Hello! I've been creeping around this website for a while, and I finally decided to post in here. Acne is definitely such a stressful psychosocial issue, so I think that keeping a log and getting feedback/encouragement/tips from you guys would be beneficial. And when (hopefully) my acne clears up, maybe this log can be *inspirational* for some of you.
So here is my obligatory sad backstory:
I am 23 years old. I started getting acne when I was around 13 years old. Mostly big, painful, inflamed pimples on my forehead and chin, and horrible cysts on my back. I tried Retin-A, tetracycline, then minocycline, none of which had any effect on my skin. Finally, in 10th grade, I went on a round of Accutane. My skin cleared up brilliantly, but then the acne returned within a few months. So I went on a second round of Accutane. Then, like clockwork, in about three months the acne returned (though it wasn't as severe as it had been previously). Instead of trying a third round of accutane, my doctor started me on Bactrim and Spiro, as well as topical Benzaclyn and Differin gel. This little cocktail worked like a miracle- my skin was crystal clear. Not even a clogged pore. I remained on this combination til probably my sophomore year of college. (Quite a long time to be on Bactrim. I thought nothing of it then, but now, being a nurse, I know that extensive use of antibiotics is bad, bad, bad.) Anyway, in my sophomore year of college, my skin was absolutely perfect, so my derm slowly weaned my off the Spiro and Bactrim. My skin was fine for a while, but then, of course, the acne returned. This time, I was started back on just Spiro and my topicals. Perfect skin for a couple more years. Then, my senior year of college (last year), I weaned off the spiro again.
I graduated college last May and had a really difficult time finding a job. I think the stress of being done with college, having to start my life as a "grown up", and having such difficulty finding a job brought on a lot of stress that eventually triggered the return of my acne. By October 2011, I had huge, inflamed pimples on my cheeks, my chin, and along my cheekbones during my period. Everything would get worse around the time of my period. I finally found a job, though, so I thought that maybe having some stress lifted off my shoulders would allow my acne to calm down. I tried a lot of over the counter treatments- Olay's acne system, some Clinique products, face masks, etc, but with little success. My skin has this cyclic behavior where it gets really terrible the week before my period, then starts to clear up after my period. Every time my skin would start to get better, I would think that maybe my acne was finally going away, but then the cycle would continue.
Finally, in January I found a derm (I had moved to a new city for my job, so I couldn't go back to my usual dermatologist). It was a derm office in the city- very busy, and the dermatologist seemed like he had little time for me. I explained to him that my acne was mostly hormonally influenced, and what had worked for me in the past. Without really listening to me, he placed me on doxycycline and retin-a cream and told me to come back in three months. Two months later, my skin was horribly irritated from the retin-a, and I had developed a ton of little bumps all over my forehead and cheeks. I had never experienced this before- they weren't really pimples, just tiny little bumps filled with a hard, waxy substance. Weird. So I went back to the derm. He simply told me to come back in a few months because the doxy and retin-a hadn't taken effect yet. Annoying. I knew that my acne was mostly hormonal, and I had heard that birth control could help clear acne, so I made an appointment with an OB-Gyn and started BC- Lo Loestrin Fe.
In April, I made an appointment with an Accutane specialist who I heard was really, really good. I explained my entire history to her, and she actually LISTENED and understood how stressed out and frustrated I was. She told me to immediately stop taking the doxy. She felt that since I had been on so many antibiotics in the past, the usual amount of bacteria in my body had been suppressed and I was actually possibly developing a fungal infection (the tiny little bumps on my face). She explained that she could put me on Accutane again and it would certainly clear my face, but the acne would eventually return. Instead, she explained, we would need to address the actual cause of my acne- hormones. She told me to continue with my BC (Lo Loestrin Fe), and start and Spiro (25mg daily). I also started using Ketoconazole cream (for the little fungal bumps on my face), a sulfur shampoo (like a dandruff shampoo- she explained that if there was any dandruff that I couldn't see on my scalp, it could actually get on my face and shoulders and clog up my pores), a sodium sulfur face wash (supposed to help with the bigger pimples), and another topical gel containing treitoin and clindamycin, I think. She told me to come back in two months.
