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What works and what doesn't

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I've had adult acne a long time and finally got it under control. I thought it might help to share my observations of what works and what doesn't so that maybe other people can get the same results. Here is what I've learned after years of research, reading books, reading forums and finally following through with a multi-pronged longterm treatment.

Basically what doesn't work is only doing one part of what has to be a multi-pronged approach to controlling chronic adult acne. So avoiding certain foods as the only approach doesn't work. Neither does using just an antibiotic or just a topical, especially if it is deep cystic like acne. Trying to follow what magazine articles say to do doesn't work either since these articles are geared towards very very mild acne due to that time of the month or late teens.

What does work is understanding why adult acne happens and why it is different that teen acne or menopausal acne. Teen acne happens because the body is overwhelmed by hormones and the pores can't adjust so clog up. Menopausal women also experience a dramatic change in hormones and sometimes get acne but it usually goes away after everything calms down.

Key here is that 80% of the population has pores that function correctly...shed properly without getting sticky and clogging up. So they might get some acne as a teen or in menopause but they clear up in a few years. They benefit from over-the-counter remedies. These are the people that magazine articles are geared for.

Those of us who have chronic ongoing acne throughout our adult life have a different problem. Our pores do not function correctly probably due to genetics or just plain bad luck. They don't shed properly, get stickly and clog up. In addition we may have skin receptors that are especially sensitive to hormones, even a normal level of hormoes and thus our skin becomes easily inflammed.

We can do all the de-stress exercises in the world, follow every diet out there, and put all kinds of lotions on our face but unless we normalize how the pores function deep down there will be no lasting success.

There are only two medications out there that actually normalize how the pores function. They are BP and retinoids. Everything else is either a surface exfoliator (scrubs, AHA's, etc.) or shuts down oil production (accutane, etc.) or affects hormones (spiro, birth control) or kills bacteria (antibiotics). These treatments definately help but still haven't normalized the pores so there usually isn't complete clearing or the treatment can only be taken for a short time over the course of adult life (accutane, birth control, antibiotics). So those of us with chronic adult acne go from one treatment to the other with flare-ups in between, scarring and lots of suffering!

The step-by-step approach that works best is this:

Mentally --- gear up for the long haul understanding that to keep adult acne under control means faithfully following treatment forever. There are no cures - just control. Stop reading magazine articles - they will torment you because they are not meant for chronic adult acne.

Find a good dermatologist --- not your regular GP or nutritionist or friend. Chronic adult acne is serious. It is an inflammatory disease that can get worse without proper treatment. Find a derm that you can confide in and who will listen to you. This is important.

Keep a journal --- write down what treatments you are using and how your skin is behaving. This will really help as you continue with longterm treatment. It also helps your derm know what is happening with your skin between visits. Emotions can cloud actual experience so keeping a log will help when progress seems slow.

Use a treatment that actually normalizes pores (Dan's BP regime or retinoids). Why? Because by normalizing how the pores function then it doesn't matter if you're sensitive to hormones or have oily skin or are genetically prone to having sticky cells. When the pores function correctly the cells will shed and the pores will stay clear...just like the rest of the acne-free population! And Dan's BP regime and retinoids can be used forever.

Try Dan's BP regime first. It will work for many people. It didn't work for me only because I finally became too sensitive to BP and my cysts were too deep...the pores were still clogging up deep down where BP couldn't reach.

Use retinoids next. They will work for all people. It takes some experimenting to figure out the best dose (5% or 1%), type (gel or lotion) and brand. But know that they work. They just take time to work...sometimes a year or two while the deep sticky plugs are working their way out.

While BP or retinoids are being used you may have to use other treatments as well to help reduce inflammation, at least in the beginning. I found that using an antibiotic really helped. Also using a very mild antibacterial soap helps. Spiro helped too. I weaned off the antibiotic and am now weaning off the Spiro. Now that my pores are functioning properly my skin doesn't seem reactive to hormones or oil, etc.

