From age 12 - approx 22 I suffered with cystic acne. I Tried every treatment available, paid to see a very expensive private dermatologist but nothing helped. I developed BDD and OCD as a result and these disorders have adversly affected my daily life ever since. The acne seemed to go away approx age 23 and I have had beautiful clear skin for approx 20 years, however I am now 42 and attempted to give up smoking in Jan 2013 (I've been a 15 - 20 a day smoker for approx 20 years). Within a couple of weeks of giving up my skin started to get bad again but I tried to ignore, assumed it was part of the detox process, and got some over the counter cream to treat the outbreaks (which incidentally works no better now than it did 20 years ago). It gradually got worse and worse until the 4 month point when it just exploded and was as bad as it had been at it's worst in my late teens / early 20's. My skin felt sore to the point it would sting when I went outside, it was red, blotchy and bumpy over my entire face and I had 2 - 3 large painful 'deep under the skin' cysts at any one time as well as numerous smaller pimples with heads. Along with the return of my acne my BDD came straight back - checking my face in the mirror every 20mins to see how bad it was, hating what I saw and crying, avoiding going out unless I had to as felt so ashamed and embarrassed about how I looked. During May I took 3 weeks leave off work to avoid having to go out in the hope that it would calm down and start to get better, I cancelled my holiday and haven't been out socially since. Part of my BDD is skin picking, and when I was in my teens I used to literally 'cut out the acne' sticking sicsors and needles deep into the cysts in an attempt to get rid of them. At my most extreem I performed a DIY chemical peels, killing the top layers of my skin by showering 10 - 15 times a day and by leaving TCP soaked cotton wool on it like a facemask for hours at a time over several days until the skin was dead and cracking. I would then peel it away, it would be raw and weeping underneath but would heal in about a month and look less pitted and scarred. Anyway, at the 5 month point of my quit smoking I could no longer resist the compulsion to pick at my acne so in sheer desperation did some internet research into what might be causing it. I didn't think for one minute that quitting smoking would be the cause, that's meant to be good for your skin, however I was not alone and the quit forums were full of people experiencing the same, and unfortunately their experience gave me no hope that the acne would be short lived but would be back to stay. Knowing how self destructive my acne triggered BDD can be (I became so depressed in my early 20's I attempted suicide several times) I reluctantly started to smoke again in the hope that I could put my body chemistry back to what it was prior to my quitting. I have been back smoking for 3 weeks now and am seeing a vast improvement already. I am hopeful that I can undue the damage of my quit attempt but think it may take a few months to get my skin back to how it was.
Has anyone else gone through this experience? If so, how long did it take for the acne to go away once they started smoking again, and did they find a way to give up smoking that didn't involve having to put up with acne for the rest of their lives? I've read that in some people smoking supresses the homonal imbalances that cause acne, which would appear to be happening in my case, but when I've looked into remedies for hormonal acne they all seem to be BCP based which isn't an option for me because of my age, also I'm now dreading upcoming menopause as it seems my hormones are still not working as they should be so have I got acne to look forward to in my 50's as well....thinking I may as well top myself now!
It may definitely be a hormonal imbalance. Smoking suppresses various different hormones in the body.
I think a good option for you would be the acne.org regimen. A lot of 40+ year old people on this forum use it and have great results and maintain clear skin.
Starting smoking again definitely would not be worth getting rid of acne, it's great that you've had the will-power to stop! This is coming from somebody that knows how it feels, I'm personally still battling with cigarettes. I always quit successfully, last around 2 months, start 'social smoking' and then end up back in the loop of 10-15 a day!
I hope everything eventually works out for you, because you deserve it! 
Cosign with LewisS... Your severe breakout was due to a hormonal imbalance that was triggered by your smoking cessation.. I'm a former smoker and have dealt with severe acne most of my teen and adult life... The regimen helped to keep my skin clear when I began the cessation process and still keeps my skin clear to date... Please try the regimen and definitely try to quit smoking again... The price of clear skin is much cheaper on the regimen than it is smoking... Good luck and keep us up to date on your progress..
