Hey guys, I've had a long battle with acne and I think I've finally come to some understanding of why I had it and what factors in my life it was related to. It's easier to pick out these things in hindsight, but at the time I really did not know and made some really stupid decisions. I'd like to share with you the picture progression from Feb 1, 2014 to present day (technically Jan 17, 2016, but close enough!). I'll add some of my insights on the mistakes I made that made my acne worse, though what I'm writing is meant to be rather unstructured/free flow so it won't be as nicely organized as some of the posts on this forum. My hope is that I can help you in some way, and perhaps together we can derive new understandings from parts I may not have thought of myself :).

The pics unfortunately do not completely capture the severity of my acne. In many of the pics my skin may look "clear" but I remember at the time always feeling like there was room for improvement and also never wanting to leave my place without makeup on. I have slight redness on my face, was once upon a time diagnosed with mild rosacea, though I think it's gotten worse over the years. Also, sometimes the lighting made my acne look much milder than it was. I'll start with a brief history of myself, my acne, and other circumstances during the past two years that may be of interest:

History

I am in my early 20s now. Have had acne since forever, though it wasn't always this bad. I took antibiotics for two years beginning in college, and then it gave me a serious digestive issue that I still deal with today. Unfortunately, I can never take antibiotics again. After the antibiotics, I was on the birth control pill for 2 years. This helped my acne immensely! I normally have oily skin, and this reduced oil production and made my skin soft, smooth, and clear. Eventually, I wanted to get off it because I just didn't think it was good for you to be on for too long. I got off the pill in May 2014. A few months later, my skin started breaking out in large cysts, painful ones (See Aug 22, 2015 pic - this was just the beginning) which I had never dealt with before (I was 21 at the time). I put on 15 lbs by Nov 2015, and previously had not really paid close attention to my weight. I believe the beginning of all my cystic acne problems was related to going off the birth control pill because it messed up my hormone balance, but the persistence of the acne was related to my own personal diet/lifestyle factors. Since I resized all the pics, you might not entirely be able to tell that I was putting on weight, but in the normal sized pictures I can see the extra weight on my face.

Around Aug-Dec 2014, I was dealing with a staph infection on my nose. This resulted in large cysts/boils on my nose, which I tried to treat with ACV and pretty much all those staph infection treatment options out there (clindamycin, honey, ACV, dieting, etc.) except oral antibiotics, of course. It went down on its own, and my belief at the time was that I was one of the unfortunate people who was populated with the bacteria and would have to deal with recurring infections. Aside from clindamycin, I didn't use any other topicals (had tried certain gels and creams before, but I didn't want to deal with the dryness and redness that comes with using them.

In April 2015, my chin suddenly broke out in terrible cystic acne. I had little whiteheads, boils, large ones that were so painful that I could feel them pulsating. Again, since the pictures are 2 dimensional, you can't really see them protruding, but believe me, they stood out. I could feel people staring at my chin when I talked to them. I was very antisocial at this time and spent my time studying for exams. I was diagnosed with PCOS, and had slightly elevated testosterone (54 ng/L when the range goes up to 50 ish I believe) and low progesterone. I had trouble sleeping (low progesterone), craved carbs all the time, didn't exercise enough, and was generally rather sedentary and depressed. I remember having severe mood swings at the time, where I would imagine terrible things happening. There was no good reason to feel depressed, but my mind would wander and create imaginary tragedies in the real world and they would depress me. Around April, I weighed around 125 lbs, though my highest was in November 2014 at 132 lbs.

In June 2015, I started long distance running and haven't given it up since. I have lost weight and now weigh somewhere between 115-117 lbs at 5'5'' - about what I weighed in high school. It helped my acne, but I still continued to break out. I was sleeping better too after exercising more, and eating regularly. Due to health reasons, I decided to follow a more rigorous diet, which helped my health condition and also my acne. There was low point around August/Sept/Oct 2015 after which I've fixed things and feel fairly certain that I won't experience one of those breakout again. Also, do note that I had put iodine on my boils/cysts/acne (it does help but it's no miracle) so it makes them appear darker and bigger than they actually are.

