Hello everyone, I'm new to posting on this board although in times when my skin is bad I often find myself sifting through this site for information. I apologize in advance for the lengthy background and post, if anyone wants to skip to my experience with retin-A it will be labeled after all the background info.
Background: male, mid 20s. Acne since 13 maybe, was mild to moderate in high school (no cysts) and started having problems with hyper pigmentation around grade 11/12.
Finished high school, skin almost completely cleared up, had someone make a comment about a spot on my cheek that had some hyper pigmentation on it and asked when I got punched. I've always cared about my appearance a little more than I should and needed to, the comment made me become self conscious and someone recommended using Bio-oil for the pigmentation. A few weeks in and the spots had began to fade quicker but then I broke out for the first time in quite a while, and fairly bad. My cheeks were both covered in white heads and red bumps and I was left with quite a bit of indendted scaring, but at this point my forehead was still clear and I wasn't getting cysts.
I was in university and still struggling with with the scars but my active acne had reduced to a mild acne. I went for a microdermabrasion (sp?) Because I thought my skin was under control enough to handle it. I was wrong and the dermabrasion caused me to break out fairly bad again, once the break out had settled down I went to a laser clinic to talk about my hyper pigmentation marks and they gave me a 10% BP wash to use to get my acne under control before being able to get laser treatment done. The BP helped a bit, although I remember it making my pigmentation last even longer. I think I stopped using it for awhile because of this.
I switched schools 2 years in to my degree after finding out I was going to be a father. I went to a college to become part of the health care system. My skin was a little oily at this point but I would say my acne was still mild. I had gone to my doctor again to talk about the pigmentation and what I could do about it and he put me on Clindamycin just to control any last acne and said the best way to treat the pigmentation was through prevention.
Beginning of Cystic Acne: age 22, I was a full time father of my now 6 month old. After the relationship with baby mama fell apart. I began a new relationship after my first semester of school and my skin was fine all the way up until the break between second and third semester. We went on a vacation with some friends from school and during that two week break I began to break out again, my first moderate breakout I have had for about a year or more. I believe at this time I started getting cystic acne on my forehead and I remember the scaring and pigmentation becoming much worse. I had not had any significant amount of acne on my forehead in years, if ever, it was almost always confined to my cheeks and near my mouth. I don't know if this was due to stress, or to the highly sexual nature of my relationship (I've always pondered whether masturbation has made my skin worse at times as well). But regardless my skin got to a point where I stopped wearing my hair up so I could hide my forehead and my skin remained to be moderate for the last 3 semesters.
Retin A 0.01: I went back to my doctor and switched from Clindamyocin which wasn't doing anything anymore and he put me on Retin A 0.01 Micro gel for the cysts. I do remember my skin getting a bit better on this, although every time it got better I would be struck with another break out of a few cysts. These break outs would be a few months apart (2-4+) but because of the pigmentation and scaring my skin was just progressively getting worse. I have some pigmentation currently still from well over a year ago, so that shows how slowly my face heals and how easy it is for each breakout to be catastrophic.
My face remained moderate (looked more severe though because of the accumulated pigment and scars) through out the rest of school. I finally got in to a derm my last semester and he prescribed retin A 0.04 , although my skin was on the mend and looking better so I didn't start using it until recently. I had a break up rate before summer, and my skin was fairly clear by this point and continued to clear through the summer (lots of exercise and no more sex) and was finally at a point I was happy with it again. I went about 4/5 months without any real break out. And averaged maybe a cyst a month. Pigmentation had significantly faded as well. I was happy.
