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Roisin75

Last attempt to clear acne before I turn to Roaccutane

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I am at a stage where I am very close to taking Roaccutane - but very scared and would rather give topicals one really good last go before I do this.

I have been struggling with my regimen (posted below) I think that there is probably too much going on and I also think it is not effective enough considering that my acne is now moderate rather than light. I think that Differin may not be powerful enough - and my derm has said as much.

What would be the most potent/effective products and regimen I could use, not including Roaccutane? I am prepared to deal with a bit of irritation as the side effects of Roaccutane include that anyway! I am looking for something that it simple but potent!

I like the idea of topical retinoids, so which is the most effective one? What would people combine with it? I am not a big fan of bp gel as it causes me irritation (the wash I use doesn't). I have heard good things about Azelaic Acid - is that something I could use in the morning if I was using a retinoid at night?

I really want to give this one last go before I turn to Roaccutane!

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I am in the same boat--and I've used Differin gel for about 5 years... I too, have made a last ditch attempt at trying out every kind of acne product. I feel like it all just made my skin look worse--:(

Anyways, Bp really is supposed to be the most effective topical--more so than a retinol. A retinol is an exfoliant anyways, so you need some sort of topical disinfectant. I would suggest ditching the bp wash and using a bp gel (like dan's) instead. Or I guess you could use the wash, but why even bother since you're just rinsing the bp away? I believe you can use bp and differin together--though I'm not sure if your skin would like it, so use caution if you try it out.

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I have had acne for most of my life, I am now 43 years old and have always struggled with social events and self image because of it.

Recently fed up but not wanting to go on Rx's I decided a radical change was worth one last try...

I stopped ALL BP's

I began moisturizing like crazy

I added saw palmetto to try to decrease my free testosterone level

Well, I have not had a cyst in a month now. Hoping it is not a fluke. I think the palmetto did decrease testosterone and the BP was causing enough irritation that my skin was rebounding with extra oils.

Just my story, everyone is different.

Good luck

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I think tazorac is the strongest retinoid. Differin is the gentlest. There's also retin-a. Maybe try either tazorac or retin a or using 2.5% benzoyl peroxide during the day and differin at night. You'll probably need a moisturizer. My skin gets so dried out from all the bp I put on at night, but the purpose moisturizer with spf 15 I use helps some. Being on this board you may have heard all sorts of diet/holistic suggestions, if you've never tried that, it doesn't hurt to try a low glycemic/dairy free diet in conjunction with the topicals. After a few months, a stronger retinoid or a differin + bp might really make a dramatic difference. The derm might have other suggestions, there are definitely some stronger topicals that might be more helpful than differin by itself.

I used to use proactiv's oil free moisturizer and I did not find it to be very moisturizing but I did kind of like the matte look it gave. I've also been washing gently with cool water lately and find it a little soothing when my skin gets somewhat irritated from topicals.

Are you female or male? I'm fond of trying the topical route too, but I ask because females always have the hormonal route - birth control or spironolactone or both.

Edited by melissa6980

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I am at a stage where I am very close to taking Roaccutane - but very scared and would rather give topicals one really good last go before I do this.

I have been struggling with my regimen (posted below) I think that there is probably too much going on and I also think it is not effective enough considering that my acne is now moderate rather than light. I think that Differin may not be powerful enough - and my derm has said as much.

What would be the most potent/effective products and regimen I could use, not including Roaccutane? I am prepared to deal with a bit of irritation as the side effects of Roaccutane include that anyway! I am looking for something that it simple but potent!

I like the idea of topical retinoids, so which is the most effective one? What would people combine with it? I am not a big fan of bp gel as it causes me irritation (the wash I use doesn't). I have heard good things about Azelaic Acid - is that something I could use in the morning if I was using a retinoid at night?

I really want to give this one last go before I turn to Roaccutane!

you forgot to mention one thing in your regimen that is probably at the root of the issue...your birthcontrol...its everything, trust me. I thought I was safe with the copper iud, non hormonal...so wrong. My post is a few away from yours on the message board. My body doesn't like ANY type of birthcontrol that is permanent, including the pill. Read up more on people who are on your type and see if you find a common thread, Im willing to bet that you may.

Edited by andromedatpa

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Thanks for the replies everyone. I cannot decide whether to stick it out on Differin for another few months and then take the Roaccutane if there is no difference or to move to a stronger retinoid now and deal with the possible IB/scarring/irritation. After a horrible experience with Duac I am not keen on putting bp gel/cream on - though I won't rule it out, maybe a milder strength would help.