So where does diet fit into all this? I think diet plays a very important role in reducing inflammation and that is good for the whole body - not just the skin. Avoid foods known to cause dilation and inflammation such as alcohol, sugars, sweet foods, dairy, etc. Following a healthy diet helps the skin to heal quicker.

I hope this helps others. I get worried when I keep reading desperate posts from people trying all sorts of things but not following a good treatment regime. I can relate because I did that for years and years. I kept thinking this miracle soap or this miracle food or suppliment would cure my acne but of course it didn't. Two of my derms tried and tried to get me on retinoids but I was scared of them because the one time I tried them I had a bad reaction (...but I didn't follow the directions on how to use them properly either...). I read a lot of posts from people saying derms are to be avoided. I think this is a big mistake. Yes there are some bad ones out there but I'd say most of them are good. It's just that to treat chronic adult acne takes time. There are no quick results (...well yes there are - accutane and shots - but you can't do that everyday...) and it takes faith and patience to follow through knowing that within a year or two your acne will be under control.

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For me, DK's BP gel works. I can use virtually any kind of (non soap) cleanser, moisturizer, shaving gel etc. Diet for me makes no difference at all. When I was breaking out regularly I tried sugar free, dairy free, caffeine free, diets that involved eating virtually nothing but fruit and veggies, drinking nothing but water and lots of it...etc. None of which made any difference whatsoever.

Using BP gel this past six years or so, after more than a decade of suffering very persistent though mostly mild acne, skin is almost always completely clear so long as I'm using the full two pumps of BP morning and evening. I used to stick to a very strict diet and deny myself treats. And I used to buy expensive cleansing and moisturizing products. These days I eat normally. Mostly I try to eat a balanced diet but I have spells of eating lots of sugary foods and junk rubbish - my skin remains exactly the same. I use cheap supermarket moisturizer and facewash (Tesco Vitamin E range lol - if you're in the UK).

I ride a motorcycle. In the active acne days I'd get break outs on my cheeks and forehead where the helmet touched. Not a problem any more. Can touch my face, go out in all weathers, hot, cold, get dirt and oil and filth all over my face. Fine, so long as I stick to the regimen.

Which just shows how people differ. I had dermatitis for a while about 7 years ago, mostly across my cheeks just under my eyes. That was awful, burned and itched like hell. If I ate anything spicy or containing onion - worsened it considerably. Strange. But this emphasizes how there are no rules to skin conditions. Everyone is slightly different, products that work for one person make another break out. Certain foods one person can eat with no problem turn the skin of others to a blemish riddled mess.

I found derms and doctors to be mostly useless lol The one and only thing that ever sorted out my skin was BP gel and the DK regimen. I guess I'm very lucky in basically needing to do so little to keep my skin mostly under control, particularly considering that I've had adult acne for about 17 years and it clearly ain't gonna just go away any time soon.

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Hi CVD - thanks for a really interesting post. I am really hoping that Differin is going to work for me. Would you say I should give it 6 months or should I try for even longer? Just wondering at what point you can tell if a particular retinoid is not working and switch to another? I am a little worried that Differin 0.1 might be too weak for me (0.3 is not available in the UK).

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Everyone is different but at least for me it took using tretinoin cream for a year or so at .5% and having tons of plugs pushing out (causing inflammation) --- although less and less as time went on (...clue to me that it was working!...) and then my derm upped the cream to .1% and within a month my skin was clear and has been since then (6 months) except for one time when I used a SPF lotion by mistake. Had to take a weeks worth of antibiotic to calm things down. But since then have been totally clear.

I think you'll know the retinoid is working if plugs are getting pushed out. This is different than usual acne...you can almost see the plugs pushing out of the skin (wierd). Anyway this is what was seen in the original studies on retinoids and it amazed the researchers. It didn't happen right away but after 4-6 months.

I'd say keep on using the retinoid. It will work. It may just take a year or two. Personally I like tretinoin cream. It is based on the original formula of retin-a but in a cream form which is better for my skin because I'm older.

