Hello everyone. I've decided to start keeping track of my progress on my latest acne routine. It is the last option my derm wants me to try before going on accutane. To be honest, I kind of just want the accutane because I'm so tired of trying things that don't work and accutane seems to be much more of a permanent solution. So here goes...
History:
I have had acne since the 7th grade (I am now 20 years old) with incredibly oily skin. I broke out all over my T-zone. I was prescribed retin-a micro which I did not keep up with. The acne eventually died down a lot by the time I started high school so I just chalked it up to puberty. I had persistent mild breakouts in high school, but only occasionally did my acne get to be moderate to severe. I have very dry skin and only break out on my cheeks and chin now. I breakout more when I'm stressed, so I think it's fair to assume that my current acne is caused by hormones. My senior year of high school and freshman year of college, I began to break out more, and was prescribed differin gel which I really only used when I had a breakout. I didn't follow the instructions of applying it daily. The summer before my sophomore year, I began to break out even worse, but figured it would go away when I turned 20 (I don't know why, I just had this idea in my head that when I stopped being a teenager I would magically get clear skin. Very wishful thinking). I did, in fact, have fairly clear skin the first semester of my sophomore year, but the second semester, all hell broke loose. I had incredibly dry skin that winter, so I used Eucarin lotion for extremely dry cracked skin. Too bad I didn't read the directions which said that applying too much could make you very susceptible to sunburn, which I got BAD. I had one pimple that was so sunburnt and became so incredibly dry and itchy. I scratched at it too much and ended up getting a terrible skin infection that ran down the entire left side of my face. I actually looked like I had some kind of terrible disease. It was red, crusty, swollen, and just all around gross. I went to the ER and was prescribed doxycycline, which I was supposed to use for 10 days, but I only used it for 7 because it made me puke like mad. Thus my infection did not completely go away, but it looked better so I thought I was alright. This entire time I was also on tazorac, enduring the initial breakout while I had the infection, so I looked pretty awful. Eventually, the infection did die down, but the tazorac was wrecking my skin. I had a terrible initial breakout and was dry, red, and peeling all over my face. This did start to subside, but then I endured one of the most stressful weeks of my life and wham. I got tons of cysts under my cheeks and chin, and using the tazorac just made it look worse. It was pretty awful. I finally broke down and made a derm appointment, telling him I had very inflamed, cystic acne. He was able to prescribe me minocycline over the phone. When I went to see him a few days later, his reaction was something like YIKES what the hell happened. He told me tazorac was too harsh for my sensitive skin, and switched me to epiduo. He also put me on the oral antibiotic Solodyn, a more improved version of the minocycline. I stayed on that for four weeks, with my skin looking far far worse for the first two weeks, and all of the cysts were being drawn out to white heads. I experienced intense burning for the first week, and severe itching for the second and third weeks. My acne has also been drying up and peeling off by the droves. By the fourth week, I was left with two cysts, one on my jaw and one on my lower cheek, and clusters of pimples around the cysts that have flattened out significantly, along with another cluster on my upper cheek that has also flattened out significantly, and two big lines of red marks running up the sides of my cheeks close to my hairline.
Currently (beginning of epiduo week 4):
My skin has started to feel smoother and softer, but it is soooooo friggen red. Like crazy red. I look sunburnt and gross. The benzyl peroxide in the epiduo makes my acne look terrible. I have this weird patch of red kinda bumpy extremely dry skin above the cyst on my cheek and a lot of pimples that are continuing to flatten out. My hyperpigmentation is ridiculously red and overall my face just looks super inflamed. I went to the derm and he set me up with a new routine, and also gave me the IPledge booklet for accutane, so I can prepare myself if it doesn't work. He said I would need to stay on this routine for 4-6 weeks to see improvement, but I decided that if I haven't seen any change in 10 days, I'm just going to give in and get the ball rolling on accutane since I would have to wait a month to start it anyways because of those annoying blood tests. This is my current routine, including all my prescription meds and other products I've bought for myself. I do not wear makeup and I don't go out in the sun.
Current Routine
CeraVe Hydrating cleanser (use with warm water, no washcloth)
Clindamycin Phosphate Lotion (topical antibiotic)
Take One A Day Women's Vitamin Supplement, Vitamin C supplement, and Sibu Seabuckthorn Oil Omega 7 supplement
Take Prednisone (I am on 20 mg for 5 days to bring down the inflammation of my cysts, which my derm said could rupture if I am to start accutane)
Take Bactrim 800-160 mg
Apply Sibu Seabuckthorn Oil (one of the few things I have found is actually able to moisturize my skin. Does not break me out)
Apply CeraVe Moisturizing lotion for normal to dry skin
Take second dose of Bactrim
Take amethia lo birth control
Wash face with CeraVe Hydrating Cleanser, warm water, and washcloth
Apply pea sized amount of epiduo gel to cheeks and chin
Wait about 30 minutes then apply Sibu Seabuckthorn Oil
Wait a few minutes then apply CeraVe SA renewing lotion (contains salicylic acid)
On a finishing note, reading this I feel kind of stupid because I think a lot of this could have been avoided if I had just gone to the derm sooner or told him when I thought something wasn't working. I guess I was just kind of in denial.