Confidence killer: Then came cram time for my board exams in September. I went on one last hike a few weeks before my exam was scheduled and got roasted really hard. Worse sun burn of my life all over my face and chest/shoulders. I stopped using all products and starting slathering on aloe and organic coconut oil (recommended by a friend) which I continued to use after the burns had peeled and healed, ultimately I think which lead to my next breakout as I was unaware it is pore clogging. Sure enough the week before the exam I had the worst break out of my life. Multiple cysts on my forehead, pimples on my cheeks. This was such a devastating blow, not only did I have to see my ex again for the first time since our break up, and have to perform a hands on exam with a bunch of professionals, I had finally gotten my confidence back after months of struggling. I was swimming for the first time in years not having to worry about how red my marks were when I got out of the water or about my skin drying up and cracking. I was finally able to do things again without worrying about how my face looked and it was such a tease. To go from that feeling after a year of suffering and months of recovery back to hiding from the world was just ruthless. I know many people on this forum have shared this experience, where your skin is so bad you lose confidence, and you lose sense of who you should be. You become a totally different person that's being manipulated by this disease and it f'*king sucks. You ask how you got to this point again, and why you. Especially when you don't know what's causing or contributing to your break outs.
Retin A 0.04: anyways it was at this point after the worst break out of my life I finally decided to switch up to 0.04 from 0.01. Started mid September of this year. My skin took fairly well to it off the bat as I had been using the other for at least 4 months. This break out had lasted for almost 3 weeks with at least 10+ cysts on my forehead within that time. About a month after in October I noticed my skin starting to get softer, my pigmentation marks were fading considerably quicker, and any new acne or cysts that were popping up were clearing quicker.
Regimen: Morning:
Earth Science vit ADE creamy cleanser in the shower. Neutrogena oil free moisturizer (which is quite light and noticing i need to apply two times in some areas). I WAS applying Retin A every day morning and evening.
Evening: wash with cleanser, retin a, sometimes moisturize.
Results: my horrific break out was clearing quicker than I thought it would, new skin was nice and smooth, pigmentation faded/healed quicker up to a certain point, and better in some areas than others. My cheeks still taking the longest and showing least improvement. Around a month and a half my skin was noticeably better from my last breakout, almost no active acne and just dealing with a few indent scars and pigmentation. My skin i should note was also not oily at this point. I was finally back to where I was able to hang out with friends on the regular again and not be too concerned in public, I was even wearing my hair up again which was a big deal, and had some confidence restored which was much needed.
The Purge?: well I had mentioned about how my skin always gets better before it gets worse and well after my last break out in September I honestly thought things would not get any worse. I was so, so horribly wrong. Mid November I started to break out again after not having any break outs or cysts since September. A few red spots on my cheeks but I started with about 5 cysts on my forehead. I didn't go into panic mode right away, but I started researching my regimen and what I was doing wrong. realized I was applying too much Retin A and not waiting for my skin to dry before hand. So I re adjusted, but the break outs have not stopped.
It is now almost Christmas, and over a month of consistently breaking out. My forehead literally has more red on it than white and at some points I have counted up to 15 active cysts at once on my forehead. Including in my scalp (which I've never had before). My skin has become oily again for the first time in almost a year. This is surely the worst my skin has ever looked in my entire life, it makes me look back at points where I used to be stressed about my skin and laugh because of how badely I would love to be at that point again and really how insignificant it was compared to this. I've pretty much become a hermit, I have an interview for a job next Monday and have no idea how I can possibly work in the health care system with skin like this. I do pick a bit, which I know is doing good for me. But even when I don't I notice white heads will pop bleed just from showers and washing my face. My skin has become very dry and tight, as well as oily (especially my nose) and my cheeks were getting quite red so I've reduced retin A to every other night.
Current regimen:
Moring. Earth science Vit ADE cleanser, followed by Neutrogena oil free moisturizer. Started using my old BP 10% every third or fourth day but its expired so I'm weary to keep using it. Started taking a probiotic vitamin with morning meals. This is insanely hard to admit but I do wear a bit of foundation every day which I apply over my pigmentation. Which doesn't really do a whole lot but does help make it appear less red in certain light. I have been doing this for the last 2 years or so, so it's not new to my mornings. I apply this last after moisturizing.
Evening. cleanser, wait 20 mins. Some nights ice to my forehead for 10+mins, every second night retin A. Moisturizer to cheeks every night and some nights forehead.
Some possible triggers:
Retin A 0.04: I didnt think I would purge, especially 3 months in, considering I've been using the 0.01 for months before hand. But I was applying too much and too many times a day, possible factor.
