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Treatment not working

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I have been using Benzoyl Peroxide gels and antibiotics (Erythromycin) for around a year now and my acne has hardly improved at all.

I cleanse and moisturise daily and use an exfoliating scrub once or twice a week.

Any ideas?

Would changing to a gel with a higher percentage of Benzoyl Peroxide help?

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You need something that can exfoliate inside the pore; something manual exfoliants and AHAs can't do. I reccommend a gentle, alcohol-free salicylic acid product at a concentration of 1 or 2% and a pH of under 4. Disinfecting alone adresses only part of the problem with acne. To prevent it, you need to unclog pores and prevent clogs as well, which salicylic acid can do since it's lipid soluble. The best salicylic acid products in my opinion are Paula's Choice 2% Beta Hydroxy Acid Liquid (or any of her BHA products), which is sold at www.cosmeticscop.com, and Neutrogena Clear Pore Treatment.

Because salicylic aspirin is an aspirin derivative, it tends to be very mild because it retains aspirin's anti-inflammatory properties.

Salicylic acid, when applied prior to other topical medications such as benzoyl peroxide, actually increases the penetration of these treatments. Therefore, it has been theorized that when used in conjunction with salicylic acid, topical disinfectants work better. The medical community is not in agreement when it comes to using salicylic acids with benzoyl peroxide. Some say not to since increased penetration can increase irritation, while others say that the increased penetration allows for a more effective treatment of acne. Those I know with acne as well as myself have used both treatments in conjucntion and here is what we experienced:

1) Mild stinging

2) Mild redness

3) Mild flakiness of the skin

4) Tightness of the skin, especially around the mouth

We generally stopped experiencing these side effects between one week and three, depending on our skins' sensitivity. Our irritation was overall mild, probably because of salicylic acid's relationship to aspirin as mentioned above. Combining both treatments together worked better for everyone I know whose tried it than just using one treatment by itself, although don't assume this it the general rule.

If you decide to use a salicylic acid product, you can apply it up to twice daily, or as little as every other day depending on what works best for you. You may need to experiment with using different strengths of salicylic acid, especially if you change the strength of you benzoyl peroxide.

I also reccommend getting a prescription retinoid product such as Retin-A, Tazorac, or Differin to help normalize pore function. Don't use tretinoin products like Retin-A in conjunction with benzoyl peroxide because benzoyl peroxide destroys Retin-A's effectiveness.

Chemical peels have also helped those with acne, and you can talk to your dermatologist about which one might be best for you. I would specifically enquire about a beta hydroxy acid peel, by the way, since those tend to be mild (assuming they are not in an alcohol base) and can unclog pores as was mentioned earlier.

Also, what cleanser do you use and what moisturizer? How do you wash your face? Do you apply moisturizer all over, or just over dry spots? Do you wear a sunscreen and if so, what are its active ingredients?

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Thanks for your reply.

I'll get a salicylic acid product, probably Neutrogena Clear Pore Treatment and see how that goes.

About the retinoid products, should I try using that instead of Benzoyl Peroxide, or what?

The cleanser I use is Clean & Clean deep cleansing lotion for sensitive skin.

The moisturiser is from Superdrug and has tea tree and peppermint oils in it.

When I wash my face I usually rinse with warm water first, apply an all natural face scrub, wash it off with warm water and then pat my face dry. Then apply the deep cleaner after.

I apply moisturiser all over my face.

I don't wear a sunscreen (it's not too hot here in England :P)

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first off

i would ditch the exfolating scrub for SURE!

they are absolute crap and im pretty sure they make acne worse not better.

i used 2 use one as it made my skin a bit dryer an i thought

"hey if my skin is nice n dry no acne is gon come up hey"

WRONG

ditch the scrub an see what happens

scrubs aggrivate the skin an most of the time make acne worse

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first off

i would ditch the exfolating scrub for SURE!

they are absolute crap and im pretty sure they make acne worse not better.

i used 2 use one as it made my skin a bit dryer an i thought

"hey if my skin is nice n dry no acne is gon come up hey"

WRONG

ditch the scrub an see what happens

scrubs aggrivate the skin an most of the time make acne worse

Alright. So I should stop exfoliating completely?

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Thanks for your reply.

I'll get a salicylic acid product, probably Neutrogena Clear Pore Treatment and see how that goes.