I would be concerned about using a salicylic acid product while using a retinoid. That was a mistake I made when I first used retin-a years ago. The combo burned my skin! But everyone's different and maybe your derm thinks your skin can handle it...

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Thanks cvd. I am seeing my derm on 20th June. I started using the bha just over 2 weeks ago and am not experiencing any burning. I don't really want to give up on it because my skin feels good at the moment, but another user has commented that they think the combination of bha and differin might intefere with the other - do you know if this is the case? I have read loads of stuff saying that retinoids and bha work well together.

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The only thing that's ever worked for me is the diet approach. This corrects the issue that the pores do not function properly.

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The only thing that's ever worked for me is the diet approach. This corrects the issue that the pores do not function properly.

Diet isn't the SOLE factor for everyonethough. Count yourself lucky that it worked for you!

It can be genetics/hormones. My father had horrible skin, as he got older, like 45ish, his acne just stopped mysteriously. I hope it will be the same for me. For now, I just got a retinoid, it hasn't even been a month, so I have nothing to say. :) But I have hope at least, that's something to count for.

Thank you so much to the original poster for this thread!

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Hi CVD,

Thanks for your post.

How long have you been completely clear then?

Also, I googled tretinoin cream; is this the right stuff? Do I have to get a prescription or can I just get it online like this, will it work as well? I've never been to the derm but have my first appointment this month and am thinking I'll ask for this.

Thanks for you help!

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The only thing that's ever worked for me is the diet approach. This corrects the issue that the pores do not function properly.

That's not the case for me. Diet never made any difference whatsoever. I can eat literally anything (well, anything non-toxic lol) if I stick to the regimen and almost never have any kind of significant acne issues.

Really, it's a bit like trying to pinpoint what causes heart attacks, for example. It's impossible because every case is brought about by a different combination of issues. This could be why no cure has ever been found for acne. The closest is probably Accutane, but that's like the acne version of chemo and can do all sorts of physical and psychological damage to some people.

I know someone who breaks out in huge cystic zits if they eat dairy. Avoiding that and they have perfect skin. How can that work? How do people with severe adult acne suddenly clear and stay clear for no obvious reason? Nothing about acne makes any logical sense. We're all just scrabbling about in the dark hoping we hit on a solution. Some of us find one that works for us, many don't. Plenty do more harm than good and spend huge sums on all sorts of products that do little or nothing or even worsen the problem.

None of this is helped by the drug companies who obviously aren't going to want to discover a cure-all treatment as it would mean the end of their highly lucrative and ever growing range of acne products. Or by the media obsession with perfection. If I had my way I'd open a cafe for people with acne and other skin problems. A place where everyone can relax and not have to look enviously and flawless complexions.

And maybe a TV series. Soap opera. Or rather a non-soap opera, because we all know what soap does to problem skin! Have an episode where some annoying guy with absolutely blemish free skin (and perfect hair, super white smile etc) is ridiculed for not having any spots or crooked teeth or having a hair out of place...ever. And some kindly old uncle (played by...I don't know...James Woods lol) sits down the bullies and explains that some people just don't get pimples. Yeah, it's kinda weird. Yeah, that guy washes his face using water from the river which is full of toxic waste, lives on burgers and chocolate, constantly rubs his face after handling plutonium and still...nothing. Not the tiniest of pustules or lesions. But hey, he's human too and you've got to respect him. He can't help having wonderful skin. That poor bastard lol

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Hi Tomisonbottom

I've been totally clear since January 2011. My skin is not reacting to any of the things I normally associate with flare-ups like emotions, stress, lapses in diet, etc. This tells me that what my derm said was correct...chronic adult acne is due to malfunctioning pores...period.

If the pores don't shed properly then other things can and do aggravate acne such as stress, bad diet, harsh products, etc. When stressed by emotions or bad diet or whatever, hormones are released and inflammation happens. The pore linings swell up causing the already clumped up unshedded cells to clump up more and voila --- cysts and pimples appear!