Stress, which makes sense for my September break out and my exams but I have been typically stress free since that breakout ended and would not explain my current.
Sugar. Cute 2 year old brings home a lot of candy on Halloween and I'm not normally someone who eats sugar as I try and eat healthy but I couldn't help myself, follow it up with Christmas baking and my sugar intake has been exponentially higher than normal since beginning of November.
Diet: was making a smoothie every morning with plenty of vitamins and flaxseed etc but noticed I have stopped making them regularly.
Masturbation: hard not to when you're stressed, but it has been a little heavy lately.
Less exercise. Maybe once a week I'll get out for something. Twice if I'm lucky.
Genetics: my aunt apparently had the worst acne my mom has ever seen, and all over. I can't remember what she used for it, it started with a T I'll have to ask again. And that somewhat helped. She also did some treatments where apparently they'd burn the top layer of skin on purpose. Her skin is clear now, progressively got better with age is what she said. My grandma also had bad acne apparently but hers went away with age as well. Both on my mom's side, my mom gets cold sores quite bad when not medicating for them. No other male in the family on my mom's side has had issues with acne though. And of course my sister takes after my dad so she's got beautiful skin.
Other weird notes: September and the winter (sometime between Dec-Feb) I have had break outs every year at these times for the last 4 years or longer. I have no idea why but it is a guarantee every year since i noticed.
So I am curious to people's opinions/experiences on this. My biggest concern is trying to understand WHY I break out and why this cystic acne appeared randomly at the age of 22. Do I keep pushing through with Retin A? Go back to my derm and get a stronger prescription? Should I get a non expired BP and throw that in to the mix for now? I am feeling quite defeated at the moment. I really wish to cancel my interview as I'm actually afraid to start working with the public every day looking like this, but its a great opportunity I can't blow off.
I'll attached my photo tonight although I think I'll start a new thread to link to this for a photo log. As I have been keeping track since my break out in September.
It is really hard to fathom the severity of my skin at this point, before September my forehead was practically spotless with maybe one or two pigmentation marks and a indented scar. Even after my severe breakout in September i was left with maybe what accounts for 15„… or less of the redness you will see in this picture. The rest is from the last month and non stop breaking out, the majority of what you will see if pigmentation. Its also fresh out of the shower so its as red as it gets.
Thank you to anyone who took the time to read this. 
Some people do really well on retin-a and others don't. Through the years derms have tried and tried retin-a on me and it always makes my skin look like yours! It is supposed to clear up cystic acne but it just inflamed my skin horribly no matter how long I used it or following directions perfectly. I'd say give up on retin-a. Go back to your derm with photos and a written history of what happened to your skin using what. I finally did this and it really helped my current derm devise a plan that would work for me.
Some people have a bit of rosacea or sensitive skin along with acne and this complicates treatment because if the skin is already irritated the derm may not see what is underneath. For me personally, a person who suffered with cystic acne flare-ups like you, the regime listed below has worked wonders. I use a BP cleanser + cleocin-t, a topical antibiotic that works best following the BP cleanser - by itself it is not as effective (...thinking of your experience...). My derm has me doing microdermabrasions once a month to open pores but it is the diamond tip kind and not the crystals which can be irritating.
I have also changed my diet to one that helps inflamed skin --- no dairy, sugars, alcohol, fermented foods, processed oils (salad dressing, fried foods, margarine, butter, etc.). Try avoiding all added oil and it will help your oily skin and further reduce the cysts.
Hope this helps. I know how it feels to be a professional with teenage skin!
i learned the hard way that tazorac CREAM was an issue but the GEL was not...are you on cream or gel?
and since accutane didn't work for me I've been focused on my diet, but seems like your is pretty good
zinc breaks me out, don't know why but it does- so maybe ditch that for a few weeks
it's always a detective game for me, but elimination and journal keeping (my mood, what I ate and drank, sleep)...helps me keep track of what tweaks I need to make
don't give up on the interviews...this is your life- but do try to hit the acne day and night, like the retin a at night (or ditch it if you really think it's the issue) then either a BP or a salicylic acid during the day....hit it on both ends BP didn't work for me, but SA does and I use 2% mild every day under my makeup
so make your plan of attack...but do NOT give up on those interviews!