Andromedapta - I don't use any birth control! I cannot take any of the bc pills because of family medical history. A few years ago I tried the Mirena coil and had to have it removed because of acne - in fact I have often wondered if it triggered my problems. However, it has been at least 2 years since I had it removed and I am still suffering, so who knows.

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Hi Roisin75

There's a couple of things I'd recommend based on my own experience and reading lots of research. The regime and products I'm using (see at bottom) are based on research and a derm who specializes in chronic adult acne. I strongly recommend it. Generic tretinoin cream is different than Differin which is like a retinoid but not quite the same. Real tretinoin cream has tons of research to back up how it works. And it does...but it takes a long time to work --- like a year. However it's worth it. All the research backs this up. I now have totally clear skin after 30+ years of cystic acne. With tretinoin cream you have to keep on using it to keep clear skin.

I read about people using other acne products along with tretinoin cream (retin-a) but everything I have read says not to. The urge is to use something along with it in the beginning because it takes such a long time to kick in but that only irritates the skin more and then people often stop the tretinoin cream thinking it's too strong but it isn't - it's using other products along with it that's the problem. I used an antibiotic for the first year while the tretinoin cream was kicking in.

Try avoiding lotion with SPF in it. If I use SPF lotion I always break out. If I keep on using it I get cysts. Doesn't matter the brand or if it's oil-free or whatever. Use a hat instead. Interestingly, I can use mineral makeup that has SPF in it without a problem...and I do.

Never use a wash cloth - ever. Wash cloths irritate the skin. Only use fingertips and wash gently to a count of 10 with tepid (lukewarm) water. This is very important to help stop the inflammation cycle.

Hope this helps!

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Hi CVD,

Is Tretinoin the same as Retisol? I'm a 32 year old female and I've just been prescribed Retisol 0.05%. I was originally given Differin, but it scared me so she gave me this instead.

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Hi CVD - thanks for the as always, excellent advice! I think you are right about the wash cloth - I am a little paranoid about making sure all my makeup is washed off - but it is probably an irritant. I gave up anything with spf in it a couple of weeks ago, along with the SA and after a bad week last week my skin now feels a bit happier.

I really wish that 12 weeks ago my GP had given me a prescription for something stronger than Differin. When I asked her about Retin-A etc she said she didn't really know about it and that she had only ever prescribed Differin. When I finally got my appointment to see the derm at my local hospital it became clear that his main job is to prescribe and monitor Roaccuatane - he said that he thought topical retinoids would not be effective enough (my acne is moderate) - which goes against so much of what I have read on these boards!

Now I am 12 weeks into Differin - my skin's texture is improving but I'm still getting plenty of spots. So, when I next see the derm on 18th July - do I

a) Take the Roaccutane he is so keen for me to take?

b) Say I want to carry on with the Differin/Tetralysal for a few months longer and then consider Roaccutane?

c) Ask for a stronger topical regime including Tretinoin/Retin A and just accept that there will be another IB, which means basically going back to square one?

...I'm not actually asking anyone to make my mind up for me, but this is my dilemma and it is driving me round the bend!

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Good to read the stories! I am 36, a life long sufferer, all types of acne- small bumps, painful cysts, chest/back/neck, oily skin. I feel like I've tried everything. BCP tweeks (I now do not take BCP), Sprionolactone for 5 years, long term antibiotics. Years of topicals- Differin, Proactiv, Ziana, prescription strength bp, on and on.

I recently switched to a new derm who offered me accutane. I said yes, did the initial paperwork, 1st blood tests, then chickened out- found out that my insurance would not cover it, not sure if I could juggle all the appointments/bloodwork. I have tied more at-home methods- tea tree oil, scrub with salycitic acid, pure aloe gel, aspirin masks. I have seen some improvements. Still, I am breaking out regularly- never 100% clear. So, I'm with you--- what else is worth a shot? Should I just bite the bullet & go on accutane?

Good luck, hope you have some good results!

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Hi there!!!!

A little over two months ago, I was desperate to start my third cycle of Accutane... it's the only thing that's ever worked for me... I've tried all antibiotics, birth control, differin, clindoxyl, sulfacet... basically everything invented by a pharmaceutical company under the sun.

Because I'm in a new city, I was on a three month waiting list to find a doc/dermatologist who would consider writing me that accutance rx. My face was out of control and I was desperate!!!!! I was ready to pay anything for the right solution, I bought the clarisonic brush, high end cleansers, vitamins... everything.

