Please define what a "horrible reaction" is to BP.

Antibiotics are not meant to be taken for 2.5 years. You're probably immune to them by now. Going off them isn't going to change anything.

So sorry to hear you are suffering with cystic acne. I know the agony you are going through. I have totally clear skin now and hope what I have to share will be of help to you. I became clear two weeks into following my derm's regime as listed below and have remained clear now for several years. Nothing short of a miracle for me, especially after decades of suffering!

I suffered for most of my adult life with cystic acne like yours and was deeply scarred emotionally by having to constantly deal with it. The ongoing anxiety and depression that happens with knowing red spots would always develop into a painful, ugly mess caused me to limit much of what I did in life. I had lots of surface acne and typically 1-2 deep cysts at all times. It doesn't take many to disfigure the face! It was near impossible to cover up with makeup without causing more attention being drawn to them. Like you, I was often on antibiotics that worked somewhat but stopped being effective over time. The most effective antibiotic for me was full strength Doxy or Bactrim. I was on Bactrim for almost 5 years trying to get things under control. I also did two rounds of accutane which helped make the cysts less deep but they were still there and infected.

I always thought I was too sensitive for BP. It took my derm years to talk me into using the BP face wash listed below. Much to my surprise my very sensitive skin did just fine with it. BP is one of the few things that actually kills acne bacteria. The right kind of cleanser (like Panoxyl 4%) is very mild and only on the skin for about a minute before being washed off. I was very skeptical if it would work but I guess enough remains in the pores to effectively kill the bacteria.

Salicylic acid does not kill acne bacteria. You need to have something in your regime that kills the acne bacteria. My derm also has me on a topical antibiotic which he says if used in combination with the BP face wash is more effective than oral antibiotics and can be used forever without the usual side effects of oral antibiotics.

Another thing which dramatically helped were monthly microdermabrasions to remove dead skin and tone the pores so meds get in better. Cystic acne skin is usually filled with hard deep plugs (hence the cysts) which make it hard for topical meds to get in.

I also take a very low dose of Spironolactone. Spiro is a very gentle anti-androgen that blocks androgen receptors so results in less acne. Spiro is another thing that can be taken forever at the low doses used for acne. My derm is an expert in adult acne, especially cystic acne and the regime below was developed to attack cystic acne in the most gentle way possible and with a regime that can be basically done forever if needed. I am in my early 60's and never in my wildest imagination would I have guessed that cystic acne would continue throughout my entire adult life...even past menopause!

Another key aspect of my staying clear was a change in diet to whole foods, wild fish/game and free range eggs, and especially avoiding all processed oils (vegetable, coconut, butter, olive, etc) and foods with lots of it (fried, mayo, dressings, etc), dairy and sugary foods. Changing my diet was the final thing that resulted in totally clear skin. I firmly believe that such a diet is essential if you want pores that aren't all clogged up and skin that is calm and not inflammed.

To me having clear skin is nothing short of a miracle. Yes, I am on some drugs and will probably continue to be for the rest of my life but I have no side-effects and my skin is clear --- BLISS.

Please read the regime below. It cleared me up (finally).

Please define what a "horrible reaction" is to BP..

The first day my skin goes bright red and itchy - yet burns at the same time. Then I get little bumps come up, after a few days the little bumps dry up and flake away and I am left with a red patch for about 2 months - just from one application of a 2% strength.

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Please read the regime below. It cleared me up (finally).

Thank you so much for your response. Unfortunately I could not see your regime? Please would you post it again? Are you in the Uk? Because I have asked my doc about spiro and bactrim and she just looked at me gone out!

Just to let you know...I have a very similar reaction if I apply BP topically - even at the lowest dose. I'm not sure why using a BP cleanser doesn't cause this reaction but it is likely due to the fact that it doesn't remain on the skin very long (only 1 minute while cleansing). Also the brand I use is specifically made for sensitive skin. Bactrim may not be available in the UK but I know Spironolactone is. It is a very common old drug that was originally used for treating congestive heart failure because it is a mild diuretic. A "side effect" is it is also an anti-androgen. If your derm is not aware of it I would check with another derm. I had a derm here some years ago who also never heard of it...and she later turned out not to be very good. She was the one who had me on 5 years of Bactrim which was insane since the cystic acne could be treated so much better with the gentler treatment regime my current derm has me on.

