Hi Brenna!

I read your story with interest. I'm sorry you are so frustrated... I can certainly understand. You are a beautiful girl, and dealing with this so long is wearing you down, I'm sure. I am an Esthetician, and I want to offer some advice based on my experience with other clients. You may or may not have tried some of these things, but I figure I'll give it a shot.

Firstly, from what you describe, it sounds like you have inflammatory acne that doesn't necessarily come to a head so you can pop it, but creates hard, red, tender papules all over your face. Inflammation makes it worse, so does stress and poor diet. You have a very clean diet and lifestyle, but it's not going away because I think your daily routine is very harsh for your skin. You need to focus on soothing treatments designed to calm your skin. Hormonal acne with inflammation is very difficult to treat, and what you are doing is loading your skin up with more stuff to inflame it! Cinnamon, nutmeg, lemon juice..... wow!! Then on the other hand... honey? That is not going to clean your skin, and that's what you need.

Think of your skin in terms of a three step process.... CLEANSE - NOURISH - PROTECT.

With each step, choose things that will be calming and reduce inflammation. You also want humectants, or things that bind water to your face, because this will help reduce inflammation. So, what you want should look something like this:

Cleanser... mild, creamy cleanser than rinses cleanly. If it has soothers, even better. Things like glycerin, allantoin, sea whip, hyaluronic acid, azulene, licorice... all good soothers and water binders.

Treatment... hold off on using any exfoliants or even Benzoyl Peroxide for now. You want to soothe and heal your skin, so if you can find a lightweight gel that has any of the above mentioned ingredients, that would be great. You want to reduce redness and inflammation. Aloe can help here, too, but ideally you want something with more than just aloe.

Protection... you mentioned that you use jojoba oil, which is fine (it closely mimics sebum) but by itself it will not create a seal that will protect your sensitive and challenged skin. You need to wear a ZINC-ONLY emollient SPF during the day (do not buy the kind with chemical sunblock ingredients, they will inflame your skin more) and at night you need a lightweight, greaseless moisturizer to help your skin heal. Oil-free or jojoba oil based if possible.

Dump everything else, including the tea tree and lavender oil... avoid all essential oils on your face, or anything with fragrance. Please do not use topical probiotics, that is total rubbish. There is no flora and fauna on your face!

Now, the way you clean your face is very important, as well. You want to be careful, gentle, and not do anything to physically exfoliate it.

(1) Wash your hands

(2) Wet your hands, then your face

(3) Use the cleanser to very gently clean your skin, starting with your eyes first, then the rest of your face and neck.

(4) Rinse the cleanser off, do NOT use a washcloth for this, just splash the water.

(5) Pat dry gently with a fresh washcloth. (Keep a stack handy and use one per wash)

You can do your nourishing and protection steps after that. You should be clean, but not tight-skinned. If you get a soothing serum product to nourish with, that should help calm redness.

In the morning, if you feel greasy, repeat the CLEANSE-NOURISH-PROTECT. This time use SPF to protect your skin. Try your best to stay out of cold weather and direct UV light, if possible. Try to keep your skin at an even temperature - not too cold, not too hot.

It will take you a few weeks or a month to see changes, but if successful you will see your skin first calm down, and then the major lesions start to recede. After a few weeks, when your skin is stronger, you can introduce a 2.5% Benzoyl Peroxide (use according to manufacturers instructions... don't think, "more is better" because less is actually better!) to control bacteria and oil production. Do this right before the NOURISH and PROTECT steps. BPO needs to be applied on dry, cleansed skin.

I hope this helps. I have had good luck with this sort of progressive care with my acne clients. Good luck.

- Lydia

If I was going to reduce your Italy trip to bullet points, this is what I gathered

- Sunshine

- Ocean

- Slightly better fatty acid ratio in your diet

- Somewhat less processed foods

- Daily exercise outdoors

- Reduced stress

Anything I'm missing?

I would not take Estroblock. For most women, more estrogen helps acne. You are skinny. Less fat = less estrogen storage. Yes, skinny people can be estrogen dominant, but unless you have some confirmed evidence that you actually are, I always assume that skinny with acne tends toward androgen issues. Since estrogen does all sorts of beneficial things for the skin, such as increasing skin hydration and counteracting androgens...in most cases blocking estrogen will only make the problem worse.

Hi Brenna!

I read your story with interest. I'm sorry you are so frustrated... I can certainly understand. You are a beautiful girl, and dealing with this so long is wearing you down, I'm sure. I am an Esthetician, and I want to offer some advice based on my experience with other clients. You may or may not have tried some of these things, but I figure I'll give it a shot.