Tretinoin cream is a perscription. A derm will help determine the best strength and product based on your skin type. I'm older and have combo skin so my derm prescribed tretinoin cream. If you're younger and have all oily skin then a gel might be prescribed. It just depends and takes some experimentation. I think it's worth the money to go to a derm and get evaluated before trying to figure this out on your own. I did that for years and years - trying to figure it out on my own - and in retrospect realize I wasted a lot of time. I could've been clear years ago if I had just followed through with what the derms were trying to get me to do then (retinoids). Oh well. That's why I did this post...

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Hi Tomisonbottom

I've been totally clear since January 2011. My skin is not reacting to any of the things I normally associate with flare-ups like emotions, stress, lapses in diet, etc. This tells me that what my derm said was correct...chronic adult acne is due to malfunctioning pores...period.

If the pores don't shed properly then other things can and do aggravate acne such as stress, bad diet, harsh products, etc. When stressed by emotions or bad diet or whatever, hormones are released and inflammation happens. The pore linings swell up causing the already clumped up unshedded cells to clump up more and voila --- cysts and pimples appear!

Tretinoin cream is a perscription. A derm will help determine the best strength and product based on your skin type. I'm older and have combo skin so my derm prescribed tretinoin cream. If you're younger and have all oily skin then a gel might be prescribed. It just depends and takes some experimentation. I think it's worth the money to go to a derm and get evaluated before trying to figure this out on your own. I did that for years and years - trying to figure it out on my own - and in retrospect realize I wasted a lot of time. I could've been clear years ago if I had just followed through with what the derms were trying to get me to do then (retinoids). Oh well. That's why I did this post...

Thank you for your help!

I'll see what he says, I hope he'll let me go on it because my cysts are pretty much gone (just under the skin now, you can't see them but they don't seem to be getting bigger nor going away), don't know if they usually require it to be severe to go on retinoids? I'm thinking maybe not because people use it for wrinkles and skin discoloration even if they don't have acne, right? Also, how much does it cost? I'm sure my insurance won't cover it. Also, if this stuff does make everything come out do you think the ones that have receded under the skin will come out? Or just shrink down? I've got 5 bumps total right now and you wouldn't even know they were there except if you press down you can feel the lump under the skin.......

thanks again for you help!

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The only thing that's ever worked for me is the diet approach. This corrects the issue that the pores do not function properly.

That's not the case for me. Diet never made any difference whatsoever. I can eat literally anything (well, anything non-toxic lol) if I stick to the regimen and almost never have any kind of significant acne issues.

Really, it's a bit like trying to pinpoint what causes heart attacks, for example. It's impossible because every case is brought about by a different combination of issues. This could be why no cure has ever been found for acne. The closest is probably Accutane, but that's like the acne version of chemo and can do all sorts of physical and psychological damage to some people.

I know someone who breaks out in huge cystic zits if they eat dairy. Avoiding that and they have perfect skin. How can that work? How do people with severe adult acne suddenly clear and stay clear for no obvious reason? Nothing about acne makes any logical sense. We're all just scrabbling about in the dark hoping we hit on a solution. Some of us find one that works for us, many don't. Plenty do more harm than good and spend huge sums on all sorts of products that do little or nothing or even worsen the problem.

None of this is helped by the drug companies who obviously aren't going to want to discover a cure-all treatment as it would mean the end of their highly lucrative and ever growing range of acne products. Or by the media obsession with perfection. If I had my way I'd open a cafe for people with acne and other skin problems. A place where everyone can relax and not have to look enviously and flawless complexions.

And maybe a TV series. Soap opera. Or rather a non-soap opera, because we all know what soap does to problem skin! Have an episode where some annoying guy with absolutely blemish free skin (and perfect hair, super white smile etc) is ridiculed for not having any spots or crooked teeth or having a hair out of place...ever. And some kindly old uncle (played by...I don't know...James Woods lol) sits down the bullies and explains that some people just don't get pimples. Yeah, it's kinda weird. Yeah, that guy washes his face using water from the river which is full of toxic waste, lives on burgers and chocolate, constantly rubs his face after handling plutonium and still...nothing. Not the tiniest of pustules or lesions. But hey, he's human too and you've got to respect him. He can't help having wonderful skin. That poor bastard lol

Well eating healthily alone isn't enough for me either! The ONLY thing that's ever worked is a) eating tiny tiny healthy preferably meals and no sugars or carbs at all b) fasting.