But what has finally brought me relief is so simple. I'm on the regimen, and yes, I use BP... but hear me out, even 5% is too high. I totally have simplified my acne treating regimen... and I got it all in the drugstore..... I bought clean and clear's foaming facial for sensitive skin, I use a 4% BP called solugel 4 in a thin layer, after that dries I use cetaphil daily moisturizer over top , and if I'm too dry I use jojoba oil... for me, this has been the magical combination, I started on May 3, and now I'm completely clear and was after three weeks in my simplfied routinie. No faceclothes, no scrubbing, no products other than the one's I mentioned.

I say you need to reconsider BP, anywhere from 2.5 to 4%, and have it on constantly... watch Dan's video about how to properly use the regimen, there's a reason he made this site!!!! I'm glad I went with it... Accutance helped me with my oiliness... this won't, but it'll keep you clear and you won't have to worry about side effects... your skin will build up a tolerance to BP, mine did. BP won't help with current acne much, but it's a preventative measure, fill your pores with it, and your acne won't stand a chance... it's much more effective that retina, differin or any prescription I've tried. Can't believe my solution was so simple and in a drugstore the whole time.

I also take Vitamin D and fish oil capsules and eat foods high in zinc, I'm really happy I went this route, I no longer feel helpless, and my life is on track again.

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I think I will replace my bp wash with a 2.5 bp gel for the morning and carry on with the Differin and Tetralysal. No more wash cloth!

I don't want to give up the Differin yet - I have put 13 weeks into using the damn stuff! What do people think of this - will it be effective?

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Glad to hear you'll try the BP, I think you'll notice big results.

So will you save the Differin for applying at bedtime? I think that might work... but once you see what the daily BP does you may just want to stick with that... ; )

I noticed that you use Clinique products... I was really hoping they would work for me too, honestly, after pretty much trying 80% of the products (including make-up) in their line I only use a gel based cleanser on occassion and their sensitive skin toner.

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Hi jellybean momma --- yes it looks like Retisol is basically retin-a...just a particular brand of it.

Hi Roisin75 --- if your doc wants you to try accutane I wouldn't be afraid of it. I used it two times in my 30's and I think it helped. It's just that once I stopped it the cysts came back. I would probably give differin a chance. It takes months and months to work. It's wierd tho that your doc has never heard of retin-a (tretinoin cream). Sort of raises a red flag to me...like where was this guy trained? I'd be careful using BP along with differin. Your skin may become too irritated and then continue to break out...and you'll think nothing's working! I think the hardest thing for me over the years has been being patient and waiting for meds to work. Differin generally is used all alone.

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Hi jellybean momma --- yes it looks like Retisol is basically retin-a...just a particular brand of it.

Hi Roisin75 --- if your doc wants you to try accutane I wouldn't be afraid of it. I used it two times in my 30's and I think it helped. It's just that once I stopped it the cysts came back. I would probably give differin a chance. It takes months and months to work. It's wierd tho that your doc has never heard of retin-a (tretinoin cream). Sort of raises a red flag to me...like where was this guy trained? I'd be careful using BP along with differin. Your skin may become too irritated and then continue to break out...and you'll think nothing's working! I think the hardest thing for me over the years has been being patient and waiting for meds to work. Differin generally is used all alone.

Take a hard look at your birth control ladies...hormonal or nonhormonal. For most of us it is the root of it all. And since most of us have been using it in one form or other since our mid teens and some even earlier, its just not something we think about. But if NOTHING else you are doing is working...Its bound to be the bc, or lack of.

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Hi jellybean momma --- yes it looks like Retisol is basically retin-a...just a particular brand of it.

Hi Roisin75 --- if your doc wants you to try accutane I wouldn't be afraid of it. I used it two times in my 30's and I think it helped. It's just that once I stopped it the cysts came back. I would probably give differin a chance. It takes months and months to work. It's wierd tho that your doc has never heard of retin-a (tretinoin cream). Sort of raises a red flag to me...like where was this guy trained? I'd be careful using BP along with differin. Your skin may become too irritated and then continue to break out...and you'll think nothing's working! I think the hardest thing for me over the years has been being patient and waiting for meds to work. Differin generally is used all alone.

hi cvd,

i'm definitely on the patience-boat with Differin as well. I've been on it for 7.5 months now and dropped BP completely (only use it to the occasional spot treat in tiny ammounts). I've been on an antibiotic the first few months and that cleared me up 100%. After quitting these I'm getting some pimples again, although not nearly as bad as before I went on Differin yet..