Firstly, from what you describe, it sounds like you have inflammatory acne that doesn't necessarily come to a head so you can pop it, but creates hard, red, tender papules all over your face. Inflammation makes it worse, so does stress and poor diet. You have a very clean diet and lifestyle, but it's not going away because I think your daily routine is very harsh for your skin. You need to focus on soothing treatments designed to calm your skin. Hormonal acne with inflammation is very difficult to treat, and what you are doing is loading your skin up with more stuff to inflame it! Cinnamon, nutmeg, lemon juice..... wow!! Then on the other hand... honey? That is not going to clean your skin, and that's what you need.

Think of your skin in terms of a three step process.... CLEANSE - NOURISH - PROTECT.

With each step, choose things that will be calming and reduce inflammation. You also want humectants, or things that bind water to your face, because this will help reduce inflammation. So, what you want should look something like this:

Cleanser... mild, creamy cleanser than rinses cleanly. If it has soothers, even better. Things like glycerin, allantoin, sea whip, hyaluronic acid, azulene, licorice... all good soothers and water binders.

Treatment... hold off on using any exfoliants or even Benzoyl Peroxide for now. You want to soothe and heal your skin, so if you can find a lightweight gel that has any of the above mentioned ingredients, that would be great. You want to reduce redness and inflammation. Aloe can help here, too, but ideally you want something with more than just aloe.

Protection... you mentioned that you use jojoba oil, which is fine (it closely mimics sebum) but by itself it will not create a seal that will protect your sensitive and challenged skin. You need to wear a ZINC-ONLY emollient SPF during the day (do not buy the kind with chemical sunblock ingredients, they will inflame your skin more) and at night you need a lightweight, greaseless moisturizer to help your skin heal. Oil-free or jojoba oil based if possible.

Dump everything else, including the tea tree and lavender oil... avoid all essential oils on your face, or anything with fragrance. Please do not use topical probiotics, that is total rubbish. There is no flora and fauna on your face!

Now, the way you clean your face is very important, as well. You want to be careful, gentle, and not do anything to physically exfoliate it.

(1) Wash your hands

(2) Wet your hands, then your face

(3) Use the cleanser to very gently clean your skin, starting with your eyes first, then the rest of your face and neck.

(4) Rinse the cleanser off, do NOT use a washcloth for this, just splash the water.

(5) Pat dry gently with a fresh washcloth. (Keep a stack handy and use one per wash)

You can do your nourishing and protection steps after that. You should be clean, but not tight-skinned. If you get a soothing serum product to nourish with, that should help calm redness.

In the morning, if you feel greasy, repeat the CLEANSE-NOURISH-PROTECT. This time use SPF to protect your skin. Try your best to stay out of cold weather and direct UV light, if possible. Try to keep your skin at an even temperature - not too cold, not too hot.

It will take you a few weeks or a month to see changes, but if successful you will see your skin first calm down, and then the major lesions start to recede. After a few weeks, when your skin is stronger, you can introduce a 2.5% Benzoyl Peroxide (use according to manufacturers instructions... don't think, "more is better" because less is actually better!) to control bacteria and oil production. Do this right before the NOURISH and PROTECT steps. BPO needs to be applied on dry, cleansed skin.

I hope this helps. I have had good luck with this sort of progressive care with my acne clients. Good luck.

- Lydia

Thank you so much for your insight. I thought I could be treating my face too harshly, but I was sure that natural ingredients and oils would be good for my skin. Curse those hippy health food store people taking full advantage of my insecurities and ignorance! What brand of facial wash would you recommend? Are there any inexpensive brands out there? For moisturizer, my sister has neutrogena oil free SPF moisturizer. would that be sufficient? I also have a natural sunscreen... but I didn't use it BECAUSE i never go out.... lol what valuable advice! So many people have tried to give me advice on acne... and I just thought I had to do everything. Thanks a lot. Really!

If I was going to reduce your Italy trip to bullet points, this is what I gathered

- Sunshine

- Ocean

- Slightly better fatty acid ratio in your diet

- Somewhat less processed foods

- Daily exercise outdoors

- Reduced stress

Anything I'm missing?

I would not take Estroblock. For most women, more estrogen helps acne. You are skinny. Less fat = less estrogen storage. Yes, skinny people can be estrogen dominant, but unless you have some confirmed evidence that you actually are, I always assume that skinny with acne tends toward androgen issues. Since estrogen does all sorts of beneficial things for the skin, such as increasing skin hydration and counteracting androgens...in most cases blocking estrogen will only make the problem worse.

HA! It would be nice to be in the sun and sea again! I wish I noted all those things to, but for the moment, they are out of reach -_-

I think I will take a real hormone test just to be sure, but I thought I had symptoms of estrogen dominance..