I'm back on the paleolithic diet at the min and after one week it's beginning to reduce. My acne is severe though so it'll take a few months.

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Hi tomisonbottom --- My insurance covers the tretinoin cream...now. At first it didn't until I complained and my derm sent in records showing I had acne. At my age most people use it for wrinkles so they weren't going to cover it. But when the dose was upped to 1% I think they knew I was serious. I can see no reason why your derm wouldn't prescribe you retin-a...it's good for the skin and keeps it in good shape. It's mostly a preventative medication which is good. It may or may not make everything "come out". When my skin was purging it wasn't like breaking out but more like plugged up pores pushing out the sticky plugs. There was some inflammation but not much. Cysts I had just went down and eventually went away. I noticed that in their place that later unusually large plugs were eventually expelled. Kind of gross but I guess that's why I had cysts over and over in the same places!

Hi En Be --- I hope the paleo diet works for you. It didn't for me. As I wrote above I don't think that for most people diet alone can solve the problem because it is more about how the pores are structured than what we eat. Diet may help reduce inflammation and sebum which may in turn reduce the overall severity of acne but you also have to help the pores shed properly in order to get totally clear. I think people with very mild acne can sometimes can get clear with diet alone but for most of us more is needed because our acne is deeper. Our pores keep clogging up even if there is less inflammation or sebum.

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Hi En Be --- I hope the paleo diet works for you. It didn't for me. As I wrote above I don't think that for most people diet alone can solve the problem because it is more about how the pores are structured than what we eat. Diet may help reduce inflammation and sebum which may in turn reduce the overall severity of acne but you also have to help the pores shed properly in order to get totally clear. I think people with very mild acne can sometimes can get clear with diet alone but for most of us more is needed because our acne is deeper. Our pores keep clogging up even if there is less inflammation or sebum.

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I tried a low carb diet for almost a year and experienced less inflammation overall. But I lost too much weight and had to stop. I think it didn't work that well for me because I only eat wild fish and a bit of turkey. Too much meat causes digestive problems for me. I'm currently on a low fructose diet (was diagnosed fructose intolerant) and can only eat some berries. I also have food allergies and follow a diet for that. The special diet is helping but it doesn't totally take care of the problem. But I feel so much better following this diet...makes a world of differance throughout my body.

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I tried a low carb diet for almost a year and experienced less inflammation overall. But I lost too much weight and had to stop. I think it didn't work that well for me because I only eat wild fish and a bit of turkey. Too much meat causes digestive problems for me. I'm currently on a low fructose diet (was diagnosed fructose intolerant) and can only eat some berries. I also have food allergies and follow a diet for that. The special diet is helping but it doesn't totally take care of the problem. But I feel so much better following this diet...makes a world of differance throughout my body.

Hey CV, I was having the same trouble with digestion of meats and fat... But I found that is so because I have eaten too many carbs throughout my life and my stomach acid has become weak as a result. I took large doses of Betaine Hydrochloride and found it helped massively. I also took fiber supplements, psyllium and flax seeds, raw garlic, coconut oil and lots of raw onion too, to kill off the yeast. If it helped your inflammation then that's got to be the answer, it's just the digestion takes some time to become accustomed to it, since the problem (I beleive) is carb-induced in the first place.