Do you think there's still improvement to be seen from here on? I read that you need to use Differin for up to a year for it to reach it's potential. I'm determined to give it that, but on the other side having some thoughts of upping to a stronger retinoid. You seem to be experienced with it!

Sorry to hijack this thread but I think its not irrelevant : )

Best

Edited by legato

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Hi Legato - good to hear you are still on the Differin wagon!

CVD - just to be clear - both my GP and derm know what Retin-A is. It's just that my GP has never prescribed it and seems unwilling to do so because of her lack of experience with it and my derm certainly has heard of Retin-A but is very keen on me taking Roaccutane. I hear what you are saying about the Roaccutane and I think I will probably take it in the autumn if things haven't improved - but the possible side effects fill me with dread!

Regarding bp - it seems quite common to do bp morning and a topical retinoid pm - or have I got this completely wrong? My gp prescribed me Duac (5% bp) and Differin in the past. At the moment I am willing to do what is most effective while avoiding Roaccutane. The redness and soreness from bp concerns me though. I have been using bp gel for 3 mornings and the sore 'burnt' feeling is there again. If it was something that would pass eventually I would continue but I am worried that it is something I might be dealing with long-term?

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Hi Legato

I found that it took over a year for the tretinoin cream to work...to finally change how my pores function and to unplug them deep down. And it really went into gear when I upped the dose from .5% to .1% --- that really did the trick and then I was totaly clear. I'm not sure about the dosing of differin...if you can up it or not. I've been on tretinoin cream for almost two years and my skin keeps getting better and better. Not just being clear but also wrinkles are less and skin texture is smoother. I still have tiny plugs that get pushed out but they aren't like pimples...just little yellow plugs. These must have been what was at the root of the cystic acne. Before using tretinoin cream they stayed deep down in the pore and caused havoc. Tretinoin cream helps the pore lining to shed like it's supposed to and naturally push out these plugs. I remember reading research about this - about how amazed the researchers were by how effective the plugs were pushed out - and my skin had really never done this. Instead what I had was big red cystic bumps in my t-zone. Now I get these little plugs pushing out and less and less of them which says to me that after almost two years the pore lining is shedding more properly without clumping up. People with normal skin have pores that shed without clumping up and that's how my skin is starting to behave...finally. My derm says retinoids are the best meds for acne --- it's just finding the particular brand that works best with your skin. She likes the generic retin-a creams just because they're cheap and generally well tolerated.

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Thanks for your reply!

I'm on 0.1% Differin, the 0.3% is available in the USA only which is a shame really because I'm sure my skin could have handled it. Literally never had any irritation, redness, dryness with this gel. It also smells pretty nice.

I have been on Tretinoin in the past for almost 12 weeks, it was the lotion though. It didn't do anything but maybe I should have given it more time. I was younger then and didn't really research the workings of it (neither did my doctor tell me anything about it; a pity really because knowldege about a medicine may contribute to it's success I believe) and maybe should have given it a lot more time.

I can definitely relate to the "plugs". I have had lots of these in the first few months and I still sometimes get them. But the first few months I had tons of them.

Unfortunately I do still get pimples here and there. There seems to be quite some activity, on my cheekbones usually, that looks like pimples coming to a halt early or never develop "properly" (well.. "properly" if you take their side; good for me). They're either tiny tiny whiteheads or just a small red lump that isn't really sore. Once in a while I get a 'normal' pimple.

Last year I think these would have grown into a full blown pustule or nodule. At least, that's what I hope, so that would mean the Differin is working. I'm not too bothered by them (I'm used to much worse) but I'm always worried that they are a prelude to havoc.

I used to get angry, painful nodules/cysts continuously but... knock on wood.. haven't had these return yet for 5 months. I'm still attributing that to the antibiotics but they must have worn off by now (off them for 2 months now) I guess.

If my situation gets worse I would try another, stronger retinoid, altho it would feel like a waste of 7.5 months of Differin and I don't think I can handle another initial breakout again..

Roisin75: Good to hear you're going for the Differin first before Accutane. If this works to your satisfaction I'm sure you'll be happy you wouldn't have chosen for the Accutane. If it doesn't work, well, then you can still get Accutane. That's a win-win in my book!