- Thin hair that seems to fall out excessively

- Mood swings, mostly from okay feeling to super depressed in a matter of minutes

- cold hands and feet

- Tender breasts

- PMS (extremely--extremely irritable, then a week before my period I get chin break outs)

- Back pain and swelling some months during period

- muscle softness (despite my body strength exercise)

- bloating

I don't know if I have the obvious signs of androgen excess:

- no weight gain (I am losing weight)

- no facial hair

- (as far as I know) no PCOS

Of course this is not a substitute to a regular hormone test, but I get an overwhelming amount of checks on the estrogen excess and progesterone deficiency.

http://www.johnleemd.com/store/resource_hormonetest.html

If in fact I were to have an androgen dominance, what natural supplements would you think do the trick? I hear spearmint tea and saw palmetto are good. I don't really have good insurance... or a job, so I am trying to keep costs low. Thanks for your reply.

It's very confusing trying to self-diagnose because symptoms tend to overlap, especially low progesterone and high estrogen symptoms. Some of the symptoms you listed could also be attributed to a vitamin D deficiency. Unexplained weight loss usually occurs due to elevated androgens, btw. If I were you I would get tested for PCOS. The symptoms for PCOS vary, that's why you should have an ultrasound that actually measures the cysts on your ovaries, rather than just testing for PCOS hormonally.

Track your acne breakouts and see if they happen more often during or before your period, and /or mid-cycle. That might give you an indication as to whether your breakouts are hormonal. The ones close to your hairline might not be hormonal, they could be a reaction to your shampoo, especially if your hair touches that part of your face a lot. To me, it looks like some type of reaction...perhaps purging? I got that type of dense acne when I used milk thistle...it caused a powerful reaction to my skin. Maybe you should stop taking all those supplements and start with one at a time to see if that helps. If your liver is unable to flush out excess toxins (including excess hormones) through normal pathways (e.g. when you go to the bathroom or when you sweat), then they get pushed out through the pores of your skin. So, by overloading your liver with a ton of supplements, you could actually be making the situation worse.

Diet-wise, you should avoid dried fruit.

Face-wise, you are doing too much! Let your skin breathe. Don't wash with harsh tap water, try using a water filter or spring/ deionized water - that's the first thing you should look at when you are trying to improve the PH of your skin.

Check your detergent too....that might be aggravating your acne. To me, it looks like a reaction to something more than hormonal, but I'm not entirely sure.

Finally, as you probably realized, depression makes everything so much worse. Vitamin D deficiency and depression go hand in hand in some cases, that's why I suspect you might be deficient.

Btw, I found out who my real friends are after getting bad acne, so it can be a blessing just as much as it can be a curse. I isolated myself from everyone for a few months and it actually made me more depressed. I focused my energy on work and finding a natural treatment plan for myself, and now I can function again in the real world. People who really like you will not care at all if you have acne....plus, you look like Cheryl Cole in the last pic, how great is that?

Finally, as you probably realized, depression makes everything so much worse. Vitamin D deficiency and depression go hand in hand in some cases, that's why I suspect you might be deficient.

Btw, I found out who my real friends are after getting bad acne, so it can be a blessing just as much as it can be a curse. I isolated myself from everyone for a few months and it actually made me more depressed. I focused my energy on work and finding a natural treatment plan for myself, and now I can function again in the real world. People who really like you will not care at all if you have acne....plus, you look like Cheryl Cole in the last pic, how great is that?

Should I get a blood test for vitamin D deficiency, too? I think I am going to pull out all the stops and get a blood test, a urine test, and have the doctor check my thyroid.... if that is possible. Whew this is getting expensive.

Also, what you said about a reaction. I feel that that is plausible. I have just now switched shampoos and body wash (although I don't really have any body acne... a few on my shoulders but that is it) But I have found that my face burns a lot in the winter, especially when I am in a hot room, and my acne seems to throb and sometimes itch... don't know really how to explain it. Funny how skin reacts to the seasons. My skin is definitely a spring/summer lover.

I definitely have found through this who my friends are and how much they care. It's just frustrating to to have repulsive looking nasties on my face and thanks for the compliment!

I wish dermatologists could identify correctly what type of acne each person has, that would make things a lot easier. I have seen a LOT of hormonal acne photos, and yours might not necessarily be hormonal. Have you looked up leaky gut/ candida and high histamines? Did some supplements/ foods make your skin worse? It looks like the reaction I got when I tried milk thistle, so maybe something you are taking is detoxing your liver too rapidly and your body is unable to get rid of all the toxins the proper way.

I get reactions from things that trigger a histamine reaction....so for me, it could be anything from body lotions & shampoos (sulfates/SLS) to tomatoes. I tested my IgG and IgE for food allergies and intolerances, which might be something you can try too.

I would definitely recommend checking your vitamin D levels as well as your hormones (saliva testing is more reliable for hormones than blood testing - I did blood twice and it didn't show much, yet I get hormonal acne the same time each month). Right now I'm taking inositol for hormonal acne and following a low histamine diet. But I had to do a lot of trial and error before I found this combo, so you need to see what works for you. In my case, I get different types of acne...I even had folliculitis at some point, so I have to treat each cause differently to keep it under control. Finding an understanding doctor or naturopath is the first step.