Even if you eat just a few carbs with meat that can cause a more neutral stomach acid and further inhibit digestion. Vitamin C also helps with meat digestion - the more the merrier. You can even take vitamin C in therapeutic doses of up to 30g per day (my grandmother with cancer is doing this with amazing results..) I usually have half a cup of water with lemon juice, some vitamin C powder and 4-5 caps of Betaine HCl to acidify the stomach for meat digestion. If I have no lemons I use apple cider vinegar. Also drink plenty of water IN BETWEEN meals so not to dilute stomach acid. This problem is correctable over a few weeks :)

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I tried a low carb diet for almost a year and experienced less inflammation overall. But I lost too much weight and had to stop. I think it didn't work that well for me because I only eat wild fish and a bit of turkey. Too much meat causes digestive problems for me. I'm currently on a low fructose diet (was diagnosed fructose intolerant) and can only eat some berries. I also have food allergies and follow a diet for that. The special diet is helping but it doesn't totally take care of the problem. But I feel so much better following this diet...makes a world of differance throughout my body.

Also I should add, for the weight issue you just have to eat extra fat. I am quite lean on this diet too, but just eat lots of oily fish and a couple of handfuls of nuts and a few tbs of coconut oil. Eggs are good too. Plus extra vegetables - as much as possible. I usually munch through about 3 large piles of salad a day. I also find fruits not to be a good thing but perhaps a portion of brown rice would put a few lbs on you too... One dose of gluten free, low GI carbs is tolerable I think. Plus it helps you sleep well..

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What happens if you don't wait 30 minutes after washing your face to put on the tretinoin cream?

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I've had adult acne a long time and finally got it under control. I thought it might help to share my observations of what works and what doesn't so that maybe other people can get the same results. Here is what I've learned after years of research, reading books, reading forums and finally following through with a multi-pronged longterm treatment.

Basically what doesn't work is only doing one part of what has to be a multi-pronged approach to controlling chronic adult acne. So avoiding certain foods as the only approach doesn't work. Neither does using just an antibiotic or just a topical, especially if it is deep cystic like acne. Trying to follow what magazine articles say to do doesn't work either since these articles are geared towards very very mild acne due to that time of the month or late teens.

What does work is understanding why adult acne happens and why it is different that teen acne or menopausal acne. Teen acne happens because the body is overwhelmed by hormones and the pores can't adjust so clog up. Menopausal women also experience a dramatic change in hormones and sometimes get acne but it usually goes away after everything calms down.

Key here is that 80% of the population has pores that function correctly...shed properly without getting sticky and clogging up. So they might get some acne as a teen or in menopause but they clear up in a few years. They benefit from over-the-counter remedies. These are the people that magazine articles are geared for.

Those of us who have chronic ongoing acne throughout our adult life have a different problem. Our pores do not function correctly probably due to genetics or just plain bad luck. They don't shed properly, get stickly and clog up. In addition we may have skin receptors that are especially sensitive to hormones, even a normal level of hormoes and thus our skin becomes easily inflammed.

We can do all the de-stress exercises in the world, follow every diet out there, and put all kinds of lotions on our face but unless we normalize how the pores function deep down there will be no lasting success.

There are only two medications out there that actually normalize how the pores function. They are BP and retinoids. Everything else is either a surface exfoliator (scrubs, AHA's, etc.) or shuts down oil production (accutane, etc.) or affects hormones (spiro, birth control) or kills bacteria (antibiotics). These treatments definately help but still haven't normalized the pores so there usually isn't complete clearing or the treatment can only be taken for a short time over the course of adult life (accutane, birth control, antibiotics). So those of us with chronic adult acne go from one treatment to the other with flare-ups in between, scarring and lots of suffering!

The step-by-step approach that works best is this:

Mentally --- gear up for the long haul understanding that to keep adult acne under control means faithfully following treatment forever. There are no cures - just control. Stop reading magazine articles - they will torment you because they are not meant for chronic adult acne.

Find a good dermatologist --- not your regular GP or nutritionist or friend. Chronic adult acne is serious. It is an inflammatory disease that can get worse without proper treatment. Find a derm that you can confide in and who will listen to you. This is important.