After two months of using this system, I've noticed very little improvement in my skin. My skin still gets terrible the week before my period, then starts to clear up a little, and then gets bad again. My bigger pimples seem to heal up a little faster, though, and I have noticed a decrease in the acne on my back and chest. It's still incredibly disappointing because in the past, spiro has worked WONDERS for me, and relatively quickly. We're talking clear skin in like two weeks. So I made my two month follow-up appt with my derm on Monday. At this point, I was breaking out BADLY and she seemed genuinely upset that my skin hadn't cleared. She explained that with birth control, your hormones don't really start to regulate until after your third period. I had just finished my third pack, so I'm hoping maybe in the next couple of weeks my hormones straighten their shit out and I start to see improvement. She also increased my Spiro dose from 25 to 100 mg/daily. I also explained to her that the ketoconazole cream had done nothing for the tiny little bumps on my forehead and cheeks. She explained that if they were fungal, the Keto cream would have certainly cleared them up, so they might just be little plugged up pores/whiteheads. She told me to start using a Neutrogea salicylic acid face wash instead of my gentle cleanser, and that might help. She also DC'd my treitonin/clinda topical gel and started me in Differin and made an appointment for me to come back again in 8 weeks. She seems hopeful that my inflamed, hormonal acne will be pretty clear by then, and if I still have the tiny little plugged pores at that point, I can do a couple chemical peels with her.
So I am on day 73 of Spiro (but only day 2 of being on 100 mgs). I currently have three HUGE, red, inflamed pimples on my forehead that are starting to heal, three big (healing) ones on my right jawline, and one under the skin type right smack dab on the middle of my nose. I am NOT touching that one, and praying that it doesn't become red and inflamed. Another problem that I have is picking. I will sit in front of the mirror for an hour, examining every single pore on my face. It's pathetic how consumed my mind has become with my skin. I hate that I've become this way. It's seriously like a psychological disorder how obsessive i am. UGH.
Anyway, I am going on vacation with my boyfriend to visit his family in LA next Friday, for two weeks. There will certainly be beaches and pools and bathing suits involved, and I am so nervous about being seen without makeup/having body acne. I am really, REALLY hoping that my skin starts to clear up by then. At least the stuff on my back. Ugh. But I am super hopeful with my increased dose of Spiro. I'm just wondering why, this time around, it's not working as quickly as it has in the past? Is it possible for my body to develop a resistance to spiro?
Ahh sorry this has been so long.
Here is my current routine if anyone is interested:
Morning:
Shower- wash face with Neutrogena oil-free salicylic acid wash. Wash shoulders/chest/back with Neutrogena body clear acne scrub.
-Clinique oily skin toner
-Olay combination skin UV lotion
-Makeup- clinique foundation and Maybelline concealer. I HATE wearing so much makeup, and I know that it's clogging my pores, but if I go without makeup I look awful. Any suggestions on foundation/concealer?
-50 mg Spiro
Evening:
-Wash face with neutrogena oil-free salicylic acid wash
-Clinique oily skin toner
-Differin gel to face, chest, back
-BC
-50 mg Spiro
ALSO! I have a bunch of hyperpigmentation marks from old acne on my cheeks. This never happened when I was a teenager. I'm Italian and have dark olive skin, so these marks are pretty dark. Not pitted scars or anything, just reddish marks that don't go away. Does anyone know of any products that can help fade these?
Feel free to post your own Spiro experiences in here! I will try to keep updating.
Your body won't develop a resistance to spiro. Spiro basically mutes the androgen receptors in your skin so they can't respond and create acne. But it will not CURE your acne. As soon as you go off the spiro and it exits your system, you will breakout again. I talked to my derm about this and she said many people have been on spiro for decades without ill effects.
As far as I know, the only CURES for acne are:
1) Accutane, because it actually shrinks your pores. But as you have experienced, it doesn't fix hormonal acne.
2) Identifying your hormonal triggers and creating a perfect lifestyle and diet that never triggers an acne response.