UPDATE
I just read that the kind of birth control I'm on can actually cause acne because it contains androgens. Yikes! I guess that's what I get for going to see the med student at my university's health clinic instead of my regular OBGYN. I told her I wanted something to help with acne so I'm not sure why she gave me amethia lo. Needless to say I will be switching to something, FDA approved for acne. Ortho Tri Cyclin Lo seems to have some excellent reviews so that's what I'd like to try next. I'll be giving my doctor a call and hopefully I can make the switch tomorrow!
Epiduo Day 30, Bactrim Day 3
I've officially switched birth control. I'm back on Gianvi, the generic version of Yaz, which I was on last summer. I don't remember it having any significant effect on my skin, but I didn't take it for very long because of the mood swings it gave me. I recently decided to see a psychiatrist to go on anti anxiety medication, so I think that'll help. Also I've read good reviews for Gianvi clearing up hormonal, cystic acne so I'm trying to stay hopeful. I think the prednisone has calmed down a bit of my inflammation because my skin doesn't feel as swollen or irritated, but it's not clearing up any of my inflamed, cystic acne. I think the epiduo has done a very good job of getting rid of any active pimples. I just wish these cysts weren't so darn hard to get rid of 
UPDATE
The birth control I was switched to is not Gianvi, but Vestura, the newest generic form of Yaz. It's still FDA approved for acne, but I'm a little concerned as it has incredibly low ratings on Web MD due to people experiencing anxiety and depression. I already suffer from depression which I've had since I was eleven, so far before I started getting acne. I'm pretty scared to start this because I don't want to feel worse, but like I said, I will be prescribed an anti depressant in the next few weeks so I'm sure that will help. Guess I'll just have to wait and see. If this does make me feel awful I'm demanding to be switched to Ortho Tri Cyclin. Anyone tried out Vestura yet and have an opinion? Thanks.
Epiduo Day 31, Bactrim Day 4
Well the prednisone my derm prescribed is definitely kicking in now. This is my fourth day of taking it, tomorrow is my last. So much of the inflammation in my skin has gone down. It's still discolored and a bit bumpy in some places, but overall it has flattened out immensely, and the blisters on my jaw line are more like regular bumps now and much less irritated. My skin is still peeling a little from the epiduo, but I think it's finally become accustomed to the harshness of the medicine. I wish the prednisone is something I could keep taking, but sadly I know it's only temporary and my skin will probably flair back up a bit after I go off it. Oh well, at least it's given me a little hope of what my skin could look like in a few weeks!
Epiduo Day 32, Bactrim Day 5
It's my last day of taking prednisone and boy oh boy am I going to miss it. I mean my acne has just flattened out soooo much and the inflammation has gone down a ridiculous amount. Why can't this last??? It's like my skin is mocking me because I'm sure by Monday the cysts will just pop right back up. If you have some sort of big event, and you want to get rid of your acne very fast and very temporarily, I would suggest asking your doctor about going on Prednisone, but just for a few days because staying on it any longer can be bad for you and your skin. No new real pimples to report except for an itty bitty one on my chin, but I did have a panic attack last night after reading the side effects of bactrim and seeing that Steven Johnson Syndrome can be a side effect. Oh. My. God. The pictures are terrifying. Apparently it's not a highly publicized disease, and I sort of wonder if that's because doctors don't want their patients to freak out over getting it and stop taking their medication, because apparently even over the counter meds can cause it, although Bactrim seems to be one of the worst offenders. I'm trying very very hard not to think about it, because stress is such a major factor in why I break out. My face is a little more itchy than usual, but I've made a resolution to stop picking or touching as much as I can. I hate to admit it, but I'm terrible when it comes to that. When I pick, it's like a stress reliever and some part of me believes it's actually going to help when I know it only makes things worse. I also touch my face a lot because it's like this ritual where I can keep checking how my skin is doing, see if it's smoother or if there are new pimples. Which is also silly because I never see major changes in my skin day to day. Most times I touch and pick without thinking, so I'll just have to stay on the alert a bit more. I've also changed up my diet a bit. I'm trying to eat more fruits, veggies, whole grains, and lean meats. I drink a TON of water, which is easy because the Bactrim makes me super thirsty, and I've cut out dairy. I don't really buy into the whole a bad diet causes acne things, but I thought it certainly can't hurt to try so might as well.
