2 hours ago, CrookedWrasse said:

So recently I had a major breakout on my cheeks, it lasted about 3 weeks and now its starting to die down, obviously the pigmentation is still there but it seems to be getting better. Initially I had no hope so I made an appointment with a dermatologist, my insurance doesn't cover anything so I had to pay $150 out of pocket for the visit and $91 for the prescriptions (discounted because I was paying myself). Not to mention I had to wait 2 grueling weeks for the appointment. I was prescribed clindamycin/benzoyl peroxide 1%-5% gel and 0.05% tretinoin gel.

Now that you've heard the story here's my question, I am terrified of the initial breakout from the tretinoin, I have LOTS of closed comedones under my skin, you can't see them unless you look closely but they're definitely there. I was wondering if all these closed comedones are going to become inflamed pimples due to the tretinoin. If they do literally my entire cheek area will be red. I just can't go through that.

My tretinoin expires in 2021 so I have some time to think about this, although my clindamycin expires in 3 months, I assume the clindamycin will reduce some of the initial breakout, so if im going to use them I should probably decide now. I wonder if I should just use the clindamycin alone and try to exfoliate regularly to get rid of the closed comedones, and then later when I'm more clear use the tretinoin.

Another consideration is that right now my emotional state is in the garbage because of my recent breakout. It was probably the worst breakout I've had since I was 15. I can't make eye contact with anyone and I've missed at least a week of work over the past month. My boss is concerned and I'm about to be promoted so I can't really afford to miss any more. If my face got worse I don't know if i could handle it. I know its worth it in the long run but the day to day would kill me. I work in a popular grocery store so I see hundreds of people every day. On top of this all I'm a man so i can't just cover it up with makeup (I know its not that simple but still), so literally everything will be visible.

Ranting aside, just wondering how bad my purge will be considering my comedones, I think I could probably handle it if the purge is about the same as it was during the last month, which compared to normal was really bad. But if its any worse than that I just couldn't deal with it emotionally. Any insight would be GREATLY appreciated. Thanks.

I have & am still using clindamycin/benzoyl peroxide prescription treatment and what I can tell you is that this also makes the skin purge, whether you use tretinoin or not, your skin will most likely purge. I think the purging will be worse with tretinoin because it is a retinoid, but I think tretinoin works better than the clindamycin/BP. Whatever your decision is, just stick through the treatment and purging and you will have clear skin soon enough. And please do not use both treatments at the same time.

Well my derm said to use the clindamycin twice a day and the tret once a day, I know not to use them at the same time because they dont interact well, but they told me to use them the same day, Ive been using the clindamycin but its been causing serious dryness, burning and peeling, I'm going to start using it only once a day, maybe every other day until my skin gets used to it. Also i think I've noticed some purging from it already, I thought it was just dryness causing irritation but I think you're right.

If anyone can answer my initial question it would be great. Will all the closed comedones under my skin become inflamed red spots during tretinoin purging or is it only some of them?

On 9/30/2018 at 12:14 AM, CrookedWrasse said:

Well my derm said to use the clindamycin twice a day and the tret once a day, I know not to use them at the same time because they dont interact well, but they told me to use them the same day, Ive been using the clindamycin but its been causing serious dryness, burning and peeling, I'm going to start using it only once a day, maybe every other day until my skin gets used to it. Also i think I've noticed some purging from it already, I thought it was just dryness causing irritation but I think you're right.

If anyone can answer my initial question it would be great. Will all the closed comedones under my skin become inflamed red spots during tretinoin purging or is it only some of them?

Hey! I just battled an eight month long malassezia, yeast breakout from Hell..the damn bumps dont respond to any typical acne meds and the treatment to kill off the overkill of yeast was brutal and left my skin grey, flat and it completely stopped turning over new skin cells...so problem number two and this is where Im hoping you get some help from my purge battle with a compounded Rx of trentinoin, azelic acid ( Rx is Finacea, 15% ) plus niacinimide to heal the damage from my skin barrier meltdown. After five consecutive nights of using this combo everything I could feel under that dead skin was and still is as I type now covered in tiny microcomedones...purge city! Well thinking I know best I kept apply the Rx every night. Now I have basically given myself a chemical peel...Ive got flat sores where the purged pores were because I was too aggressive. So what Im doing is a very light cleanse only twice daily with a boring yet effective drugstore wash from the Simple brand. No exfoliating, no moisturizer except fresh aloe from my plant. I extract with a quality extractor around ten or so little, pesky CCs per night. I slap on a hydrocolloidal bandage to keep those sores (from my over zealous application of the retin- a) moist. My skin looks hideous because of the little burn spots all flakey and I am zit free but until the topical keeps accelerating my skin cell turnover Im going to have less closed comedones , but will still have to deal with a few more...until all of that crap is forced to the surface...I hope some of this is helpful...stick with it, Im pushing through. And I will look hideous for Thanksgiving... XoXo not a single purged plug turned into anything resembling a pimple we can both ride this out! Best to you!

