I'm a female in my 30's. I've had acne since I was 14. It was pretty bad during my 20's but it's calmed down a lot. Nowadays, I only break out prior to my period or when I'm extremely stressed. My diet is decent, I use great products that don't break me out, and the acne that I do get tends to be superficial, non inflamed acne that goes away fairly quickly.
What's the problem, right? My problem is hyperpigmentation - I have marks on my skin from a year ago. I also have a problem with picking, but even if I don't pick, acne leaves a mark. Retin a micro works on PIH, but it's slow going.
So I don't have any active pimples, but I do have lots and lots of marks. I try getting rid of the marks with peels, azelaic acid, hydroquine etc. and while it helps it also usually brings on more acne. I try to be patient and do nothing, and that works for awhile until I break out during my period. The quality of my skin visibly changes leading up to my period - so two weeks out of the month my skin is nice and the other two weeks it's crazy-acne prone. So I inevitably get a new crop of hyperpigmentation every month. I have to wear make up, I can't go swimming, and it's very upsetting.
I've read up on everything and ultimately, the advice is that preventing acne is the only way to prevent hyperpigmentation.
So simple right? Well, I've come up with 3 possibilities, all with their own pros/cons:
1. Stick with my regular routine but prior to my period, take tetracycline to prevent premenstrual break outs. I've done this in the past and it works decently.
2. Get on spiro. I have a no hormone IUD and am not on birth control pills because I think that is what made my skin so bad in my 20s. I don't like the idea of messing with my hormones if I can help it.
3. Get on a low-dose of accutane - maybe 10 mg per day. I'm leaning towards this one, but I'll have to do this on my own as I imagine my dermatologist would not consider me a candidate for accutane.
Internet - what do you think of this? Which is the lesser of three evils?
Thank you!
I'm a female in my 30's. I've had acne since I was 14. It was pretty bad during my 20's but it's calmed down a lot. Nowadays, I only break out prior to my period or when I'm extremely stressed. My diet is decent, I use great products that don't break me out, and the acne that I do get tends to be superficial, non inflamed acne that goes away fairly quickly.
What's the problem, right? My problem is hyperpigmentation - I have marks on my skin from a year ago. I also have a problem with picking, but even if I don't pick, acne leaves a mark. Retin a micro works on PIH, but it's slow going.
So I don't have any active pimples, but I do have lots and lots of marks. I try getting rid of the marks with peels, azelaic acid, hydroquine etc. and while it helps it also usually brings on more acne. I try to be patient and do nothing, and that works for awhile until I break out during my period. The quality of my skin visibly changes leading up to my period - so two weeks out of the month my skin is nice and the other two weeks it's crazy-acne prone. So I inevitably get a new crop of hyperpigmentation every month. I have to wear make up, I can't go swimming, and it's very upsetting.
I've read up on everything and ultimately, the advice is that preventing acne is the only way to prevent hyperpigmentation.
So simple right? Well, I've come up with 3 possibilities, all with their own pros/cons:
1. Stick with my regular routine but prior to my period, take tetracycline to prevent premenstrual break outs. I've done this in the past and it works decently.
2. Get on spiro. I have a no hormone IUD and am not on birth control pills because I think that is what made my skin so bad in my 20s. I don't like the idea of messing with my hormones if I can help it.
3. Get on a low-dose of accutane - maybe 10 mg per day. I'm leaning towards this one, but I'll have to do this on my own as I imagine my dermatologist would not consider me a candidate for accutane.
Internet - what do you think of this? Which is the lesser of three evils?
Thank you!
RE option #3, the bolded part: No. You absolutely cannot take accutane on your own. You need to be monitored for LFT's etc.
Working out, taking b6, or even taking aleve during your flare time may be all you need to do. The aleve is seriously worth a try.
If that doesn't work: I think you should do option 1. It works, so you know that, and it's less risky than the other options. I do think you should try the aleve and B6 though first.
I suggest exercise because it's supposed to even out the hormones. B6 is supposed to help with PMS acne. If you work out, you'd need to do it regularly, not just pms. Maybe you already work out, but I'm just throwing it out there.
I've heard of spiro being used just around the time of one's period to control sebum production which will in turn control acne flare-ups. Although taking spiro all the time works best. It is a very mild tx...certainly better than using antibiotics every month. Have you tried a more complicated regime...like the one I am on (see below)? You may need a bit of BP to help kill the acne bacteria, along with using the retin-a. The BP will also help with pigmentation. Key here is to get your skin to where it can handle the monthly hormone change...to where your pores are unplugged eneough to handle the extra sebum that happens due to hormone fluctuations. To do that you may need a more complicated treatment regime. One that helps the skin unplug + kills acne bacteria. Talk with your derm about this.
Do not under any circumstances use accutane, even low dose, on your own. This is an extremely dangerous drug to use and has to be monitored by a doctor. Do not do it. You could get in way over your head and harm your body!
These days so much research has been done on how to effectively treat acne. As a patient you have to communicate with your derm at all times, especially when things aren't working eneough...so that the derm can modify your treatment. It takes much experimenting to get just the right mix of meds. For some people it is simple...one med does the trick. For others it can take a mix of meds. And then the skin changes over time and it takes more adjusts. This is just how it is. Don't get discouraged but talk about your concerns with your derm. The more he/she knows about your skin the better you can get treated.
I've often wondered about using something like spiro only at TTOM, but from what I've seen and experienced, it takes a long time to work, so I don't know. Do you know anyone who has tried this?
I think she should do the antibiotics since she already knows it works. Some people get IBs on spiro and sometimes it doesn't work for people.
A lot of people have had success with aleve around TTOM. There's a sticky thread on it on one of the forums here. I forget which one. I take a baby aspirin around TTOM, because spiro killed my stomach, so I feel I shouldn't be taking anything like that. The baby aspirin is such a low dose of aspirin that I feel it's my best alternative. Aleve has more medicine, so in my situation, I'm afraid about that right now. Besides, baby aspirin prevents heart attacks, so I get that bonus -- well, around my TOTM. ha.
Don't use accutane... see my post and photos. Acne is not something to hurt yourself over. I live with it successfully everyday. A lot of people don't even know I have it. My makeup routine is simple and fast. I am 29 with scars and active acne due to hormones, birth control did not work for me.
You do not have to have active cystic acne to be put on accutance. Another indication is if you are having horrible scarring. You may need to call around local dermatology offices to see which docs will treat scarring acne with accutane. Your likelihood of getting on accutane is going to be higher if you can demonstrate that you have tried everything else they usually try and are still having the same issues. Spironolactone didn't work for me. Two different derms tried it due to the acne pattern I have (lower face) but there was no significant improvement. I recommend you do whatever you feel is right for you. Everyone here will have their own opinion about what is best but remember that your body and chemical make up are unique so what works for one will not work for another. Good luck!
You do not have to have active cystic acne to be put on accutance. Another indication is if you are having horrible scarring. You may need to call around local dermatology offices to see which docs will treat scarring acne with accutane. Your likelihood of getting on accutane is going to be higher if you can demonstrate that you have tried everything else they usually try and are still having the same issues. Spironolactone didn't work for me. Two different derms tried it due to the acne pattern I have (lower face) but there was no significant improvement. I recommend you do whatever you feel is right for you. Everyone here will have their own opinion about what is best but remember that your body and chemical make up are unique so what works for one will not work for another. Good luck!
Hi, You said spiro didn't work for you.
Can I ask how much you were for taking and for how long?