Here is the regime:

Status - 99.9% clear

Morning - Panoxyl 4 Cleanser (BP), Cleocin-T, DML Lotion, Physician's Formula SPF 30 Mineral Pressed Powder, Spiro 100 mg

Night - Cetaphil Antibacterial Bar, DML Lotion

Monthly - Professional microdermabrasion

Diet - Whole high nutrient unprocessed foods. Avoid oils, dairy, sugars, bread, nuts, alcohol, caffeine, and fermented foods.

Supplements - Opti l-zinc, citrical + D3

Daily - Walk, breath deeply, meditate and do yoga daily, wear hats for sun protection

Thank you very much. The trouble with the NHS is that if you don't like your derm its tough. There is only one per area. You can't even go private, unless you live in London, dermatology just doesn't seem to be a thing here!

So sorry to hear about the NHS and difficulty changing derms. That makes it much harder! That said, there are some things you can still do. The BP cleanser Panoxyl 4% used to be prescription but now it can be bought over the counter or on the web. You need something that will kill the acne bacteria.

Would your derm consider a topical antibiotic? If used following the BP face wash it is clinically proven to work the same as an internal antibiotic but stays more potent...something about BP and topical antibiotic working synergistically. I only use the BP face wash and topical antibiotic in the morning so it's very gentle. Would your derm consider Spiro for the anti-androgen benefits?

You can also tweak your diet. The biggest diet thing that helped me was avoiding all oils. Last week I was tired and out with friends and didn't order well so ended up eating a greasy omelet and potatoes. Normally I would order a salad with hard boiled egg, avocado, etc. A day later I broke out with two pimples...granted they were teeny tiny and went away in a day but usually I rarely if ever break out now.

Re: cysts --- when my derm put me on the regime below I literally stopped getting cysts. Never have had one again! But I think it requires doing all the parts ---- a acne bacteria killing cleanser + topical antibiotic + internal anti-androgen + monthly microdermabrasions + whole foods diet that avoids dairy, sugars, oils.

This is very much like me, keep getting a cystic spot on my chin which, as soon as going away, another springs up somewhere else on my chin. Like you, red marks left and take at least 6 months to fade. Had clear skin until last November when, aged 25, this nightmare began. Like you, have tried lots of things, including antibiotics which did nothing. It is so frustrating having this as an adult

Hi! I am super susceptible to cysts. Yes, they would just seem to pop up overnight. I hated getting up in the morning to look in the mirror. Sometimes, if I felt the pain beforehand, I could shrink them a bit with ice. But I always had something on my face..whether a full blown cyst or the large bumps... This started when i was about 20..and I am now 36!!!

I tried many things. Some worked for a while. The best thing so far, for me, has been Paula's Choice regular strength clear 2% BHA (salicylic acid). I noticed that after a big cyst would come to a head, it would shrink but never go completely heal until this little "sesame seed" thing would come out. People on here call them plugs, so I figured that for some reason my skin makes these things and it gunks up my pores. Anyhow, I have had some success with store bought stuff like Stridex in the past and I figured that PC would be even better quality. It was highly reccommended on this site, so I finally took the plunge several months ago. My skin finally cleared.

I mean, it took about 4 months of daily appliation. But, my skin cleared. I don't cry in the mirror any more. I still have red spots, but better than acne! I also use Paula's 2.5% BP..it is gentle enough for me. But, if you have a reaction to BP, then I'd skip it. You migth can try something like bacitracin (it's an OTC antibiotic that you use for cuts, etc. I've used it before and it has helped at times). I've been pretty happy with my skin for a few months now. I did break out a bit the past few days and I think that was my fault.

1. It was period time

2. the weather turned colder and my skin tends to be dry in winter, oilier in summer--I was using PC earth sourced cleansing gel and I think that coupled with the SA dried me out. ARGH..

3. I also thought it was a smart idea to do a retinol treatment around that time.

So, I'm trying to figure out a new routine for winter, but overall, I'm still pretty happy! I don't see many of those "plugs" surfacing any more and most bumps that do come up, (that before I would FEAR would turn cystic) can be shrunk/eliminated within 2 days with the BP.

I really hope you find a regimen that works for you! Of course, what works for one might not work for another. If diet is causing your cysts, then you'll still get them even if you apply topicals. But if you happen to have the plugs as a cause, then salicylic acid might be a selction..and then maybe a weekly glycolic acid to clear off the top skin layers!