Here I am, months later to tell the tale. Wow, thinking back I was in such a bad place, I wish I knew what I know now.

Im not through it all yet, but Im at the point where I only get a new breakout once a week or even every other week (fingers crossed haha), It was almost kind of amazing to see, one week I had countless new breakouts, seriously, countless, and then the next I only had 3-4 and now here I am 4 months since I started treatment and my skin is better than its been in what feels like forever. I still have post-inflammatory hyper-pigmentation left over but its healing.

To answer my initial question about comedones, yes I am pretty sure like 90% of my comedones turned into inflamed pimples. They weren't little babies either, some of them were big honkers. I still have some comedones, but they only inflame every week or two. And they don't come back anymore. So its definitely worth it. Eventually they will all be gone.

First lesson learned, the combination of the two medications was a terrible idea, I honestly wonder if my dermatologist was even awake when she put together my prescription. The tretinoin caused sensitivity, and the clindamycin/BP literally burned my skin, its normal for mild/moderate stinging when applying the clindamycin/BP, but this was a whole different story. So after about 2-3 weeks of the treatment regimen I gave up on the Clindamycin, I didn't consult my derm because I was under the impression they were incompetent, (not entirely true ofc). Quickly I noticed less redness, irritation, and sensitivity. Ironically the clindamycin cost me $90 out of pocket and the tret was fully covered by my bad insurance.

Second lesson, it WILL get better, there's a lot of misinformation on the internet about the efficacy of tretinoin, perpetrated mostly by people that don't understand how to use tret, they give up after 2 months, or they don't use it regularly, or they continue with their old skincare routine, slathering on actives like crazy. You have to use it for at least 8-12 weeks to even see the beginnings of improvement. And it WILL get worse first, even people that never have had acne before sometimes develop it when using tretinoin. My purging is technically still ongoing considering there are still closed comedones under my skin, and its been 4 months (I think). You have to use it regularly, I would say start with every other day for a week or two then switch to every day, that's what I did, but you might just start every day right off the bat, thats what my derm recommended. Not only do you have to use regularly but you have to make sure to cover the same areas on your face every time, there was a point where I missed some areas for a week, and those areas had to undergo another purge (redness and flaking yay), although it was mild. Another point is that you cannot treat your skin the same as before, tretinoin causes extreme sensitivity, i used to have fairly tough skin, yes it was oily and acne prone, but it could handle a beating without redness or dryness. After retinization, my skin is like a baby's bottom, literally anything irritates it. You cant use salicylic acid, you can't use BP, you cant use any actives. Not until your skin has FULLY adapted, which mine still hasn't after 4 months.

Final lesson, moisture is everything. I was your typical guy who had no idea how to care for skin. I washed vigorously with soap (safeway body wash, yikes) and after my face dried I would slather on the tret and that was that. I didn't even think about moisturizer. Its KEY that you moisturize before your skin fully dries after you wash, tretinoin does something that saps your skins ability to lubricate itself. If you let your skin dry after cleansing it will crack with the slightest tension. When your skin cracks then it has to exfoliate the skin away, leaving behind fresh new skin that wasn't ready to be exposed yet. Moisturize as soon as possible after washing. I moisturize as soon as I leave the humid bathroom after my shower. I found that the areas most prone to dryness are around the mouth and nose, make sure they get good coverage, using vaseline or another occlusive on top of that before bed is a good idea (providing you don't break out from occlusives, some do I guess I don't know).

Long story short I learned alot that would have made this journey easier, but most importantly I learned that its not easy no matter how you go about it. I took the cowards way out, I took a leave of absence from work, 2 months off, the first month was the worst of the purge, I'm so glad I took the time off. Luckily I had saved enough to pay bills and rent, food was another story haha.

Hopefully this can help someone, or at least provide some comfort.