I'm sorry to hear about your acne. A change of diet and stress can sometimes trigger a break out on your skin. I would suggest that you keep away from sugary and processed foods as much as possible and find some time to relax. Being a parent can sometimes be very stressful especially to an active toddler. For more information on other options for treating acne, kindly use the link provided below.
http://www.acne.org/acne-treatments.html
You might also wan't to try home remedies if OTC acne medication does not work out for you. The sometimes work better on the skin. For more information on home remedies, you may use the link provided below.
http://www.acne.org/reviews/household-natural-treatment-c11/
Good luck!
Your skin seems really sensitive to what you put on it. My skin is like that, and if I put the stuff you're putting on your skin on mine I would also get cysts. The combination of the cleanser, moisturizer, foundation, and retin-a would destroy my skin. They all contain potential cloggers. Have you ever tried just cleansing with water and using no moisturizer or makeup?
Thank you everyone for such quick and thorough responses.
@cvd - I'm sorry to hear about your experience with Retin A, I thought I would be doing alright with it as my skin was looking great while on the 0.01, but there were a lot of other factors that I was doing better with at the time (diet/exercise, etc.) So that could have been more behind the clear skin than I thought. I will go back to my derm and give him a report like you mentioned and see what I can do from there, unfortunately it was about a 4 month wait the first time so hopefully I'll be able to squeeze in before that. I'm a little hesitant about the microdermabrasions after my last experience, but I'll look into the difference between the diamond and crystal tips. Thank you.
@mrsrobinson, a journal is a great idea. I noticed even when trying to make this write up I was having a hard time remembering what I was using and when, and whether it was working or not. I am using the gel, I read the cream is very prone to clogging pores so made sure I stayed clear of that. How long did you use BP to determine whether it was working for you or not? I will look into the SA. Thank you.
@katiebear79, yes I know the feeling. I like to think I would normally be a pretty handsome human being, but my acne and residual pigmentation have always kept me from reaching that potential. Whether people even notice it or pay attention to it when its not all that bad is debatable, my last girlfriend said she never noticed it and wondered why I'd always freak out about it. But even if its only a few spots (hard to imagine ive been there at this point) when you're around a group of people and everyone has clear skin but you, its hard not to think about it and ponder how much you stand out. I'm very happy to hear of your success with the Brewers Yeast! I have started a probiotic and I will try and add this into the mix as soon as possible. Hopefully one day I'll be able to post on this board with a success story to give others hope as well. Thank you.
@IzzyTizzy, I will definitely have to be more careful with my diet and keep track of when it starts to slip. I will look into the links you sent, thank you.
@paigems, I was cleansing with just water for awhile, although it felt like it wasn't leaving my face clean. The moisturizer is a necessity for me unfortunately, especially in the winter. Without it my skin would crack, be tight and become quite flaky in certain areas, mostly along the inside of my cheeks near my nose and mouth, I did a lot of research before getting this one though and it is supposed to be quite light and none clogging. At the time of my first severe break out in September I wasn't wearing foundation, moisturizer or using a cleanser. Although my skin was healing from a burn and I was coating coconut oil on like no tomorrow not realizing it was pore clogging. At this point i also feel as though the foundation is a also a necessity, but I only put it on days that I leave the house. It doesn't even do a whole lot but any reducing in redness helps the confidence. I know its probably the worst along side retin a for clogging pores and is probably perpetuating the situation, its not something I can realistically cut at this point. And I've always been too embarrassed to go down and get some opinion and maybe find a better brand that won't clog my skin as much. But I might just have to bite the bullet and do it. Once I feel as though I don't need it I will happily cut it from my routine. I may try using the cleanser once a day and washing with just water for my second cleanse. As well as cutting the moisturizer out at night. Thank you.
Once I find the photo of myself before my breakout in September I will post it so everyone can see the drastic comparison.
