A little background info, I have had acne since I was 10 years old, and I am turning 20 this year, finally with clear skin. I call the past 10 years the "decade of hell".

I think we all encounter some kind of moment where we go, damn, I've had enough of this crap. And thus began my last ditch efforts to salvage my skin, which I am happy to say has finally become beautiful. Having lurked on this forum for years, I feel like its time for me to give back.

1. Diagnosis

First I narrowed down and diagnosed what conditions I had. Cystic acne on forehead, painful boils on my butt andpityrosporum folliculitis on my back (recurrent, would flare up from time to time). Now this was tricky, because I had both bacterial AND fungal infection. Am I supposed to care for my face and butt and aggravate the situation on my back, or the other way round? Damn this body of mine.

2. Prevention

Having determined all the skin conditions to be treated, the most important thing now was to PREVENT FURTHER SCARRING AND PIGMENTATION. I cannot stress how important this is, because deep scarring is so much more difficult to cure, and being fair skinned, my hyperpigmentation takes a hell lot of time to clear. I'm talking about dark spots that remain even after a year.

For my bacterial infections (acne on butt and face), I immediately went on doxycyline. Cheap, effective, doesn't cure the root problem but it did the job for now. The doctor would only prescribe me 3 months of doxycyline, 2x100mg pills per day. What I did was take a 100mg pill a day with breakfast, which lasted me for 6 months and worked fine.

For my fungal infection on my back, I began orally taking oil of oregano by Swanson. The dosage is 150mg per softgel, and you are recommended to take 1-4 pills per day. Now this varies by manufacturing brand, so follow guidelines accordingly. I started off with taking 2 a day in the afternoon and evening (not clashing with my doxycyline).

In addition, I would also apply topical oil of oregano to my back (either buy the liquid in bottle kind or cut open a softgel). Be sure to do it sparingly, and dilute it with an oil/cream of your preference if its not diluted beforehand because the strong stuff can burn your skin.

Last of all, I used Head and shoulders shampoo to wash my back as it had 1% zinc pyrithione.

All this is gonna make your back dry as hell, but do not moisturize because the fungus thrives in wet environments.

Along with all these, I was applying 5% benzoyl peroxide on my forehead and 2.5% on the rest of my face as a precaution. I use the brand Benzac, but probably any kind of BP will do.

All of these worked to curb the acne from ever rising to the surface for the time being.

3. Dealing with scars/pigmentation

Now the acne was gone, but there were A LOT of scars and pigmentation, which looked especially terrible because I'm a fair skinned Asian.

This is the part where it all gets expensive.

For my face, I caved and did a full ablative Fraxel on it, which removes pigmentation, scars, and returns pores to original size. This is very costly in most countries, but I was in Seoul, South Korea for a month, and I managed to find a clinic that offered Fraxel for 280 usd. Fraxel was significantly painful and I had red peeling monster skin for about 7 days, but the end result was flawless.

For my back, I did a 35% TCA peel for about 130 usd. Once again, skin blisters, angry red skin, the whole works. This was truly painful as hell after the numbing cream they used wore off. However, I had clear skin after it all peeled off and the one week mark.

For my butt, I had been using arbutin and hydroquinone creams, but the results were too slow for my liking. I did a ng yag laser for brown spots at about 130 usd. I believe that alexandrite lasers could do the job as well. One session was all it took for the brown spots to dry up and flake off, but if I had not been using creams beforehand I might have required more sessions.

4. To cure the root cause

Now this was the hardest thing of all, because I suspect my acne has hormonal causes (it got drastically better when I was on hormonal birth control for 6 months). However, I am not willing to be on hormonal bc full time (I use a copper iud), so that made things difficult. In addition, as a female who is open to having kids in the future, what the hell am I going to do when I get off bc? Suffer the same skin conditions once more?

So I did it.

I WENT ON ACCUTANE.

Now there are smart ways to do this, and stupid ways. One stupid way is to go on low dosage accutane (about 10mg-40mg) and then complain that the results don't last. I am horrified at the number of derms and docs that actually allow this. Of course it doesn't work, accutane is not meant to be used this way.

One good way to calculate dosage is by body weight:

1.0mg x ___ kg = your dosage

I weigh about 45 kg, and this was my dosage for 6 months

Month 1: 40 mg (To adjust to the dryness etc.)

Month 2, 3, 4: 60 mg

Month 5: 80 mg

Month 6: 120 mg to knock the acne senseless forever

Depending on whether your weigh more or less, your dosage will vary.

Monitor yourself, don't push the limits of your body and take care of yourself. Note the side effects you suffer from accutane and DO NOT STOP taking it halfway just because your skin has cleared and you think you're set. You are not using accutane as an antibiotic to keep acne at bay, you want to knock out this pesky acne once and for all.

Be smart about this, take a fatty meal with accutane so your body can absorb it better. For dry skin, any rich moisturizer will do, for painful cracked peeling lips, go to the pharmacy/get a prescription for certain brands of lip ointments that not only moisturize but promote healing of lips. (there are several, they cost about 10 bucks a tub, ask your doc/derm about it)

Most people do not experience the feelings of depression that may come as a side effect, but if you do get a family member/friend to monitor you. Remind yourself that this lasts 6 months, but the results will be for a lifetime.

Now I know some of you are firmly against accutane and prefer changing your diet/using whatever topical creams and solutions. I'm happy it works for you, but you have to understand that for a lot of people acne is not necessarily caused by diet, and topical treatments only keep the acne at bay, not cure the root cause. Do you really want a lifelong battle to keep the acne from erupting to the surface?

5. Aftercare

All the problem skin areas on my body are finally clear after approximately one and a half years since I started this entire war against acne/pityrosporum folliculitis.

For maintenance, I use very simple and gentle products on my face, just a face wash, toner and moisturizer. Sometimes I apply some 2.5 % bp on my nose, to keep it from getting too oily. For my back, I bought a znp bar to wash my body with, and I am starting with a new treatment-ELECTROLYSIS. Yes, without the hair follicles, there is no way for the fungus to survive. Ha! This is because although I no longer have even a single red spot on my back, 10 years of suffering have made me paranoid as hell and I will never go back to that ultimate emotional and physical low I was at before.