I would go to a dermatologist. If you were clear in August and most of your life and now all of a sudden have acne, it could be some type of infection or something. I know most people hate going to the dermatologist, but find a good one who actually listens, and it's not too bad! Good luck!

If I was going to reduce your Italy trip to bullet points, this is what I gathered

- Sunshine

- Ocean

- Slightly better fatty acid ratio in your diet

- Somewhat less processed foods

- Daily exercise outdoors

- Reduced stress

Anything I'm missing?

I would not take Estroblock. For most women, more estrogen helps acne. You are skinny. Less fat = less estrogen storage. Yes, skinny people can be estrogen dominant, but unless you have some confirmed evidence that you actually are, I always assume that skinny with acne tends toward androgen issues. Since estrogen does all sorts of beneficial things for the skin, such as increasing skin hydration and counteracting androgens...in most cases blocking estrogen will only make the problem worse.

You are absolutely correct on the estrogen issue. A big part of what we are unable to do here is gather a complete history and exam. A knowledgeable physician will already have clues as to what's going on before you say a thing.

As women age they can will generally either be:

Estrogen deficient; or

Estrogen dominant (progesterone deficient).

The time when the deficiency or excess occurs is very important in understanding what's going on hormonally.

Women with narrow hips and small breasts in their youth have lower levels of estrogen. These women will generally have a higher probability of hirsutism.

Women with wider hips and large breast in their youth have proportionally higher levels of estrogen than progesterone and are more likely to experience estrogen dominance later in life.

What makes this a bit more complicated is that a woman that had high levels of estrogen in her youth can be deficient in midlife and beyond. This causes breast ptosis (sagging) among other problems. So, It extremely important to also understand when the symptoms occur. For example, a women with estrogen dominance that has tender swollen breasts all month is a different scenario than only during the last half (luteal phase) of her cycle when progesterone peaks and should be neutralizing the side effects of excess estradiol.

90% of the testosterone (metabolized from DHEA) you produce is from the adrenal system. The balance is from the ovaries.

DHEA is released from the Adrenals at the same time as cortisol.

Obviously something happened right after your trip. Were you on vacation in Italy? If so, then most people are relaxed and experience a period of low stress.

Looking at your first photo, it looks like you may have a mild cortisol deficiency. If you can back to high stress situation and your adrenals couldn't keep up, then you may have overproduced DHEA that converted to testosterone.

If this is the case and you are cortisol deficient, then dexamethasone may help. It will replace cortisol and decrease androgen production.

heck yeah i second the dermatologist's for sure and you could get your hormones tested while you there even though most times they dont seem to find an issues with them. if i were you though i would hit the derm get some antibiotics and ask about trying spiro and then i would get some sort of topical to use to help clear that all out. i did the whole diet thing and tried this supplement and that supplement for a long time and it did nothing so now i eat and drink what i want and have been fine. no sense being food deprived on top of everything else. good luck to you!

Wow! I honestly feel like I could have written this-- besides going to Italy. haha.

First of all, you are so incredibly beautiful!! In all the pictures!

I wish I could comment on every single thing you wrote in this post because it has ALL happened to me. Including the eating whatever, not washing face much, but being ridiculously happy-- and having clear skin. Then I found thelovevitamin and tried the holistic route...where I was still ridiculously happy...and I thought that washing my face with Manuka honey and only putting aloe on my face afterwards was giving me clear skin. I also thought that my 20 minutes of sunlight and smiling and reading all the time was giving me clear skin. Nope, it was being ridiculously happy because it was summertime and I had a different perspective on life...lol Then it all went to poop, and I ended up depressed and hey! all the acne came back. This was about 2 years ago.

I have taken every single pill that you've taken. The worst my skin has EVER been was trying to be "paleo" and taking borage seed oil, flaxseed oil, saw palmetto, and zinc. My skin was covered in cysts...covered. No end in sight type-- with no head. My jawline...tiny cysts in every pore. Oh man, it was terrible. Then I started taking Burdock root. AHHHH. Omg. 16 cysts in one day...on July 4. I was so freaked out. All I could do was cry.

I even have all the same [hormonal] symptoms that you do, and I honestly thought that I had estrogen dominance, as well. I don't have excess hair, but I have excess acne, dangit! That's a sign of a problem! Well, I started taking Beyaz in August...and my skin has been improving ever since. I know you don't want to go on a birth control, but it has seriously helped me. I feel weird about altering my hormones, but sometimes that's what you gotta do. I actually just started 25mg of Spironolactone about 20 days ago, too. I tried doing it "naturally" with all the supplements, but it didn't work. I'll include a before and after picture...the "Before" is after it started getting better. It was a lot worse than this picture, and you can't see the tiny cysts ALL along my jawline and my neck in the before, either. It's not perfect, but a definite improvement.

