to come back and see him in October. By then the school hols will be over and I will have been on Tetralysal for 7 months and Differin for 6 - giving them plenty of time to work. If things are still bad, I will take the Roaccutane.

I am not prepared to swap Differin for another topical retinoid yet - it would mean more IB/ irritation/ scarring and I would never know for sure if the Differin would have worked. So I have decided to try and make my present regimen as effective as possible and stick with it.

I am going to take peoples' advice and swap the bp wash for 2.5% bp gel in the morning.

I am going to stay off the SA.

I am going to stop using the washcloth - this is a wrench because I am kind of addicted to it - but it cannot be helping with the general inflammation.

So, I have been using the bp gel in the morning for 3 days now. My skin feels sore and a bit itchy but not too bad at the moment.

General skin condition - nearly all of the under the surface bumps have disappeared - all over my face. The general texture is looking really smooth. My forhead is completely smooth and has only one spot on it. My right cheek has been bad this week - 3 angry spots, just in the place where I scar worst. My left cheek is pretty smooth. My chin also has a couple of newish ones. So the spots are still coming - but I cannot get over how smooth the skin in between the spots is becoming. No more congestion bumps - for now!

I know now not to get my hopes up too soon - so we will see - but my general mood so far is a little more positive than last week.

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.......Ouch!!! I spoke to fast about the bp gel. Last night my face felt like it was on fire! I remember now why I stopped using Duac, it had exactly the same effect. I had hoped that it wouldn't be as strong because the bp gel I am using now is 2.5% and Duac is 5% - no such luck.

I couldn't put the gel on this morning - I don't think it is something I can use. When I used the Duac previously, the burning continued for the full 12 weeks I was on it - I'm not sure I can take that.

So for now, I am using the Panoxyl wash again - I know, not as effective, but at least it doesn't set my face on fire. I am wondering if I could maybe spot treat with the bp gel - or is there no point? Does anyone do this?

Would azelaic acid have the same burning effect?

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BP - I curse you!!!

3 measly mornings on the bp gel and my lower face is a mess. My skin is dry, dry, dry and covered in flakes and cracks. I cannot believe the damage it has done ... and just as I was beginning to see an improvement. I feel embarrassed to go out at the moment. I was supposed to see my bank manager this morning and couldn't face it with literally a beard of white flakes all over my chin.

This is much worse than Duac, and the Panoxyl gel is weaker.

Lesson learnt.

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Hi, I've just read your log, I see your on panoxl, i just think panoxyl really damages skin in the long run, makes pores huge and doesn't help acne, I really regret taking it myself, it would be good to stop! I hope you don't mind me asking, was it your G.P that prescribed you accutane?

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Hi Reealgood - my GP referred me to a derm at my local hospital who then prescribed me the Roaccutane. I have an appointment with him on Monday - I'm trying to work out what to say to him!

The Panoxyl gel was awful! I stopped using it yesterday but today literally, about half my face has peeled off. It's going to take a while to mend the damage - you live and learn I suppose. I find that the Panoxyl wash I have been using on and off for the past few month is fine for me and actually seems very gentle - though I am sure it is not nearly as effective as bp gel.

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My Differin days are now over. The mental strain that this has been putting me under is just too much and I have decided to give Roaccutane a go. If it doesn't work for me, you may well find me back on this board.

Good luck to you all!

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