I have also read that BP is often prescribed (am) alongside Differin (pm). They even seem to go well together at the same time, unlike other retinoids. I refrain from doing this as it kind of stings if I apply them together. I think that's what you may be experiencing too Roisin. I never had any soreness from BP, and I applied loads of it in the past. Since I'm on Differin the BP seems a lot more irritating, maybe because the skin is thinner (although that's an uneducated guess).

I'm trying to avoid irritation like the plague now, because I may have induced my last-autumn's-immense breakout myself, by overapplying BP, overwashing and squeezing. I always thought "the more the better".

Edited by legato

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Legato - my skin was so sore this morning that I couldn't face the bp gel and I had to resort to the bp wash again! This takes me back to when I was on Duac/Differin for 12 weeks and my skin was permanently sore. It looks like 2.5% gel has the same effect! I know what you mean about feeling reluctant to go through the whole process on another retinoid - I'm not sure I could do it either. I will keep my fingers crossed for you! I also really, really wish that Differin 0.3 was available in the UK - I really think it would do the trick for me.

CVD - thanks for the advice. I wish I had your derm!

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Legato - my skin was so sore this morning that I couldn't face the bp gel and I had to resort to the bp wash again! This takes me back to when I was on Duac/Differin for 12 weeks and my skin was permanently sore. It looks like 2.5% gel has the same effect! I know what you mean about feeling reluctant to go through the whole process on another retinoid - I'm not sure I could do it either. I will keep my fingers crossed for you! I also really, really wish that Differin 0.3 was available in the UK - I really think it would do the trick for me.

CVD - thanks for the advice. I wish I had your derm!

I've never seen BP wash. Is it a prescription only wash?

I'm still playing with the idea of applying Differin twice a day. Maybe I'll just pick a day and spend a month doing it and see what happens.

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I use Panoxyl 10% bp Wash, it is bought over the counter at Boots in the UK - I remember you saying you are in Europe - I don't know if they stock it where you are? It is a lot milder than the gel but a lot of people have said that they think it is probably pretty ineffective - and I think they may be right - but I have had no irritation from it. How effective do you find spot treating with bp?

I would be really interested in trying Differin twice a day too. Have you read much about this? Is it generally aproved of? I think I am right in saying that adapalene is not sun sensitive or is that completely wrong?

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I use Panoxyl 10% bp Wash, it is bought over the counter at Boots in the UK - I remember you saying you are in Europe - I don't know if they stock it where you are? It is a lot milder than the gel but a lot of people have said that they think it is probably pretty ineffective - and I think they may be right - but I have had no irritation from it. How effective do you find spot treating with bp?

I would be really interested in trying Differin twice a day too. Have you read much about this? Is it generally aproved of? I think I am right in saying that adapalene is not sun sensitive or is that completely wrong?

Yeah I wonder how it could be effective if you wash it right off..

I use the cream to spot treat and I think it's good for drying smaller spots out, although I'm not 100% sure as I haven't really tried leaving them 'untreated'. I just usually feel better putting a dob of BP on them so I know there's something going on. I used to use loads of BP (as I thought drying everything out was the way to go because I was always so oily) and that's definitely not the way to go. Irritation is really the main enemy here and BP can be irritating, I think especially if you have adult skin.

I haven't read much about Differin twice daily. I once found 1 guy on the forum who experienced major improvement after upping the dose, but it doesn't prove much of course. Everyone's skin is so different. It may be too much for one, but perfect for the other. I think it's just a matter of trying it out for a few months.

taken from http://www.hawaii.edu/hivandaids/Controlli...20Teenagers.pdf (oops that link seems to be broken now.. anyway)

1) Q: If the patient™s acne is moderate rather than mild, how do

you adjust the therapy?

Dr Amos: In such cases, I recommend that adapalene and benzoyl

peroxide be used twice a day.

2) Q: Is there any preferred manner of application?

Dr Amos: I usually suggest the patient apply the benzoyl

peroxide first, and add the adapalene on top. Again, this is

because adapalene is stable in the presence of oxidizing agents.

Some patients can tolerate both products at once.

Differin is in fact sun sensitive. But I never sunbathe anyway. I have been casually exposed to quite some sun but never had any burning, although this will be more of an issue if you'd apply it during the day.

Edited by legato

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Legato - I am seeing my derm on Monday so I will ask him about using Differin twice a day. I am a bit nervous about telling him I didn't take the Roaccutane - I have to remember that I am a full grown adult and not a naughty kid! I really want him to give me some good advice and agree to see me in the autumn. If he sends me back to my GP I will not be happy.

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