I've been where you are. I've done every strange diet imaginable (and nearly starved from some of them), and I've developed rigid washing and cleaning rituals. And like you, I've tried my fair share of supplements. But for some people (me included), those things don't work. My acne didn't respond to any of my "healthy" life changes, and I found that I spent more money and stressed so much more when I did them. And whenever I added a new product to my regimen, my skin exploded with angry red pimples. So I decided to stop worrying about it, eat normally, wash normally, and take a simple multivitamin. And my acne didn't get worse, if anything, it improved. I think that when we overload our faces and bodies with products (even healthy ones) we can really do some damage to our skin. And not everyone's skin reacts well to certain products. For example, I break out terribly on probiotics of any kind.

If I were you, I would consider using a more simple regimen. Many people (myself included) have good results using CeraVe AM and PM moisturizers, and the Dove Beauty Bar for washing. That's it. For some people, diet may play a role in acne, but for others it does not. And in my opinion, your type of acne likely isn't caused by the foods you are eating. If I were to guess, I would say you either had a hormonal imbalance, or are like me and simply have lousy luck. In any case, you may consider seeing a dermatologist AND endocrinologist. You have options like Spironolactone (which works wonders for many women with hormonal acne) and Isotretinoin, which is what I am currently using.

You should check into Spironolactone. The pattern of your acne looks 100% hormonal

You should check into Spironolactone. The pattern of your acne looks 100% hormonal

All acne is hormonal.

Wow! I honestly feel like I could have written this-- besides going to Italy. haha.

First of all, you are so incredibly beautiful!! In all the pictures!

I wish I could comment on every single thing you wrote in this post because it has ALL happened to me. Including the eating whatever, not washing face much, but being ridiculously happy-- and having clear skin. Then I found thelovevitamin and tried the holistic route...where I was still ridiculously happy...and I thought that washing my face with Manuka honey and only putting aloe on my face afterwards was giving me clear skin. I also thought that my 20 minutes of sunlight and smiling and reading all the time was giving me clear skin. Nope, it was being ridiculously happy because it was summertime and I had a different perspective on life...lol Then it all went to poop, and I ended up depressed and hey! all the acne came back. This was about 2 years ago.

I have taken every single pill that you've taken. The worst my skin has EVER been was trying to be "paleo" and taking borage seed oil, flaxseed oil, saw palmetto, and zinc. My skin was covered in cysts...covered. No end in sight type-- with no head. My jawline...tiny cysts in every pore. Oh man, it was terrible. Then I started taking Burdock root. AHHHH. Omg. 16 cysts in one day...on July 4. I was so freaked out. All I could do was cry.

I even have all the same [hormonal] symptoms that you do, and I honestly thought that I had estrogen dominance, as well. I don't have excess hair, but I have excess acne, dangit! That's a sign of a problem! Well, I started taking Beyaz in August...and my skin has been improving ever since. I know you don't want to go on a birth control, but it has seriously helped me. I feel weird about altering my hormones, but sometimes that's what you gotta do. I actually just started 25mg of Spironolactone about 20 days ago, too. I tried doing it "naturally" with all the supplements, but it didn't work. I'll include a before and after picture...the "Before" is after it started getting better. It was a lot worse than this picture, and you can't see the tiny cysts ALL along my jawline and my neck in the before, either. It's not perfect, but a definite improvement.

Have you had your thyroid levels checked?

It looks like you have the "Sign of Hertoghe" as well as suborbital edema.

Translation.

The sign of hertoghe is the loss of the outer 1/3 of the eyebrow. Suborbital edema is swelling of the lower eyelids. It's actually myxedema or waste products that accumulate causing swelling. Both point to hypothyroidism. The symptoms of hypothyroidism are always exaggerated in the morning.

Have you had your thyroid levels checked?

It looks like you have the "Sign of Hertoghe" as well as suborbital edema.

Translation.

The sign of hertoghe is the loss of the outer 1/3 of the eyebrow. Suborbital edema is swelling of the lower eyelids. It's actually myxedema or waste products that accumulate causing swelling. Both point to hypothyroidism. The symptoms of hypothyroidism are always exaggerated in the morning.

Holy shit! Ouch...I had literally just woken up. Didn't know I looked like I had health issues. -_- or that's just how my face is....? I still have my eyebrows... But thanks for the concern... Also, those symptoms are for people who have ADVANCED hypothyroidism. And, um. I'm 23...there hasn't been time for that.

Translation: Pretty douchey of you to be diagnosing me based on my facial features.

Have you had your thyroid levels checked?