So, the question is, what happened? And why did I have those horrible breakouts? I feel like there are a few major explanations as to why:

Diet

Back in 2014 and early 2015, I was eating a high carb diet. I do not eat any junk food because my digestive system cannot handle it, so even though the foods I was eating were considered healthy, the proportions in which I was eating them were not. When I was studying for exams, it was most convenient to eat rice cakes and peanut butter as a snack. At the most, I would eat 2 bags of rice cakes, aka about 200g carbs, and top each one with peanut butter. I would eat upwards of 1,500 calories of peanut butter, and as you can imagine this is not very healthy.

I think this diet was related to the staph like breakouts, because all the omega-6 fats in peanut butter contributed to an inflammatory response in my body (and also I noticed that when I eat too much high fat foods, it makes my skin oilier the next day). High carbs lead to insulin spikes, and thus can affect testosterone and progesterone and other hormones - I'm not entirely sure what happened, but I believe there's a pattern in my hormonal chin breakouts and eating too many carbs and ultimately gaining weight. What I can say is that whenever I get addicted/eat too much carbs/sugars for an extended period, several other things happen, including: I start having sleeping problems, gain weight in the belly area, feel lethargic, breakouts on chin mostly.

I love nuts and nut butters, and this really made my acne worse. I am the kind of person who will eat 1/3 jar of peanut butter in a day. And yes, I do not feel good after eating that much, but my eating habits are my own problem. Most nuts are high in omega-6s, meaning that eating say, 1 cup of peanut butter means I'm consuming 36,000mg of Omega-6 fatty acids. This is a LOT! And it is inflammatory. So it makes sense that I was breaking out. Looking back, this is very stupid of me, and anyone would say that eating so many nuts is not good, but given the circumstances at the time and how easy it is to overeat nuts, I did not realize my mistake.

My current diet takes into consideration the omega-3 and omega-6 balance. I eat mostly salmon and eggs, some chicken. I eat nuts sparingly, and the only ones I eat without minding portion sizes. I watch my carb intake, I definitely don't eat 200g in one sitting. And I noticed that I don't crash after meals anymore so I take it that my insulin levels are no longer spiking my blood sugar like they used to.

Exercise

After I started exercising, this made a difference in my skin. It helped me sleep, so mostly I'd say it had a beneficial hormonal effect. Also, the sweating process is apparently good for your skin. However, my diet seemed to have the greatest impact because exercising alone didn't prevent or reduce acne, but changing diet alone does reduce acne.

Where I Am Now

My skin is much better than before, for that I'm grateful. I am just waiting for the scarring and hyperpigmentation to go down. I started using retin-A and aczone a few months ago, and it made me break out more for a while, but that is slowly going down. I still break out but they are mostly smaller ones that go away in a few days as opposed to a few months. Whenever I eat too much sugar, my chin flares up again. So I make sure I have a balanced diet. From all the acne, my nose and cheeks have this persistent redness to them, I'm not sure if this will ever go down.

Also, do remember, it's not easy for me to put my face out there. I'm very embarrassed by my appearance these past few years, because I feel like it is a reflection of me not being able to take good care of myself and "letting myself go". I would be mortified if someone I knew saw them. I don't like being seen without makeup, and even with makeup I am self conscious. However, I felt that this could help many of you if you've been on the birth control pill, taken antibiotics, tried the topicals, have cystic acne, have anything that looks like what I had, or were curious to see how I figured out what was causing my acne. Feel free to ask me questions and I'll try my best to answer. Good luck! And remember not to try anything extreme - I've tried week long water fasts, using undiluted ACV on my face, holistic remedies such as turmeric, painting my face with iodine, large diet imbalances, etc. I found that the best remedy was living a normal routine life - sleeping and eating at the same time, making sure each of my meals has protein/carbs/fiber/fats aka balance, adding a moderate amount of exercise, and keeping my skin care routine simple. It hasn't cost me any excess money to clear my skin.