Keep a journal --- write down what treatments you are using and how your skin is behaving. This will really help as you continue with longterm treatment. It also helps your derm know what is happening with your skin between visits. Emotions can cloud actual experience so keeping a log will help when progress seems slow.

Use a treatment that actually normalizes pores (Dan's BP regime or retinoids). Why? Because by normalizing how the pores function then it doesn't matter if you're sensitive to hormones or have oily skin or are genetically prone to having sticky cells. When the pores function correctly the cells will shed and the pores will stay clear...just like the rest of the acne-free population! And Dan's BP regime and retinoids can be used forever.

Try Dan's BP regime first. It will work for many people. It didn't work for me only because I finally became too sensitive to BP and my cysts were too deep...the pores were still clogging up deep down where BP couldn't reach.

Use retinoids next. They will work for all people. It takes some experimenting to figure out the best dose (5% or 1%), type (gel or lotion) and brand. But know that they work. They just take time to work...sometimes a year or two while the deep sticky plugs are working their way out.

While BP or retinoids are being used you may have to use other treatments as well to help reduce inflammation, at least in the beginning. I found that using an antibiotic really helped. Also using a very mild antibacterial soap helps. Spiro helped too. I weaned off the antibiotic and am now weaning off the Spiro. Now that my pores are functioning properly my skin doesn't seem reactive to hormones or oil, etc.

So where does diet fit into all this? I think diet plays a very important role in reducing inflammation and that is good for the whole body - not just the skin. Avoid foods known to cause dilation and inflammation such as alcohol, sugars, sweet foods, dairy, etc. Following a healthy diet helps the skin to heal quicker.

I hope this helps others. I get worried when I keep reading desperate posts from people trying all sorts of things but not following a good treatment regime. I can relate because I did that for years and years. I kept thinking this miracle soap or this miracle food or suppliment would cure my acne but of course it didn't. Two of my derms tried and tried to get me on retinoids but I was scared of them because the one time I tried them I had a bad reaction (...but I didn't follow the directions on how to use them properly either...). I read a lot of posts from people saying derms are to be avoided. I think this is a big mistake. Yes there are some bad ones out there but I'd say most of them are good. It's just that to treat chronic adult acne takes time. There are no quick results (...well yes there are - accutane and shots - but you can't do that everyday...) and it takes faith and patience to follow through knowing that within a year or two your acne will be under control.

Dear cvd,

This is the second post I've read in the few years I've been using this site that has actually encouraged me. I am 47 and have been dealing with acne on and off since I was a teen but in the last 15 years it's been a real battle with the last 7 really being true hard to cure adult cystic acne. I've tried almost everything except accutane. Currently I am in month 4 of Retin A use. I really thought it was helping but in the last three weeks I have had issue after issue. Every day I wake up with a new zit, some huge undergrounders, some juicy poppers, some that just inflame under the skin but go away leaving a really pretty scar, and some small clogged pores that just peel away (those are my favorites-no one can even tell). Today I hit a low point. I'm trying so hard to give Retin A a chance. All the research I've done tells me this is what is going to do it for me. My skin seems classic adult acne prone, very oily and given my age, I know my cells are shedding slow and gunky all my pores up. My derm really thinks this will work too but this recent breakout is testing my resolve. I was using finacia in the a.m. but I am thinking of changing to Benzaclin to get the benefit of a topical antibiotic. I'm trying to be patient and stick it out for a year but it's unbelievably depressing not to mention embarassing at my age! Thanks for your post. I'm going to print it and read it for inspiration. :)

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I think you'll know the retinoid is working if plugs are getting pushed out. This is different than usual acne...you can almost see the plugs pushing out of the skin (wierd). Anyway this is what was seen in the original studies on retinoids and it amazed the researchers. It didn't happen right away but after 4-6 months.

OMG I am experiencing the plugs coming out! I also have black heads apearing and when I get them out there is a plug under them! It's working! :)

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I'd upvote you if there were such a system, but take a bump instead.

A very thoughtful and detailed post without scaring people with a data overload.

Good work.