I tried #2 for a long time, but after years of failure, realized I don't have enough time/money/intelligence to figure out why my hormone levels are out of whack. So I went on 100mg/spiro. After 4 months, I am almost into that "only scars left" stage. Only downsides for me have been about 5-7 pounds weight gain. Makes sense, since less androgen response = lower metabolism, less muscle mass. I tried going down to 75/mg to get rid of the weight...but I broke out. 100/mg seems to be my magic acne number.
By the way, my face sucked until month 3. It took a lot of patience to believe that the spiro was doing anything worthwhile.
For reddish marks, well, that's what Differin is for. I was on Differin for years, but my derm recently bumped me up to a stronger retinoid. My older scars were not responding at all to the Differin.
Your birth control is affecting your hormones greatly. Your dosage of spiro may have to go up to counteract any androgen activity your BC is creating. I'm on a non-hormonal copper IUD so fortunately I don't have to deal with two medications altering my hormone levels.
I'm going to include something I posted elsewhere....honestly I think vitamin D-3 is extremely relevant to most people with acne. Especially body acne.
How much sun are you getting? The FDA vitamin D-3 requirement is 400 I.U., but there is new research suggesting that that is a very bare minimum. You won't get rickets with 400 I.U. but your body needs more than that. I would say AT LEAST a full 30 MINUTES of sun exposure DAILY if you are pasty white like me...a lot more if you are darker skinned. Or supplement with at least 10,000 IU vitamin D-3.
It's important that it's D-3...foods that "contain vitamin D" are often in D-2 form...which is different.
A study on vitamin D-3 and acne summary:
Of the 132 acne patients he studied, 28% were much better at three months. 47% were healed at three months.
Here is the doctors summary:
I believe I may say that at no time in my dermatological experience have I felt such complete satisfaction with a treatment as I have with the cases of this series. I know that vitamin D is an imperfect weapon to slay this disfiguring disease, but it undoubtedly gives one a feeling of being well defended. From the patients viewpoint, it has left little to be desired, as they find themselves improving, both in appearance and in general well-being. Many have expressed the sentiment, Never felt better.
The last time I had a summer vacation where I got a lot of sun exposure I cleared up almost 100%. Remember SUNSCREEN WILL BLOCK VITAMIN D-3 PRODUCTION. I burn easily, so I rely on Vitamin D-3 in pill form.
Day 77 of Spiro (Day 6 of 100 mg)
So this past week I had the WORST skin I've had since going on Accutane in high school. A few terribly inflamed pimples on my forehead (I usually don't break out on my forehead), a couple along my jawline (standard), and one cyst right in the center of my nose that eventually became bright red and inflamed (I didn't even touch it. Ha.). It was literally so bad I just had to laugh. Right in the center of my face. I couldn't even attempt to cover it up with makeup. Awesome!
But the good news is that all of those big suckers are now healing and will hopefully be gone within the next few days. Right now I just have a few new pimples along my jawline, which I can deal with. I still have a ton of little tiny bumps on my forehead and cheeks that never seem to go away. They never increase or decrease in number, or become red and inflamed. I tried using a Neutrogena salicylic acid wash as my derm had recommended, but that only made my skin dry and flaky. Hm.
I have really had no side effects being on the 100 mg of Spiro, save for some light headedness with my first two doses or so. I have tried to increase my water intake, which I believe has helped. I have actually lost about 7 pounds since beginning my spiro/birth control regimen. Not sure if it's from the spiro or BC, but I really haven't made any other lifestyle changes so I assume it's from one of them. Not complaining.
Green Gables- Thank you for the reply! I am fine with being on Spiro long term, as long as it works and does not negatively affect my body. I may get tested for PCOS out of curiosity. I don't exhibit all of the typical symptoms, but it would be interesting to see the results. As far as sun exposure- I have a darker complexion but I rarely get sun anymore. I am a nurse, and I work a lot of night shifts, so I sleep a lot during the day. I'm sure my hectic schedule has also taken a toll on my body- switching from day shift to night shift every couple of weeks cannot be good for me. But anyway. I have actually used tanning beds in the past (shame on me, I know), and I have noticed that my skin clears up a bit after use. Not sure if this has to do with Vitamin D production, or the actual UV light drying out my skin? I know that in the past, dermatologists have used UV light therapy for treatment of acne, but I'm not sure if the benefits are from Vitamin D production or its drying properties. Interesting. I will try taking Vitamin D in pill form. Can't hurt!
