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27 Year Old Female Cystic Acne

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My battle with severe acne started when I was 23. I started developing deep, swollen, painful cysts. These have persisted until now and I am 27. I've been to multiple dermatologists and placed on every combination of oral and topical antibiotics knows. At one point I was getting twice weekly extractions and facials from my dermatologist. I've also tried just about every over the counter option. I've tried the paleo diet and cutting out all dairy with no avail. My acne is worse than ever, I'm in tears because of pain and embarrassment and I'm embarassed to even leave the house for work. I've cancelled fun plans such as swimming as a result. It is really taking its toll on my emotional health. My last option is Accutane which I've been reluctant to go on as I hope for children in the next few years, but it has gotten to the point I'm considering it. I can't smile without severe pain and other people staring at my face is getting exhausting. I try my best with makeup but the huge bumps are impossible to cover. I'm exhausted from this, depressed and feel like I'm forever stuck hating my appearance. My cysts cover my whole face, cheeks, chin, nose and forehead. My skin is greasy and shines just hours after washing it. Any help out there?

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Don't be afraid of accutane. I had terrible cystic acne and did it twice in my late 20's. Only side effect was chapped lips. While on it I was clear (...a wonderful respite from cysts...) and afterwards my cystic acne returned but milder. Meds that never worked before began to work better. The regime I'm on now is the one that finally got me clear and has kept me clear now for several years. FYI --- full strength antibiotics did too but you can't take those forever. Also harsh acne topicals like BP and salicylic acid were too much for my sensitive skin. Here is the regime that got me clear. Using these things individually did not work...it is using them together that works.


BP cleanser (Panoxyl 4%) --- in the morning gently swoosh on for one minute and rinse with lukewarm water. Pat dry.

Topical antibiotic (Cleocin-T) --- apply in morning all over face and spot treat as needed at night.

Lotion for acne skin (DML) --- apply evenly with gentle strokes of fingertips, let dry naturally, don't rub.

Anti-androgen (Spironolactone 100mg) --- take one in the morning.


Mild cleanser (Cetaphil Antibacterial Bar) --- in the evening gently swoosh on briefly and rinse with lukewarm water. Pat dry.

DML lotion

Anti-inflammatory Diet --- this diet is for oily cystic inflamed skin --- avoid all dairy, sugary foods, processed oils (salad dressings, fried foods, etc.), nuts, caffeine, alcohol, spicy foods. Eat fresh whole foods.

Monthly microderms help keep more pores clear and help the topical meds to penetrate.

I really like a zinc supplement called "Opti L-Zinc". Studies have shown that most people with chronic acne have a zinc deficiency.

Hope this helps!

Edited by cvd
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For severe acne in women, typically hormonal treatment via medication or herbal supplements is the only option for true clearance.

The chain is

Hormones -> sebaceous gland -> sebum production -> pore blockage -> bacteria feeding -> inflammation -> acne.

You have to modify the hormones in a significant way to break the cycle. Diet changes can and do alter your hormonal state, but for severe acne you would have to make much more serious diet changes than you realize.

I would recommend you get on an appropriate birth control pill (see the link in my signature) or start using anti-androgenic herbal supplements such as saw palmetto. One of these two steps usually gets women with adult acne on the right track faster than anything else you can do.

You can further optimize your results by helping the process through diet changes. Avoiding sugar, dairy, processed foods, high carbs, inflammatory oils (omega 6s--most vegetable oils), and high glycemic loads (even if you eat totally great meals avoiding all these things, if you eat a lot in one sitting it's still a problem).

Topicals such as benzoyl peroxide and salicylic acid will not cure acne but combined with hormonal mediation they will help keep it in check. Hormonal changes can take months or years to go into effect, and unless you're extremely patient, you will probably need to have some sort of topical regimen going so you can socialize normally.

If you are considering Accutane, realize that it often helps but the acne often comes back. Accutane shrinks the sebaceous glands to the point that you almost produce no sebum at all. So even if your hormones are raging, if the sebaceous gland is very small the chances for acne are slim. However the problem is that sebaceous glands always grow back. So with your hormone problems now, it is likely that in a year or two after Accutane you will be back where you started or close to it.