I like to cleanse with an oil because just cleansing with water doesn't leave my face feeling clean either. I experimented with many oils and the best for me are meadowfoam seed oil and watermelon seed oil. I mix them with an emulsifier (cromollient) so they rinse clean. Coconut oil and a few other oils clog me, but these oils are higher in linoleic acid which are supposed to be better for acne prone skin. Unfortunately, most ingredients used in skincare products today are derivitatives of coconut oil. The products you are using have several and also other clogging ingredients. The bad ingredients can be seen here on cosdna:
http://cosdna.com/eng/cosmetic_58e0106193.html
http://cosdna.com/eng/cosmetic_916446092.html
Oils are usually much less problematic and can also be used as a moisturizer.
My guess is is you got rid of the products you're using (including the retin-a) and simplified your routine (including getting rid of the makeup) you'd see a drastic improvement in your skin.
Ok retin a micro gel.04 , my worst nightmare.
First ,you were not supposed to use retin a morning and night.
Retin a has to be used at night only, using a pea size after washing your face and letting it dry for ,30 minutes.
Dermatologists usually recommend washing your face with a mild cleanser, usually purpose cleanser.
Second you can not go in the sun , much less get a sunburn.
Dermatologists recommend that If ,going in the sun , use a sunscreen.
In my case my face looked like yours , I used it for 9 months,OCD ? Yes,stubborn ? A lot .
Ended up with the worst cystic acne ever, before that my skin was oily, after that the worst dryness and redness ever.
Stop using that immediately, go back to the dermatologist , but don't let them out you on corticosteroids,, they will say that you have atopic dermatitis, eczema, my mom as long as I remember, yeah cold sores.And an occasional pimple , but it's because she uses some thing called vitacilina that has
Retin a .
Ok something that I used while using retin a was the olay complete for sensitive skin,I noticed that it made my face less itchy and less red,I didn't know what it was until recently, since my retin a micro disaster I have tried many things and have been trying to decipher what went wrong.
About the things that I used to fix the damage, after my face felt like having a treatment again,I talk in the rosacea forum, under the seborrheic dermatitis thread starting page 46.
Ok clean and clear dual moisturizer action oil free will calm that redness, apply a thick film is ok.
My daughter used ziana that has retin a plus clindamycin.it worked fast , and then after a year, bumpy all over nose, cheeks , inflammation redness all over.So back to the dermatologist who wanted to put her on costicosteroids I said no.
She, like me, used that dual action moisturizer until we got to see the dermatologist.it feels like tingling because of the menthol, but it doesn't burn skin more , it's just a moisturizer with a small percentage of salicylic acid , so it won't clog the pores.
The dermatologist might say seborrheic dermatitis, for that ketoconazole is the one that I have seen people recommending the most in the seborrheic dermatitis thread.
For atopic dermatitis,eczema that retin a seems to provoke that on people who have or are prone to eczema(its in the brochure).
Ok for that I would probably ask the dermatologist for something like zinc oxide , and that was my connection to the olay moisturizer that I was using while on retin a .
Zinc oxide is used in diaper creams, for diaper rash, is very healing.
First you need to fix and calm down all the inflammation that the retin a has caused .after that you will think about more treatment for that acne.
But first thing first, ok , don't panic.
Acne or any skin condition can be controlled.
Wash your face with a mild cleanser.
My daughter liked purpose, while on ziana.
Oh and staying away from sugar its important,cleansing your system with chia seeds to calm you down, Google chia seeds and how to use them its important, that you know how to use them properly.
And sex has nothing to do with having acne or not , hormones do, though.
And of course stress , and if you exercise see if you can do meditation or yoga.My daughter breaks out with heavy exercise , so she does yoga .
Best wishes.
Don't worry about other people, they don't pay your bills.
Interesting about the Brewer's Yeast...actually nutritional yeast is what is supposed to be good (...brewer's yeast is leftover from beer production - not good...). People often confuse the two. I have been using nutritional yeast for about 6 months now and love it. It is a great way to get B vitamins and it is very good for skin. Don't think it'd cure cystic acne by itself but along with other treatment is definitely a big help. That said, am happy to hear that it "cured" poster above.