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Hi Tiger 1 --- It takes a really long time for retin-a to work...at least in my experience. I had to use an antibiotic along with it for the first year and a half to make it through the old plugs pushing out and causing inflammation. Without the antibiotic to help keep down inflammation I might have given up. I think using Cetaphil Antibacterial Soap for Sensitive Skin (I think that's the name...)helped too because the ingredients are incredibly mild and it helps reduce inflammation. To give you encouragement...since switching up to 1% retin-a (tretinoin cream) in Jan 2011 I have stayed totally clear except for one week when I stupidly switched from my usual lotion to Olay SPF lotion which is too thick for me so my pores plugged up and I broke out again. Had to take my antibiotic for a week to clear it up. I can totally empathize with being older and soooo tired of dealing with this issue! Send me a private post with how it's going for you. We have to give each other support!

Hi Catl --- If you don't wait 30 minutes before putting on the cream your skin will get terribly irritated and peel a whole lot more. I made this mistake when I tried retin-a years ago...that and also trying to use other acne treatments along with it. My skin blistered up! Very awful. The cream is made to go onto totally dry skin so that it's absorbed very slowly...sort of like time-released medicines. Then there's little if any irritation. I've found that avoiding irritation is very important to healing acne. I think Dan's regime emphasizes this too and the research studies support this.

Hi TexMurphy --- thanks!

Edited by cvd

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Hi Tiger 1 --- It takes a really long time for retin-a to work...at least in my experience. I had to use an antibiotic along with it for the first year and a half to make it through the old plugs pushing out and causing inflammation. Without the antibiotic to help keep down inflammation I might have given up. I think using Cetaphil Antibacterial Soap for Sensitive Skin (I think that's the name...)helped too because the ingredients are incredibly mild and it helps reduce inflammation. To give you encouragement...since switching up to 1% retin-a (tretinoin cream) in Jan 2011 I have stayed totally clear except for one week when I stupidly switched from my usual lotion to Olay SPF lotion which is too thick for me so my pores plugged up and I broke out again. Had to take my antibiotic for a week to clear it up. I can totally empathize with being older and soooo tired of dealing with this issue! Send me a private post with how it's going for you. We have to give each other support!

Hi Catl --- If you don't wait 30 minutes before putting on the cream your skin will get terribly irritated and peel a whole lot more. I made this mistake when I tried retin-a years ago...that and also trying to use other acne treatments along with it. My skin blistered up! Very awful. The cream is made to go onto totally dry skin so that it's absorbed very slowly...sort of like time-released medicines. Then there's little if any irritation. I've found that avoiding irritation is very important to healing acne. I think Dan's regime emphasizes this too and the research studies support this.

Hi TexMurphy --- thanks!

Thanks TexMurphy for your encouragement!! I was so hoping the Retin A was going to start clearing my skin after 3 months but the more I read the more I realize it takes longer with some people. Unfortunately I can't take antibiotics for a long time (longer than 10 days or so) because then I have to deal with yeast issues-basically trading one problem for another and I'd rather just try to deal with the acne since at least I can cover it with makeup if I have to but yeast is a whole different ball game-here in Florida yeast is stubborn-ugh! I recently started using Benzaclin during the day hoping a topical antibiotic will help. I was using finacea during the day but it wasn't helping and was causing the oil on my face to be worse. I'm using Dan's cleanser right now and it is very gentle but I may try the Cetaphil - I would love something to help the inflammation! My face has become pretty used to the Retin A because I started slowly and I'm very religious about using only a pea sized amount. I have learned my lesson about treating my skin gently as I've messed with a few zits here and there and it just creates a HUGE mess because my skin's so sensitive so I try really, really hard not to pick but sometimes I just get so frustrated I can't help myself. I'm going to hang in there for at least a year, hopefully the breakouts will get fewer and fewer. I do not want to try Acutane and I feel as if Retin A is my last hope......

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i am persisting with retin a after reading this thread. see my log under hormonal for spiro + retin a. I still feel my skin is bad but the photos do show progressive improvement.

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