Edited by Green Gables
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I was on birth control for many years, went off of it about a year and a half ago due to a slew of other problems it was causing for me. Accutane scares me in that I am looking to have children in the relatively near future, also another reason I'm not on birth control. I am considering going to see an ob/gyn to be evaluated for PCOS which I think could be underlying many of the issues I am having health wise. My acne continues to worsen to the point I'm only leaving the house when absolutely necessary (ie work). I hate how I look.

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Can you see a dermatologist? PCOS is usually treated with birth control pills which you say don't work for you so you'll have to do something different. Spironolactone might be a better choice since it isn't a hormone but instead blocks androgens which in turn helps stop the acne cycle.

For really oily skin try avoiding all processed oils (olive, canola, mayo, butter, fried foods, etc.) and eat whole foods instead (avocado, salmon, whole coconut, olives, etc.). Google "Dr McDougall acne" and his article will come up about cultures that don't get acne and how to eat to clear up skin. It works...along with avoiding dairy and sugary foods.

For really deep cystic acne you will have to do more than diet. It is doing a combination of things that works...not just finding one "magic bullet". The combination approach is diet + something to open pores + something kill acne bacteria + soothing the skin.

I battled deep cystic acne for years and years until finding an approach that consistently keeps me clear (see signature below). Hope this helps!

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I honestly was just like you a couple years or so ago...... I was breaking out since puberty and my adult acne worsened once I hit my 20's and 30's. I began getting cystic acne all over my face I lost count numerous times. I am not gonna lie.... I spent a lot of money and time on getting my skin to where it is today. The regimen I have now is the most effective one I ever tried and I'm still on without a breakout since. I was getting cortisone injections nearly twice a week at my dermatologist office that are super painful. It was difficult to cover up all the blackheads, scars, mix of new and old cystics all over my skin. I was trying facials, extractions and all kind of over the counter treatments including Proactiv Solution that made my skin worse!

My primary doctor did throw the word Accutane my way but I refused and was determined to find a way to cure my acne without going that far. Here is the routine that worked for me.......as I have really oily skin.....

-Doxycycline 100mg twice daily (eventually I tapered down to once daily) for the cystic acne and preventing new ones from forming

-Spironolactone 150mg. once daily for hormonal acne

-Tazorac 0.1% PM application mixed with a light moisturizer (the most powerful Retin A you can get through a doctor to get rid of the blackheads and whiteheads, it speeds up cell turnover, exfoliates, and changed my skin texture to completely smooth instead of rough and bumpy)

-Acanya AM application mixed with a light moisturizer (Benzoyl Peroxide and Clindamycin topical)

-Obagi Clarifying Serum AM application after washing, fades and prevents brown spots from forming making my skin even over time.

-Sunscreen every morning because you don't want new brown spots forming only to fade those it'll be a never ending cycle. Protect your skin!

I get away with any salicylic acid facial wash like Clean and Clear twice daily ..... and toner only at night to remove dirt and make up. I also use Sephora Tarte make up this is the best line of make up that's not only kind to my skin but is good for it with the amazonian clay that's acne healing. The Tarte Tinted BB Cream Moisturizer is my secret to a buttery, shimmery, complexion... I get endless compliments with this product as it makes my skin very flawless.

The secret is to be dedicated to your skin health and work with your dermatologist a good one at that.... I got very lucky to find one in San Francisco that worked extremely well for me.

I wish you the best of luck on your healing acne journey, I know first hand what it's like to go through it. I wish I had this skin when I was younger but better late than never.....


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I'm just a normal 30 year old female with cystic acne. Painful, annoying, ugly looking... not awful, but enough to bother me and leave patches of trouble skin on my face. I've been washing my face at night and applying dermalmd acne serum over the troubled areas and my morning the swelling is significantly reduced!! I sometimes also apply in the morning. I have bought other acne topical treatments that have not helped anything like this has helped! Totally worth what I paid for it.

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