It looks like you have the "Sign of Hertoghe" as well as suborbital edema.

Translation.

The sign of hertoghe is the loss of the outer 1/3 of the eyebrow. Suborbital edema is swelling of the lower eyelids. It's actually myxedema or waste products that accumulate causing swelling. Both point to hypothyroidism. The symptoms of hypothyroidism are always exaggerated in the morning.

Holy shit! Ouch...I had literally just woken up. Didn't know I looked like I had health issues. -_- or that's just how my face is....? I still have my eyebrows... But thanks for the concern... Also, those symptoms are for people who have ADVANCED hypothyroidism. And, um. I'm 23...there hasn't been time for that.

Translation: Pretty douchey of you to be diagnosing me based on my facial features.

How sweet of you. You have a hormonal disorder-acne. You are posting photos in the hormonal forum, I take the time to reply with a legitimate, thoughtful comment based on clinical features of hypothyroidism and somehow I am the douchbag???

The two symptoms I mentioned are not indicative of advanced disease but can signal mild hormone deficits. Correcting thyroid function can also increase several other hormones as well, including those related to acne.

Not sure why you think there isn't time for hypothyroidism but you think there is time estrogen dominance? Please explain that.

Blood tests are used to confirm a clinical diagnosis and catch gross excess and deficiencies. Your physician should have seen a number of clues to what hormonal imbalances exist by looking at noting more than your face and silhouette. A history and complete exam should fill in the bulk of the details.

So no, it's not douchey of me to pass along my thoughts on your possible hormonal imbalances by looking at nothing more than facial features.

deleted

Have you had your thyroid levels checked?

It looks like you have the "Sign of Hertoghe" as well as suborbital edema.

Translation.

The sign of hertoghe is the loss of the outer 1/3 of the eyebrow. Suborbital edema is swelling of the lower eyelids. It's actually myxedema or waste products that accumulate causing swelling. Both point to hypothyroidism. The symptoms of hypothyroidism are always exaggerated in the morning.

Holy shit! Ouch...I had literally just woken up. Didn't know I looked like I had health issues. -_- or that's just how my face is....? I still have my eyebrows... But thanks for the concern... Also, those symptoms are for people who have ADVANCED hypothyroidism. And, um. I'm 23...there hasn't been time for that.

Translation: Pretty douchey of you to be diagnosing me based on my facial features.

You can have thyroid problems, at any stage, at any age.

Have you had your thyroid levels checked?

It looks like you have the "Sign of Hertoghe" as well as suborbital edema.

Translation.

The sign of hertoghe is the loss of the outer 1/3 of the eyebrow. Suborbital edema is swelling of the lower eyelids. It's actually myxedema or waste products that accumulate causing swelling. Both point to hypothyroidism. The symptoms of hypothyroidism are always exaggerated in the morning.

Holy shit! Ouch...I had literally just woken up. Didn't know I looked like I had health issues. -_- or that's just how my face is....? I still have my eyebrows... But thanks for the concern... Also, those symptoms are for people who have ADVANCED hypothyroidism. And, um. I'm 23...there hasn't been time for that.

Translation: Pretty douchey of you to be diagnosing me based on my facial features.

You can have thyroid problems, at any stage, at any age.

Thank you. You're right. Maybe I'll get it checked out. But to jlcampi...I had allergies in the morning. This does not equal hypothyroidism. And how could he/she tell that OP had cortisol deficiency from her first photo? lol It's just silly...

Heitea,

I'm sorry if I offended you with my comment. There is nothing wrong with your face. You are very attractive. I too am in the science business and can be very matter of fact. It comes off as arrogant and condescending at times.

The sign of hertoghe is a thinning of your outer eyebrow. If you don't know what to look for, it will won't even be noticed.

As far as the sub-orbital edema, that too is very mild.

It's just a thought.

If you really want to know about the cortisol comment I will reply. What sucks for us, is that there is a huge amount of information on the endocrine system that our docs have chosen to ignore.

90% of the testosterone (metabolized from DHEA) you produce is from the adrenal system. The balance is from the ovaries.

DHEA is released from the Adrenals at the same time as cortisol.

Obviously something happened right after your trip. Were you on vacation in Italy? If so, then most people are relaxed and experience a period of low stress.

Looking at your first photo, it looks like you may have a mild cortisol deficiency. If you can back to high stress situation and your adrenals couldn't keep up, then you may have overproduced DHEA that converted to testosterone.

If this is the case and you are cortisol deficient, then dexamethasone may help. It will replace cortisol and decrease androgen production.

I was not really vacationing, although it felt like a vacation. I was on an internship there teaching English, and helping with various programs. I had stress there, trust me--speaking your second language all the time is super stressful when you are constantly around people (especially when you are introverted like me ©_©).