I'll keep posting every couple of days. Trying to remain positive!
ALSO! Any suggestions for a gentle (yet effective) face lotion? My skin tends to get super dry and flaky after using topical treatments, and I feel that my Olay complete lotion makes my skin react a bit. Also it reeks of sunscreen.
Day 78 of spiro
No new breakouts. Three along my jawline and then the healing ones from last week. Nothing new on my back/shoulders. Good.
This morning I bought Neutrogena Ultra Gentle Soothing Lotion to replace my Olay moisturizer. I generally like Neutrogena products, and this one seems good. Doesn't irritate my skin or cause itchiness like my Olay lotion does. So we'll see!
Light therapy is mostly used because certain wavelengths of light (I believe it's 550 blue light? but don't quote me) will instantly kill bacteria on the surface of the skin. I'm not sure how much they affect vitamin D production since it's a very limited portion of the light spectrum.
A lot of people here use the CeraVe cleansers and face lotion. They are pretty gentle and effective...have ceramides...the lotion soaks right in.
Day 79.
I am super pleased with my skin today. No new breakouts- just two healing ones and some redness/dryness from the large breakouts on my nose/forehead last week. I actually went to work today wearing just tinted moisturizer and some concealer instead of my usual heavy foundation, and my skin feels great. I have been at work for six hours and I have developed no new breakouts, and my makeup isn't sliding off my face.
Maybe an increase in my spiro dose was all I needed? We'll see. I'm nervous that I'm going to have another mega breakout before my period in a few weeks. Fingers crossed that things only improve from here.
Day 80
Still no more breakouts! Skin is only getting clearer and actually starting to feel soft and smooth. I switched my routine around a bit because using the neutrogena salicylic acid wash twice daily was drying me out too much. Now I use the salicylic acid wash before bed and a gentle neutrogena scrub in the morning. Yay!
Day.... Whatever!
Still no new hormonal acne. Nothing along my jawline/chin. The only new acne I've gotten has been on my forehead and cheeks ( like closer to my nose) where I don't normally breakout. The pimples have been relatively small, noninflamed, and go away in a couple days.
I still have the old red marks and the tiny little bumps on my forehead and cheeks, though they seem to be decreasing in number.
My ultimate goal is to be able to go without makeup and have skin that GLOWS.
So I went on vacation last week, and my skin got a bit worse on my trip. I blame this in part on my forgetting to pack my treatment topicals, so all I had for the week was my face wash and moisturizer. I am supposed to get my period next week, and normally a week or so prior (now) I would be breaking out in painful, under-the-skin nodules along my jawline. On spiro this is not the case. I have one large pimple on my chin (I never break out on my chin), a healing one on my forehead (that was there for one week. I never used to get pimples on my forehead), and then a relatively large pimple on my jawline (though it's not painful and under the skin like my previous hormonal breakouts). Weird that the nature of my acne has changed since starting the Spiro, but it's definitely better than the painful, inflamed hormonal breakouts I would get before. But this is still not where I want to be. Also, I have a ton of those little closed comedones on my cheeks and forehead. I had a red eye flight last night and slept in my makeup, so I think that contributed, but those suckers are really difficult for me to treat. It's like once they're there, they don't go away. UGH. Anyway, I'm glad to be back home so I can get back to my regular routine. Hopefully I'll see some progress this week.
Okay so this is what is going on with my forehead. (Sorry the photo is sideways. I'm dumb and I don't know how to change it.) Those are the tiny bumps that I had mentioned. What the hell are they? Just whiteheads? Fungal? Some sort of allergy? They never go away, and they're all over my cheeks too. Does anyone have any suggestions for treating them?
Okay so this is what is going on with my forehead. (Sorry the photo is sideways. I'm dumb and I don't know how to change it.) Those are the tiny bumps that I had mentioned. What the hell are they? Just whiteheads? Fungal? Some sort of allergy? They never go away, and they're all over my cheeks too. Does anyone have any suggestions for treating them?