Hey, so sorry to hear about your struggle! I don't know what else is going on with your life, but remember that smoking is an outlet for STRESS. Now that you don't have that outlet anymore, the stress may be contributing to your skin problems. Time and time again, we read that stress is a huge contributor to skin problems. Is there any source of stress that you can reduce in your life? I know that during exams and other stressful times, I break out worse. Find an outlet for stress! Yeah, I know that the biggest source of stress is probably your skin (it is mine), but if you can manage other sources of stress better, that will help. p.s. Do you suspect diet as a culprit? Gluten and dairy are typical sensitivities. Keep posting, and hopefully you can get this figured out, with the help of others.
All, thanks for your comments / advice. Am now 3 and half weeks back smoking and skin much better, only outbreaks have happened around my cycle and have been much less severe, which pretty much confirms my suspicion that my acne is down to hormonal imbalance rather than food alergies or stress being factors, and that my skin will go back to normal once I've been smoking again for a couple of months. It's a shame as I really wanted to be smoke free but I'll take quality of life over quantity any day, and hopefully I will eventually find a minimal level I can smoke at and be acne free as don't think I'll ever be brave enough to try quitting completely again. It's not the acne as such that's the problem but the psychological problems it triggers, and unfortunately I have more than my fair share of disorders (all of which started with the acne and my reaction to it when I was in my teens)but the BDD has got to be the worst as it causes severe depression, self harm and suicidal behaviour. Unfortunately there's no magic pill I can take to make my various disorders disappear so I have to do things the hard way using talking cures and self management, it's hard work, but on the whole I do OK, I have a (on the whole) happy marriage, I've always been in work, and most people (even close friends) would have no idea I had these problems unless I told them. If being smoke free means being messed up and housebound then I'd rather take the risk and have a happier life...lol...I could be one of the rare cases of where smoking actually extends life expectancy because I guarentee I would have successfully committed suicide by now if I'd had to live with acne / BDD for the last 20 years!
I'm really sorry to hear of your struggle with acne coming back. I completely understand as I also gave up smoking in January this year and my face has gone haywire. Started off with small pustules on my forehead (where I have never had acne) which developed for about 4 months and now I am getting a lot of cystic activity along my jaw and mouth so I completely agree with the hormonal theory. I am also a huge picker of my face and look at and touch it constantly. When my acne was at it worst I did suffer a huge breakdown and suffered agoraphobia. So I know the struggles you face but not to the extremes you suffered.
I won't give into smoking again as I feel this is taking one problem and masking it with another and I want a healthy body. I do however understand your frustration and desperation to not fall back into your old ways. As others have stated maybe you should go to your derm and see whether there is another way to fight your acne. You may find another way to fight your acne and live a much healthier lifestyle.
I wish you nothing more than good luck and hope you find your cure soon.
If its not the chemical imbalance, consider if you have done any of these changes.... Have you moved?... Hotter and humid temperatures might affect people with acne-prone oily skin. Water quality in shower - some houses use hard water and some use softer quality water... If so, consider getting a water filter for the shower. This can improve the texture of your skin and hair. Consider changing your pillow cases often, such as weekly, along with towels.
This is why the government needs to recognise skin disease as more than a minor ailment. Some of us are confined to the house like lepers & suicide has been my every waking thought for years.
Smoking is suppressing either testosterone (which you can create with Saw Palmetto or Peppermint Tea) or the immune system, which I think sometimes does also react to hormones, or you have a food intolerance or maybe a candida/gut flora imbalance. Hope this helps.
I wrote a post on scarring you might be interested in
I agree with optimistsmile that smoking is usually an outlet for stress. I was smoke-free for 2 years, and recently started smoking again to cope with overwhelming stress. It did help my inflammation and stress, but unfortunately the smoke creates more congestion in my pores and I also get tiny milia. Last time I quit smoking, my skin was glowing and I looked healthier overall. I'm planning on quitting again soon because I feel disgusting. What helped me quit last time was replacing smoking with a hot beverage, like herbal tea, and also exercising more.
I don't think there's a direct correlation to smoking and clear skin, though, because I had acne at times when I was a smoker, and I also had acne at times when I wasn't smoking. I think stress is the main culprit, and if you don't have an outlet for stress - like smoking -- then it accumulates and can cause hormonal imbalances. I suggest replacing smoking with something productive like exercise. At least try to cut down gradually, and then quit completely. It's easier said than done, I know!