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Trying To Treat My Adult Acne Topically (Ziana) And Internally

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Hi everyone! I'm 24/F and here's some background information if you are interested :): I had acne during puberty, then it went away. I began getting mild to moderate acne again during college, really easily manageable but post college my skin started going downhill. I went to the derm for the first time in my life a month and a half ago because it seemed as if every single pore was clogged (not exaggerating). I am experiencing a blow to my self-esteem with constant pustules and even nodules (which I never had before turning 24) on my cheeks, jawline, chin. Jawline acne popped up just this September! I look back and I wish I could get my old skin back, but that's not very productive thinking. I'm pretty bummed about my skin, it has affected my enthusiasm for going out and my self-confidence.

I got my hormones checked recently and it turned out I produce a low level of Sex Hormone Binding Globulin (SHBG) which causes me to have high levels of free testosterone. It turns out many females with acne have a problem with either low SHBG, or high levels of testosterone production. It was nice to find a reason for my breakouts, but now to treat it... Most docs recommend going on OCs (it increases SHBG), but I don't want to further mess up my hormones in the long run. I will go the natural route for now by adding in flax seeds and more soy products in my diet (literature has stated it may increase SHBG levels), and will get tested again in 2-3 months. (Side note: I eat pretty well and am pretty active)

As for what I'm doing right now to deal with it more superficially:

Topically: Ziana retinoid (0.025% tretinoin and 1.2% clindamycin)

Orally: Saw Palmetto (SP) (2 pills/day to get 320mg)

I am 5 weeks in on the Ziana retinoid and 1 day in on the Saw Palmetto.

I'll keep you posted on any progress I see with the SP and Ziana. Ziana has been doing what a typical retinoid does: I've gotten more pustules/papules/some nodules/less clogged pores. My acne marks are super red with this retinoid and stays for so long, I'll let you know if it gets better by month 2. Any suggestions/input/questions are welcomed :). I'm really new to acne.org and wanted to join because I'm so confused about how to deal my acne/hormonal issue. Thanks for reading!

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It's been almost 2 weeks, I haven't noticed a decrease in my acne or oil production... maybe it's still too early? I started upping my dosage to 6 pills a day. Do you think you need to increase your spironolactone dosage, the saw palmetto doesn't seem that strong. I've had no side effects from it. Good luck!

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Hello! If anyone is interested surprised.gif :

I took a 1.5 week break from Ziana because I ran out of samples and my insurance doesn't cover it. I just went to the derm and got more sample tubes, so I will jump back on it. It definitely worked to clear my chin and forehead acne because within the 1.5 weeks of not using Ziana, I'm getting clogged pores in those spots again. My cheeks and jawline are still bad, I always have a new pustule everyday + bad hyperpigmentation.

I just got prescribed spironolactone! For the first 2 weeks I'm on 50mg, then I will up it to 100mg. I come back in 2 months to get my blood checked. I was doing saw palmetto, but I just need a stronger medication for now. I'm honestly mentally/emotionally exhausted from this surge in acne, so I need to try this first and then perhaps go back to Saw Palmetto later. I'll update in 2 months.

Also when I am able to, I want to figure out why I have low SHBG which causes my high level of free testosterone. I'm active and petite. Two possibilities: insulin resistance and hypothyroidism. I don't have any symptoms that point to any of them, but in the future I will still get blood work to see. Also I'm going to continue having flax seeds and soy products in my diet.

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Hello, it's the 2 month mark for spironolactone at 100mg!

My skin/hair is just a tad less oily, but it's still pretty oily :(. The frequency of inflammed pimples have gone down, but I still get them to the same severity. Anytime I see a closed comedone on my cheeks that start as a size of a pin, most of the time it will get super inflamed. It sucks because it gets really red and tall, which makes it pretty impossible to cover with make-up. I still have lots of clogged pores and whiteheads, which I don't mind in comparison to the inflamed pimples.

As for as side effects goes, at 50mg, I noticed no difference in my body. AT 100mg, I was very dehydrated/feeling under the weather/peeing more often for 3 days, then it went away. However, I have bloating that hasn't gone way and a light "period" every 2 weeks. Hopefully it will get better. It's so interesting how differently it affects people.

As for the topicals:

The Ziana retinoid is too weak for me, so I am trying out Differin 0.3% gel. It is stronger, but still tolerable. I really think retinoids can be great for whiteheads/mild papules/blackheads, but not for very inflamed pimples. Derms love retinoids... maybe too much. I will still use it because of the numerous hyperpigmentations I have from the horrible breakout in Oct/Nov/Dec all over my face!

Any questions, please feel free to ask :), I will update in 1.5 months (which will be the 3.5 month mark using spiro).

Hmm, I guess this should be tagged under Spironolactone, not sure how to do it now. Sorry!

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Hey Splashberri smile.png

Its so interesting how similar we are in breaking out/hormone issues. If it is any consolation I know what you are going through. My face has been breaking out so bad its hard to even go out... makeup covers but you can still see the bumps and pitted scars crazy.gif I hate washing my face every night... seeing all those red marks is so freaking depressing.

I have tried Ziana and Differin in the past. The Ziana left my skin oily and I didn't like it. I don't remember the Differin working too well. You say that you have hyper-pigmentation .. so do I! Boy... do I hate it... If I get one little zit it is SO RED. My skin likes to have some little purplish dots everywhere as well. I am taking Finacea cream and it is the only thing that I have ever tried to get rid of the redness. I have been taking it for almost a month and have noticed great results. My post acne marks that have been there for months are less red some are even gone (not all of them... lol, don't get me wrong but some of them and the others really are fading)! Thank god. It really works for the hyper-pigmentation, red marks and post acne marks. After putting it on it has a matte like finish so I am not as oily and I notice little results every morning. There are a couple cons (aren't bad at all in my opinion) 1.) It burns. The first couple weeks are rough and then your skin gets used to it. I always use a moisturizer about 10-15 minutes after the application and it really works to get rid of the burn. I would avoid liquid foundation if you are going to apply it right before though because you won't have a smooth finish at all. 2.) From my experience it didn't necessarily break me out but brought white heads to the surface in most my zits that I had. I had to keep telling myself not to pick. I thought I would let you know about this because it has really worked wonders for my face. I have tried many retinoids and they just didn't do the trick for me. This cream is for rosacea so it gets rid of all the redness and inflammation cheer.gif Maybe just ask your doctor about it and see what he/she says? If your insurance covers it, it should be around 40.00. There is a generic brand as well.

Have you read about/seen the videos of "the regimen on this site? I came across it last night and it was a little bit of a revelation for me. Ever since I was thirteen I have washed my face pretty rigorously to get everything out of it and then really scrubbing it dry with a towel after. This totally didn't help with all my red marks... made them far worse... Anyways I now have been washing my face as they do, putting on my Finacea and then moisturizing after in the exact way that they tell you too (basically barely even touching the skin). Within the day I have noticed my face isn't quite as red because of the scrubbing that I do.

Just thought I would let you know of these things because they are really helped me. I totally know what you are going through, you're not alone! I am going to schedule a hormone testing in the next few weeks. Hopefully I can get it squared away!

Let me know how everything goes!

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Hi splashberry,

Any updates on spiro and Ziana? I am using both, but am thinking of asking for a stronger retinoid. Thanks!

Edited by cwctmo1
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