My first post on my journey to combat cystic adult hormonal acne as a 41 year old female. One factor unique to my situation is that I never had any (or very, very little) exposure to sun and I've always worn sunscreen and foundation, even though I have olive skin and tan easily and didn't need make-up/cover-up.
The Birth Control Years
I took BCP for 21 years, from the age of 18 to 39. I had few side-effects over the years and did go on an off them for a few months at a time, but my first signs of trouble really started when I was switch from brand to generics. There is definitely a difference between the original brand manufacturer vs. the generics, I don't care what the doctor or chemist or pharmacists say. Ortho brand controlled, for the most part, any sustained acne breakouts, but I would have a few bad cysts a few times of year. My weight didn't fluctuate more than 8-10 pounds for two decades and mostly it was on the thin side (5'6" height, 115 pounds).
The Generic Birth Control Years
During the final 8 years of generics, I tried many types, but almost instantly I would feel better (emotionally, physically) but my acne and hormones did not agree and suddently I had backne, cyst on my head, hairline, chest, neck, and of course face--cheeks, chin, and brows. During this period, I tried a low dose of spironolactone, differin, and all OTC or mail by order products (ProActive, Murad, Nutrogenea, etc.) None of this worked, but going back to the BRAND NAME Ortho BC Pill always did the trick. I had a 4 session photo facial laser treatment at 37 to eliminate small acne spots, which I consider necessary maintenance.
Six Months of Bliss
Only one time the past twenty years did I have clear skin--off the BCP and I got a tan and was in the best shape of my life, 6 pack abs and everyting. I've heard that sun exposure can improve deficiencies in vitamins A & D, stripped by BCP and living indoors. If only I could time-travel and remain in suspended animation.
The End of BC Pills, Sterility
For my 40th birthday, I treated myself to a 45 min non-invasive procedure called tubal ligation. I didn't have kids and I don't plan (obviously) to have them in the future. A little over 18 months ago, I had the procedure and took my last little BC pill about two weeks after to finish out the course. It took a few more months to feel normal physically because they bloat you with gas and move all of your inners around.
Today, One Week on 150 mg of Spironolactone
Since the termination of BCP and tubes tied, my body and in particular my hormones are on revolt.
I have gained 20 pounds--the most I've ever weighed in my entire life, I now know what a muffin top feels like.
My breasts went from 34 B to 34 DD (which is ridiculous), all of my 0-2 or SM sized shirts cannot be buttoned.
And then came the hormonal raged acne--inflamed, unrelenting and scarring pretty much everywhere on my face that isn't occupied by an eye or nostril. So much for staying out of the sun and protecting myself for my entire life.
Hair growth, pretty much all the places you don't want it as a female and much faster growing so thatt you HAVE to shave everyday--especially now living in California where it's flip flop and dresses pretty much all year long.
I would have started a hard core course of Accutane if my derm doctor would have been agreeable, but she went with 150 mg of spiro (great, three pills daily when BC was just one small one a day), ACzone daily, and wash with Dermalogica Medibac. I've dropped Trentinoin from my regimen because all it did was cause my entire face to peel of over and over again even though I've had regular dermabrasion treatments over the years to lift dead skin. As of week one, I did experience all of the fore-warned side effects, breakout, breast tenderness, frequent urination, ...one day my skin looks like it is about to make a turn around and clear up, the next morning, it looks like I've been bitten by fire ants.
My Advice to Young Ladies
I'd rather have acne then an unwanted pregnancy, so I would do it all over again if given the option. If you have a mate, make sure he or she is supportive. My guy is wonderful and never makes me feel like a monster, even when I can hardly look myself in the mirror. And invest in high quality cosmetics and brushes that you can clean regularly. Take the time to apply it properly just so you can see what it might be like when one day--it is better and smile.
I'll keep adding to this weekly as the Spiro journey continues--but I am cautiously optimistic to win this battle.
A doctor that knows even a modicum about spironolactone would not start you directly on 150mg. Most women cannot tolerate such a high dose, and it is also detrimental to start at a high dose, you always need to gradually ramp up.
My derm had me at 50mg for a couple of months before I was upped to 100mg. I wouldn't dream of taking 150mg unless there was a really good reason for it.
150 is really a lot to start with. Besides the Spiro I would really see a gyn and endocrinologist. I think chances are high you have PCOS and maybe need additional metformin, especially your weight gain is suspicious for it to be more than a DHT receptor hypersensitivity.
Week 3 - Sticking to 150 mg/day.
So far, mostly as expected, a few new unsightly painful cysts on my cheeks and temple areas that take forever to heal -- my skin feels very thin. I am careful to only wash with warm water and Dermalogica twice a day and pat dry, but even that can create cracks that bleed, when applying topicals. A few new albeit smaller pimples have appeared on my back and neck. Mainly the breast tenderness and heaviness is dreadful and it reminds me of why I hated being on the pill so much. I feel like I am retaining more fluid in my boobs then ever before. I don't feel dehydrated, headaches or thirsty, but I drink excess water just to be safe. The blood test is in a couple of weeks to make sure this stuff isn't messing up my potassium, but it probably is. Really like ACzone, so I am going to stick with it, but only applying before bed.
First Month Finished and Ordered 30 Day Rx Refill
No new acne to report from the past two days, but still a lot of healing to be done on the existing/active front--redness is better. I didn't miss a single dosage over the 30 days so I am pleased about that--and more hopeful about month two. Wishing everyone a happy acne free new year!
Month 3
Finally able to get back on the site to write an update. I am still on 150 mg of Spiro and things have improved immensely. I did have two periods in the month of January which sucked hugely. First week into February--no new breakouts, healing on all of the old blemishes, and my skin is tight, soft, and smooth in complexion. There are many dark scars still and few pock marks, yet to fade. After morning shower, I will find a couple of pores with tiny whiteheads, but they don't turn red or return (gone in a day or so). No acne on my chest, back or scalp for at least 6 weeks. I've contemplated lowering my dosage to 100 mg and running the course for another 2 months or more--I really don't want to stop Spiro since things have just started to improve. For all of you still looking for motivation--I hope this helps because I really did not have any expectations that this would work, but it has for me.
It has been 5 months since my last post. A lot has happened, I broke my ankle at the end of Feb which required emergency surgery. This ended my use of Spiro because I was on bed rest for 3 months and on a ton of pain medication. I am back writing because six days ago I started taking 40 mg of Accutane and I wish I had just been adamant with my doctor's and derms because I have had immediate results from Day 1. I am acne free and only have some minor irritation (like a mild sunburn feeling, which I am managing with a supplement instead of antihistamine), with dry lips which is expected. I've been able to go out without any make up two days in a row, slathered in sunscreen and lip balm. I haven't been able to do this for at least 2 years. I am looking forward to seeing how this plays out over the next few months.