Epiduo Day 34, Bactrim Day 7
It seems as though the prednisone my derm gave me is finally wearing off. My skin is so very not smooth anymore, but I did think it actually helped to reduce some of the acne by reducing the inflammation. The two blister things I had on my jaw are a lot less swollen and irritated, and my face overall is less red and swollen. Still not really presentable enough looking to go out though because it is still covered in cysts. I also have these three small pimples all in a row on the center of my forehead, which is incredibly annoying because I almost never breakout on my forehead. They are small but they've been there for several days. I cannot wait for them to go away!! I started my new birth control last night and I'm a little worried about that dreaded initial breakout, but I guess we'll see if the epiduo and bactrim can prevent that from happening.
Epiduo Day 35, Bactrim Day 8
A very disappointing day. My acne has flared back up after being on the prednisone quite a bit now, and I have a monster zit right smack dab in the middle of my forehead. I can't understand why I'm still getting new pimples after doing everything right. Quite depressing.
Epiduo Day 36, Bactrim Day 9
I don't know if it's just my imagination but things might be looking slightly better today. The two mega cysts feel like they are flattening out quite a bit. Still have the zinger of a zit on my forehead but I've been good and haven't picked at it so hopefully it'll be gone in a few more days. Yesterday I kind of had an emotional breakdown and began to panic, so my mom called my derm and asked him if I could just go on accutane. He said I need to give this stuff more time, but that I can go ahead and start getting my blood work done so I don't have to wait an additional month to start it if the Bactrim doesn't work. So I'll be having a needle stuck in my arm today. Huzzah! Am I the only one who kind of likes to watch when they take the blood? It's like coooool that red stuff is inside me!
On another note, if there's one type of zit I HATE it's the dreaded lip zit. They are the WORST. Everytime I move my mouth around or take a drink I can feel them and right now I have THREE all on different corners of my mouth.
Dear lip zits,
burn in hell
Your truly,
Caroline
Epiduo Day 42, Bactrim Day 15
Not exactly sure how I'm feeling about my progress right now. The left side of my face is doing much better. Everything just keeps flattening out. The right side is not so great. The giant cyst is still there, although it too is slowly flattening out. I had a bit of a breakout this morning just next to the cyst, but it was stuff I could feel had been under the surface for a while and needed to come out. A few hours after taking my morning bactrim it subsided a bit. Besides the cyst, I don't have any big bumps. The only problem is everything is so. friggen. RED. It is crazy how red every little spot is, even the ones that are almost flattened out. I don't know if this means the epiduo gel is killing them off and they just get really red before they die, but I certainly hope it's not the beginnings of hyperpigmentation. I am expecting some scarring, but I just hope its not as red and covering my entire cheeks like it is now!! I'm really hoping this Bactrim starts revving up it's game, but sadly, I think it'll be another two weeks before it does. I also got prescribed some anti anxiety medication today, which I'll be starting tomorrow. It should help with stress, and I'm hoping it may help my skin in that regard further down the road when I'm in maintenance. I hate the first few weeks of starting a new treatment. You never know what to expect, exactly how long it'll take, or if it will even work. Like I said, I'm hoping after the first month things will start getting a lot better. That's what most people have said about Bactrim. Positive thoughts are appreciated and I'll be sending the same to you all my brave acne warriors!!
Please please please be wearing sunscreen with an spf over 30. Hopefully your derm stressed that with any retinoid or any acne medication for that fact you must rain or shine wear sunscreen if he didn't -_- gtfo of that office and find a new derm. As each layer of your skin is exfoliated to reveal new skin if it isn't protected from the sun (number one reason for premature aging and a skin irritant) that new layer of skin which is so sensitive becomes damaged and as each layer of your skin is exfoliated by the retinoid it becomes damaged and your skin never gets a chance to heal and over time the damage might become permanent. Also being acne prone try to find mineral based sunscreens that aren't waterproof because waterproof sunscreens bind to the skin and don't wash of well with gentle cleansers. Also you mention that your face is always red. Not wearing sunscreen and not protecting that sensitive new skin can be the reason why. That new skin gets sunburnt at a much quicker rate so please add sunscreen to your routine also try to avoid the sun with a hat or an umbrella and if you can't, reapply sunscreen every two hours if you are in direct contact with the sun. A tan, a sunburn all mean damage to the skin and eventual skin aging.