Hmmm I was gonna say maybe milia but they don"t really look like it. I have similar bumps on my chin and they never go away. Nothing helps. I've heard exfoliating helps or any topical that will exfoliate , but i've used those before and no such luck.
Yeah I've been using Neutrogena Deep Clean Gentle Scrub in the morning and a salicylic acid face wash at night (my derm recommended salicylic acid) and nothing has helped. They've been there for like 6 months. It's almost more annoying than my hormonal acne because there are so many of them! Ugh
Currently NO inflamed/hormonal acne on my face. And I'm about to get my period, too! I had a couple pimples on my jawline earlier this week but they went away within two days. So I'd say my hormonal acne has significantly improved since increasing my Spiro dose to 100 mg. Right now I just have those little bumps all over my forehead and cheeks. I think I'm going to give my ketoconazole (anti fungal topical) another shot.
Day 101
Just finished having my period yesterday and had NO breakouts during my period. Right now, I just have one pimple on my skin that's pretty big and under the skin. I'm not going to touch it. I tend to pick at my skin so much out of stress and I know that a great deal of my acne is my own fault. So I'm going to try so hard not to pick. Other than that, I just have a few little ones on my jawline and, of course, the little bumps on my forehead/cheeks. But I think those are actually starting to decrease in number! Maybe it was the addition of the salicylic acid face wash? Or my starting to use ketoconazole topical cream again? I dunno.
So here is my current routine:
Morning:
Wash face with Neutrogena Deep Clean Cream Cleanser (use Neutrogena Deep Clean Gentle Scrub every other day)
Wash back/shoulders with neutrogena body scrub
Apply Clinique Toner (for oily skin) if skin is especially oily
Apply Ziana gel to actives
Apply Neutrogena Ultra Gentle Soothing Cream all over face
Apply Clinique Even Better foundation
50 mg Spiro, 1 fish oil tablet
Evening:
Wash face with Neutrogena Salicylic Acid Wash
Apply Clinique Toner (for oily skin) if skin is especially oily/if I worked a 12 hour shift, etc
Apply Ketoconazole cream to forehead/cheeks
Apply Ziana gel to actives
Apply Neutrogena Ultra Gentle Soothing Cream all over face
50 mg Spiro, 1 fish oil tablet
So that's that. Also, I just realized that I really haven't had any acne on my back/shoulders since starting spiro! Hooray
Day 114:
SO FRUSTRATED!
I'm sure that most of you who have gone on Spiro have experienced exactly what I'm going through. My skin starts to get really clear, and I think the medicine is actually starting to work, and then BAM! Tons of hormonal breakouts all over my jawline. And then it starts to heal and clear up again. And I think the medicine is actually working this time. And then the cycle continues.
I know that spiro often takes many months to work, and I'm trying to be patient, but this is just so frustrating. I have about five big pimples on each cheek that I can't even attempt to cover up with makeup, the tiny little bumps all over my forehead and cheeks that never go away, and on top of that, my skin is so dried out. It sucks.
I made an appointment to go to my gyno on Friday to see about switching birth control. I'm currently on Lo-Loestrin Fe, which I know is a high androgen birth control and may be contributing to my acne. Any recommendations on birth control?
Also, I'm seeing my derm on August 9th. That will mark 2 months since I upped my spiro dose to 100 mg. Part of me just wants to go back on Accutane because I know it will clear me up, although I know it isn't a cure. My acne will just come back within a year like it did the past two times..
Ugh.
Day 115
Still feeling super down about my skin. I've got a huge cyst on my right cheek that will likely be there for at least two weeks, three nodules on my right jaw,
a cyst on my left cheek, a cluster of little nodules on my left jaw, and the tiny little bumps/blackheads/clogged pores all over my forehead and cheeks. My skin is dry, flaky, and irritated.
i'm really, really eager to talk to my gyno about switching birth controls. I started the Lo-Loestrin Fe about a week before going on Spiro, so maybe that's why I haven't seen spiro's effects yet..