I have a question: how can you tell from my first photo that I am cortisol deficient? I am interested for your response!

I just went today to have my DHEA, testosterone, estrogen, and vitamins tested. I will get the results in a week. will be keeping all posted on this

I wish dermatologists could identify correctly what type of acne each person has, that would make things a lot easier. I have seen a LOT of hormonal acne photos, and yours might not necessarily be hormonal. Have you looked up leaky gut/ candida and high histamines? Did some supplements/ foods make your skin worse? It looks like the reaction I got when I tried milk thistle, so maybe something you are taking is detoxing your liver too rapidly and your body is unable to get rid of all the toxins the proper way.

I get reactions from things that trigger a histamine reaction....so for me, it could be anything from body lotions & shampoos (sulfates/SLS) to tomatoes. I tested my IgG and IgE for food allergies and intolerances, which might be something you can try too.

I would definitely recommend checking your vitamin D levels as well as your hormones (saliva testing is more reliable for hormones than blood testing - I did blood twice and it didn't show much, yet I get hormonal acne the same time each month). Right now I'm taking inositol for hormonal acne and following a low histamine diet. But I had to do a lot of trial and error before I found this combo, so you need to see what works for you. In my case, I get different types of acne...I even had folliculitis at some point, so I have to treat each cause differently to keep it under control. Finding an understanding doctor or naturopath is the first step.

I have looked up leaky gut and candida... but I don't know if that is my problem. The high histamines I missed, but I think I have stopped eating all of the high histamine foods for the most part... after looking them up. I do eat spinach though. Maybe I should omit that? I have really itchy acne sometimes--and it gets really exasperated by heat, like when my scarves or hats or hair touches my face, I get really hot and then itchy. Even when there is nothing on my face, when my face is hot and throbbing, it will start to itch. Would you recommend benadryl? (it is an antihistamine, right?) I bought a clear, fragrance free detergent for my clothes... let's hope it helps.

I am so discouraged today. The doctor I saw really treated my issue as if it were nothing. It was like she wasn't even listening to my symptoms. I said I wanted to get my blood checked for possible hormonal problems or vitamin D deficiency--it was like pulling teeth. She was like, "well, all my other patients have had success with a combination of topical and oral antibiotics, birth control, or accutane... I don't think there is even a reason to do a test. Your periods are regular and light." I also asked her if they did saliva hormonal testing, and she said in a really condescending tone: "We don't do those kinds of 'holistic' tests here," like I was some kind of joke! I felt like even I knew more than her about hormones and diet being related to acne than she did. She just poo-pooed everything like I was a joke hypochondriac! UGH this is why I hate visiting doctors! SOOO know it all and close-minded! And, she completely ignored my concerns about a possible thyroid issue. Anyway, I am getting my androgen, estrogen, DHEA, and vitamins checked. Maybe the results will shed some light.

I even have all the same [hormonal] symptoms that you do, and I honestly thought that I had estrogen dominance, as well. I don't have excess hair, but I have excess acne, dangit! That's a sign of a problem! Well, I started taking Beyaz in August...and my skin has been improving ever since. I know you don't want to go on a birth control, but it has seriously helped me. I feel weird about altering my hormones, but sometimes that's what you gotta do. I actually just started 25mg of Spironolactone about 20 days ago, too. I tried doing it "naturally" with all the supplements, but it didn't work. I'll include a before and after picture...the "Before" is after it started getting better. It was a lot worse than this picture, and you can't see the tiny cysts ALL along my jawline and my neck in the before, either. It's not perfect, but a definite improvement.

It is not that I am against any prescription drugs, but I want to get to the root of the problem before I take any big action against my acne. I don't want to take birth control for the reason that I don't want to have to be on the pill all the time. I don't want to risk getting a really bad flare up if I quit it all of a sudden. It has only been 6 months. And I know that sounds like a long time, but I don't want to throw in the towel and take a drug that may mask my symptoms, but might not get to the root of the problem. I want to know what my body is doing and why it making my hormones out of balance. I want clear skin just as anyone else, but I am not looking for a quick fix. I am looking for a cure! And hopefully, I will find that cure! You are gorgeous by the way! So happy that you got rid of your skin probs and hope I get success like yours!

I've been where you are. I've done every strange diet imaginable (and nearly starved from some of them), and I've developed rigid washing and cleaning rituals. And like you, I've tried my fair share of supplements. But for some people (me included), those things don't work. My acne didn't respond to any of my "healthy" life changes, and I found that I spent more money and stressed so much more when I did them. And whenever I added a new product to my regimen, my skin exploded with angry red pimples. So I decided to stop worrying about it, eat normally, wash normally, and take a simple multivitamin. And my acne didn't get worse, if anything, it improved. I think that when we overload our faces and bodies with products (even healthy ones) we can really do some damage to our skin. And not everyone's skin reacts well to certain products. For example, I break out terribly on probiotics of any kind.

