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Don't know what to do after my first dermatologist appt in 14 years

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I've been struggling with acne since middle school.  I remember the days when my skin was clear, and then poof, acne came and has not let up since, and I am now 33. I used to see a dermatologist in high school through the beginning of college. I was on all sorts of topicals, and an anti-biotic, nothing worked completely. So I stopped going and used the acnefree regimen for ten years throughout college and after, then unhappy with how I still broke out with bad ones, cysts sometimes, I weened myself off to only using the 2.5 BP cleanser just six months ago. It's still never been a way to keep it completely under control, just moderately, and some days are better than others. I tried to use a SA cleanser instead, or using a  gentle hydrating gentle cleanser, still got pimples.  So I asked my general doctor about it a month ago, and he gave me clindamycin phosphate water based 1 %.  I've been using that on the areas I am more prone to breaking out and it's definitely helped. I still get pimples though. I wanted to see a dermatologist at this age, see what they can recommend.  So I went, explained my situation, they looked at my skin.  They said it's not bad, but since nothing seems to work all the way, they pitched accutane (I recall being pitched it in high school but was worried about all the side effects so I turned it down.) It sounds great today...4-6 months, then my acne would be gone.  The side effects weren't that bad according to the derm.  I've read a lot of good and bad online about it, and how it doesn't work for everyone.  The thought of something entering the blood stream and having to get blood levels checked each month is very unsettling (not to mention expensive.) I don't have the best health care plan, just basic.  So accutane wouldn't even be covered, and the only generic form I saw on their list was claravis and even that would be over 200 bucks. I told her for now I don't want accutane, so I got prescribed a tretinoin.  The derm's recommendation was to wash my face with Johnson and Johnson baby shampoo (I've never heard of such a thing to use for an adult's face that has acne prone skin) morning and night ,and apply the clindamycin in the morning as I have been, and use the tretinoin at night.

So I can fork up the money and risk it and take a pill for 6 months and be done with this, or wash my face and apply topicals morning and night for the rest of my life?  That's assuming the baby shampoo doesn't make me worse, or the tretinoin does as well. 

What are everyone's thoughts on this? I'm at a crossroads, I don't know what to do because there's no easy answer.  I hate that it's come to this at age 33..when I've been dealing with it for so long.  It's caused me to be really depressed and feeling hopeless...I was hoping the derm visit would be a good experience and give me some sort of hope..but instead it's left me with the opposite....

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In the same boat as you are, check my log. I chose to get on Roaccutane 5 years after nothing has worked for me.

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I'm still considering it.  I can decide and go on it, I just worry from all these things I've read, and to spend that long a time and to have acne still return.  At least topicals can be used then changed. 

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Do I really need to go on accutane if I just get some pimples?  I get under the skin ones once in a while and white heads once in a while.  Do I need to go on something prescribed for severe acne or should I continue with topicals?

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