Bah
Day 115
Still feeling super down about my skin. I've got a huge cyst on my right cheek that will likely be there for at least two weeks, three nodules on my right jaw,
a cyst on my left cheek, a cluster of little nodules on my left jaw, and the tiny little bumps/blackheads/clogged pores all over my forehead and cheeks. My skin is dry, flaky, and irritated.
i'm really, really eager to talk to my gyno about switching birth controls. I started the Lo-Loestrin Fe about a week before going on Spiro, so maybe that's why I haven't seen spiro's effects yet..
Bah
I would recommend a moderate to high estrogen pill, not a Lo pill, and one that doesn't have a ton of progesterone activity.
Day 121:
Visited the gyno on Friday- will switch to Ortho Tri Cyclen-Lo once my current pack of BC finishes (in a week). Then I have an appt with my derm on August 9th. I'm interested to see what she says about my skin as I've had no improvement with the 100 mg of Spiro for two months.
This is so frustrating. I'm sure all of you on Spiro have gone through the same thing, as our acne is hormonally influenced- my skin starts to seem like it is clearing up. No active pimples, just healing ones. I start to think that my regimen is beginning to work. And then BAM, I get hit with a ton of inflamed, hormonal acne around a week before my period. Then it starts to clear up again. Then I break out again. And the cycle continues. It's so annoying. Right now I'm in the "clearing up" stage, but I'm sure that next week my skin will break out like crazy again. UGHHH. I'm interested to see if my skin starts to get better on the OTC-Lo, though (since my Lo-Loestrin Fe may have been counteracting the effects of the Spiro). We shall see.
ALSO I bought Neutrogena's Clear Pore cleanser/mask. It's got BP in it, and it really seems to dry up the active pimples on my face, so that helps. And then I also purchased Neutrogena Ageless Essentials Continuous Hydration night cream. I wanted a super rich moisturizer for overnight, and I really like this one. It's really velvety and I wake up with really soft skin.
Sooo, my skin has been basically clear ever since I started using the facewash with BP (previous post). I have zero hormonal, cystic pimples right now. I'm on the placebo pills of my pack of Lo-Loestrin Fe, and starting Ortho Tri Cyclen Lo on Tuesday. Hopefully the OTCL doesn't break me out and only helps my skin improve! Then derm appt on Thursday. This is the best my skin has been in months.
Sooo, this would be Day 127 on 100 mg Spiro
My skin is CLEAR. Clear, clear. Except for a tiny pimple on my forehead (more like a clogged pore), and one sort of below my ear. And those tiny bumps/blackheads on my cheeks. I am still not completely satisfied because I know that my skin can be better than this. It used to GLOW and have such great texture. And also, of course, I'm afraid I'm going to start to breakout out again, as I always do when I start to get clear. We'll see.
Day 133
Still doing pretty well! I kind of broke out after working night shift at the hospital last night- I've noticed that my skin does get worse when I work nights. I have a few small-ih pimples on my jaw, but nothing like the huge cystic/inflamed/painful things that I used to get that would stay on my face for weeks on end. I went to the derm on Thursday, and she seemed really pleased with my skin. For now, she is going to keep me on the 100 mg/day of Spiro, and hopefully I will see more improvement in the months to come (especially since I just started Ortho Tri Cyclen-Lo on Monday). She also recommended that I get a couple chemical peels, since I still have a ton of tiny little bumps/clogged pores that never go away. I am debating getting the chemical peels done by a professional (for several hundred dollars), or just buying the little chemical peel wipe things that you can get at Sephora or something. I dunno.
Dreamcatcher88- my skin really isn't oily anymore. I used to have to re-apply my foundation powder to my face multiple times a day because my makeup would literally slide off my face within a couple hours of putting it on. So yeah, it's gotten a lot better. I can't say exactly when I started to see improvement in the oily-ness because it's kind of just been a slow, gradual improvement.
Day 139
Not many new changes. I always have at least a couple pimples on my face, although they are smaller and go away much faster than they used to. Right now I have a healing pimple on my temple, two on my right cheek, and one that just started developing on my forehead that I can already tell is going to be a huge pain.
I haven't noticed a change in my skin since I switched birth controls. No increase in breakouts or anything. The only side effects I have experienced so far are some nausea and bloating for a few hours after I take the pill. Hopefully this will subside with time.