If I were you, I would consider using a more simple regimen. Many people (myself included) have good results using CeraVe AM and PM moisturizers, and the Dove Beauty Bar for washing. That's it. For some people, diet may play a role in acne, but for others it does not. And in my opinion, your type of acne likely isn't caused by the foods you are eating. If I were to guess, I would say you either had a hormonal imbalance, or are like me and simply have lousy luck. In any case, you may consider seeing a dermatologist AND endocrinologist. You have options like Spironolactone (which works wonders for many women with hormonal acne) and Isotretinoin, which is what I am currently using.

I have begun a new, simple, and nourishing regimen with a fragrance free, moisturizing sensitive skin cleanser, a cream based organic serum (not used every day), and a high moisturizing oil free moisturizer made for sensitive skin types. Again, I am trying to avoid strong prescription drugs like isotretinoin. My mind is not completely closed to the idea of prescription hormone treatments, but I am really trying to avoid them if possible because I want my body to balance on its own... I took a hormone and vitamin deficiency blood test today, and am waiting for the results. We will see how it goes!

I eat spinach too, it doesn't seem to bother me. Tomatoes are one of the worst histamine triggers, so if you can avoid those or have them in small quantities, it can help. Try to get the FULL hormonal panel (including cortisol and thyroid T3 AND T4 - doctors usually omit comprehensive thyroid testing) preferably saliva or urine. I did the blood test twice and it was nearly useless. You can plan it so that you get blood tested on a day where your hormones fluctuate the most (I believe day 21 - jcampi wrote about it somewhere), but most of us here are in the "normal" range. The normal range is very broad and doesn't take into account whether the body is sensitive to androgens on a skin level. That's why I think saliva testing would be more indicative of an imbalance. You can get saliva testing in certain places, depending on your area, and naturopaths in particular offer it. Ask for vitamin D as well, and maybe selenium, magnesium, and zinc.

If you want to supplement while waiting to order tests, the most harmless vitamin to supplement with is vitamin C, anywhere from 500mg to 1500 (no megadosing) per day. Make sure all supplements you are using are coloring-free, gluten-free, dairy-free, etc...just to be on the safe side. My current multi is herpanacine, and I also add vitamin C daily for good measure. I haven't had a full blown cold is years, and I never get those stupid flu shots.

I am totally with you on wanting to find out the cause before you take any medication. Most doctors will use birth control or antibiotics on a trial and error basis anyway. I don't think those are the only options available. Most mainstream doctors have a very limited knowledge of how acne is caused and the remedies for it because it's not considered a top medical priority. You need to be inquisitive and do your own research. I have had more luck with herbs in the past and now with supplements and lifestyle changes. Stress is the biggest trigger if you have a hormone sensitive condition. Even if you try to minimize stress now, it will take months for your body to fully release pent-up stress.

Try to listen to your body and pay attention to your acne patterns to see if flare ups happen during particular times of the month or 24-48 hours after eating certain foods.

I disagree with what was said above about all acne being hormonal. There are some types like folliculitis (often mistaken for acne vulgaris) and comedogenic acne that can take place on the surface of the skin. I would advice you to put less stuff on your skin, even if it's "natural." Using filtered, spring, or distilled/ de-ionized water to wash your face can help balance your skin's PH. It looks irritated right now, and putting lots of things on it won't help the situation. Let it breathe every day. Check the .org for posts on skin PH and water quality.

Lastly, avoid anything that is supposed to detox. If your liver is weak, then detox herbs/ supplements can do more harm than good, especially if you take more than the lowest dose.

It is not that I am against any prescription drugs, but I want to get to the root of the problem before I take any big action against my acne. I don't want to take birth control for the reason that I don't want to have to be on the pill all the time. I don't want to risk getting a really bad flare up if I quit it all of a sudden. It has only been 6 months. And I know that sounds like a long time, but I don't want to throw in the towel and take a drug that may mask my symptoms, but might not get to the root of the problem. I want to know what my body is doing and why it making my hormones out of balance. I want clear skin just as anyone else, but I am not looking for a quick fix. I am looking for a cure! And hopefully, I will find that cure! You are gorgeous by the way! So happy that you got rid of your skin probs and hope I get success like yours!

Yeah, knowing what's happening in your body and treating it permanently is so much better than a quick fix! I needed to get clear quickly (ish) though because I'm going to basic training in February and there's always the off-chance that they could disqualify me based on acne. I'm really terrified of the day that I come off birth control to conceive or something-- I dread the breakout which is undoubtedly going to happen. One day, after basic training and tech school, I'd like to explore the holistic route again and really try to find a way to permanently fix it. I guess for now, I'm good with the superficial fix... lol Good for you for digging deeper! I hope you do find your cure!