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Persistent Cystic Acne..3 round of Accutane? not sure what to do next

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Hi everyone,

As probably a lot of us on here I have a long story with acne. I’m a 23 year old female and I started getting SEVERE cystic acne when I was 12 and still dealing with it to this day. I’ve been on every medication that exists: Minocycline, Doxycycline, birth control, Spironolactone, every prescription topical and over the counter, and two rounds of Accutane once when I was 13 and once at 15. Still, my acne always came back. When I turned 23, I was convinced something was causing my acne, so I decided to go to a naturopath. My dermatologist prescribed me a vitamin called Nicomide, which was a MIRACLE for me and completely cleared my skin as well as Accutane did! My naturopath tested my Zinc levels and said I was deficient in Zinc, which is one of the ingredients in Nicomide. She gave me a zinc supplement and other supplements to balance my hormones so I stopped taking Spironolactone and birth control. From June-October I had the most beautiful, clear skin. Too good to last :( In October, I started getting a rash around my mouth that my dermatologist called Perioral Dermatitis. The rash kept getting worse and worse, and I slowly started breaking out again and slowly the acne has gotten worse and turned into pretty severe cystic acne. In the beginning of January my rash finally went away, but my acne is as bad as my pre Accutane days!! It’s like the Nicomide just stopped working for me, and now nothing works. 

As for my diet/lifestyle, I’ve tried EVERYTHING. I gave up dairy, gluten, sugar, all processed foods, eat very few grains, low carb, I’ve tried going vegan, raw vegan, only eating fruits and veggies, tried giving up all fruit, did an elimination diet, Candida diet, tried eating low fat/high carb, tried eating a bunch of fermented foods, tried drinking celery juice on an empty stomach every morning…the list goes on and on and nothing worked. I’m in school to be a Registered Dietitian so I eat a very healthy, balanced diet with lots of veggies, fruit, healthy fats, lean protein, no processed foods, I don’t drink alcohol. I work out 5-6 days a week, I try to not stress but honestly my acne is stressing me out more than anything else!! 

Currently my naturopath has me taking a bunch of supplements: Omega 3, Milk Thistle, a probiotic, Vitamin D, Inositol, Ichol, Sulphur pellets

My insurance just stopped covering Nicomide so I’m taking all of its ingredients over the counter: Zinc, Chromium, Niacinamide, Methyl Folate, Selenium

Nothing is working and I’m completely at a loss for what to do. My dermatologist gave me 3 options: Spironolactone and birth control (didn’t work for me), Accutane, or a new antibiotic (I forget the name sorry). I was against going on Accutane for a third time for so long because of the long term side effects we all hear about and I wanted to figure out the root cause of my acne. I felt like all these medications were just covering it up but not solving anything. But it’s gotten to the point where my acne is effecting my entire life, I have no confidence and it’s constantly on my mind, I cry almost every morning when I look in the mirror. So I’m leaning toward Accutane again. Has anyone been on 3 round of Accutane? Or has anyone actually figured out what causes their acne? ANY advice would be greatly appreciated!!! 

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