I am sorry that you continue to struggle. There is a solution out there but you haven't found it yet (neither have I). It seems you have tried many things but TBH, if you stop every time you purge (which will happen with MANY treatments), you won't know if something will work for you or not. I don't think a simple topical will make much of a dent if hormonal issues are your route cause. Many people say diet and dietary supplements geared towards hormonal balancing may help. Hopefully someone with a bit more experience can respond or you can check out the hormonal forums

Good Luck hun and try to stay encouraged.

Part of the problem is that two weeks of the month, my skin is moderately clear--just covered in acne marks.

Is something like Epiduo supposed to be preventative?

I am on year 12 of a battle with cystic acne and have gotten cysts in the same spots for at least 5 and could use some advice about how to use Epiduo, or even if I should. Sorry if I ramble a little here. I will talk about what I've tried, what I'm doing now, and what I'm afraid of.

MY SKIN: Lately my cycle has been up and down and I notice the cysts are more long term. I also can see despite a cycle of aldactone that I have increased hair growth on my cheeks, chin, and forehead; all the ingrowns are leading to cysts.

WHAT I'VE TRIED: I have tried aldactone (3 years) + benzaclin, Retin-A, Tazorac, and Aczone. I have to admit, I know you need to stick with them, but in the last four years, every single one caused hard papules after a "patch test" and painful pimples. I guess that's normal? Should I have washed the new topicals off instead of leaving them on overnight?

In the two months I was on benzaclin, it only made the acne marks more purple and made the pimples hurt more by sensitizing the skin without really helping the bacteria.

CURRENT REGIMEN: Currently I use:

-Ivory face soap without scent (actually doesn't dry me out)

-Clean and Clear Oil Controlling astringent

-Mario Badescu Buffering Lotion on cysts. (It doesn't work on the really painful stuff.)

-Skinceuticals Phyto+ with kojic acid to help with acne marks; I suspect it is causing blackheads and whiteheads/congestion

I use Revlon Colorstay, remove with make-up remover, and do not use any hair or face oils and no facial products. I use an aloe moisturizer and go over all ingredient lists in my skincare with a fine tooth comb to make sure there is nothing acnegenic in it.

I suspect even now my tolerance of salicylic acid is changing, but I break out if I don't use it to get rid of the excess oil.

I sleep on my arm (not a pillow) on my side, and notice I get zits on that side here and areas (temples, forehead) where my hair touches my face (hair breakage).

I have been on and off Doxycycline a year and know it has stopped working at this stage. I could try a different antibiotic for a while, but I don't know how helpful that will be. As far as supplements: I cannot even take zinc or multivitamins anymore (I check to see they're low in vitamin A or biotin) without purging. I cannot eat anyone with fractionated coconut oil or sea weed...I suspect there is something off with my liver and I don't know how to correct it or test that.

I eat a lot of green vegetables but admittedly also eat refined sugar; the thing is that the only time I noticed my skin was perfectly clear was when I wasn't really eating much of anything due to stress.

I have elevated androgens and cortisol in my blood. The obvious solution is BCP but 100 mg of aldactone for three years was pointless and awful; it caused serious hyperpigmentation and did not touch the hormonal acne.

I tried Dianette for a month or two and the cysts were plentiful, big, and painful.

The only thing that worked (in college)--and not until I went through a terrible trial of purging--was Accutane. I am scared to go on it again and cannot for at least six months because I need to get a surgical procedure done in the next year.

SUMMARY: In short, I get whiteheads all over where hair grows, papules in some of the "hairy" areas, and localized severe hormonal acne. I am considering birth control and Epiduo; I am scared of what I've read and don't think Epiduo will necessary help given how poor the experiences I've had with Benzaclin and Retin-A were.

Should I put on Epiduo and then wash it off after five minutes to build up tolerance? Should I put it on cyst and whitehead prone areas?

Will Epiduo help me when Retin-A caused me so much misry in the past, or will it just cause forever-purging?

Might birth control (Yaz or Ortho Tricyclen Low) helped someone that responded so poorly to aldactone?

Doxy helped so much and now I have lost control of my life again.

If your cortisol is elevated and your androgens, this is a serious concern. You need to be evaluated for this. It could be any one of hormonal conditions.

My advice: Find a doctor willing to work with you and discover why your cortisol is high. That's not normal. Typical causes can be pituitary related or adrenal related. Acne is one side effect among many. I have seen some people with high cortisol levels have Cushing disease and it's nothing to mess around with. Not diagnosing you one bit , but get yourself to a doc until you find the cause, or you may regret it. There is a reason this is happening - - not necessarily because it just felt like happening.

Edit: I wouldn't take birth control. Not only can it make acne worse, it's especially bad news for people who already have screwed up hormones.

Part of the problem is that two weeks of the month, my skin is moderately clear--just covered in acne marks.

Is something like Epiduo supposed to be preventative?

Hey bizz,

Epiduo is supposed to be preventative; the doctor told me I wouldn't see improvement until after 3-6 weeks because it works beneath the skin to stop the microcomedone from getting inflamed and whatnot. That's why you have to apply it everyday all over your face (or affected areas) everyday.

If Retin-A did not sit well with you at all, Epiduo probably isn't the best choice to go with. I've used Retin-A before too and even though the doctor said the irritation would be pretty bad, I was completely fine. I was the same with Epiduo, no serious irritation. With Epiduo, you have the added potential irritation of the BP, which seems to irritate your skin also based on when you used Benzaclin. However, lots of people seem to get awful irritation on retinoids and Dan's BP, but they end up with clear skin. So, if you want to try Epiduo, you could start by using it every other day in the tiniest amount. Just keep in mind that it won't really look like it's doing anything until after a couple months.

I posted in your other topic about this, but it worked on my big, inflamed nodular pustules which may or may not be hormonal. If you want some visuals, I posted about it in my blog (only if you want to take a look at the kind of acne I have and how Epiduo cleared it up).

When it comes to your skin, you are the one who really knows it and has to live with it, so never do anything you don't want to do.