About the retinoid products, should I try using that instead of Benzoyl Peroxide, or what?

The cleanser I use is Clean & Clean deep cleansing lotion for sensitive skin.

The moisturiser is from Superdrug and has tea tree and peppermint oils in it.

When I wash my face I usually rinse with warm water first, apply an all natural face scrub, wash it off with warm water and then pat my face dry. Then apply the deep cleaner after.

I apply moisturiser all over my face.

I don't wear a sunscreen (it's not too hot here in England :P)

I wouldn't completely ditch the benzoyl peroxide unless you have another topical disinfectant. I would just apply tretinoins and benzoyl peroxides at least twelve hours apart. As far as all retinoids go, I have heard that not-tretinoin retinoids are OK to use with benzoyl peroxide, but am not sure. This is another thing I would discuss with a dermatologist. Differin and Tazorac both do not use tretinoin, by the way.

As far as your cleanser goes, I couldn't find an ingredients list for it, but I did find one for a product called Clean & Clear Deep Action Cream Cleanser, Sensitive Skin. It contains a small amount of menthol, which is a skin irritant (hence, the "tingly" feeling) and shouldn't be used on the skin. Also, the cream cleansers generally contain thickeners that can clog pores. It does have salicylic acid, but medicated cleansers usually don't work because they often times have too high of a pH for the salicylic acid to exfoliate, not enough of it to be effective, plus a lot of the salicylic acid can be washed away, or a combination of these things. A gentle cleanser, such as Aveeno Ultra-Calming Foaming Cleanser, should be great.

As far as your lotion goes, I am unfamiliar with it but you mentioned it has tea tree oil and peppermint. Tea tree oil in concentrations of over 5% can act as a disinfectant for the skin, but most cosmetics don't contain enough of it. Peppermint, on the other hand, is very irritating to the skin and shouldn't be used. Also, watch out for ingredients like lavender, ylang ylang, camphor, citruses, mint, arnica, sage, oregano, clove, rose, alcohols (excluding fatty alcohols like cetyl alcohol), sodium lauryl (not laureth) sulfate, and sodium C14-16 Olefin Sulfonate since these are some of the most common irritants used in cosmetics. Another thing to watch out for is any lotion that appears too thick in consistancy, meaning that they probably contain waxy, pore-clogging ingredients, or a lotion that contains animal derived oils, since these more closely resemble human sebum than plant oils and can also clog pores. I reccommend Dove Sensitive Essentials at night and Dove Essential Nutrients Datime Lotion Spf 15 during the day (I know you said you don't use sunscreen, but I'll get into that below).

All the information I provided can be found at www.cosmeticscop.com/learn/dictionary.asp, along with sources and links.

It is VERY important to use sunscreen because as you might already know, unprotected sun exposure leads to skin cancer, wrinkles, "age spots," and the breakdown of the skin's intercellular matrix. Sun damage is cumulative and can occur in less than a minute of unprotected sun exposure. Even if you don't get tanned or burned, the damage still takes place to your skin, becoming visible later. Sun damage also can worsen acne because it destroys collagen and interferes with the skin's ability to heal and protect itself. You especially need to wear a sunscreen with medicines like benzoyl peroxide, retinoids, and chemical exfoliants since they make your skin even MORE sensitive to the sun. Look for a sunscreen that uses the active ingredients of titanium dioxide, zinc oxide, avobenzone, or mexoryl SX (outside US), because sunscreens that don't have them fail to provide adequate protection against UVA rays, which are the rays thought to be especially responsible for the negative effects of unprotected sun exposure mentioned above. These rays are not usually noticed until the damage becomes visible. Also, it is reccommend to use at least an SPF 15 sunscreen to block against an adequate amount of UV rays.

You can check this information at www.cosmeticscop.com (look under the "learn" section on the left side of the screen), at http://www.aad.org/public/Publications/pam.../Sunscreens.htm, and from any dermatologist (unless he's a hack).

Unfortunately, many sunscreens look and feel greasy on the skin, which is not a desired effect when it comes to acne. Usually, those with acne prefer sunscreens with avobenzone unless they are sensitive to that ingredient. The above recommended moisturizer with sunscreen did not feel greasy to me, but if it does, I have heard rave reviews over Neutrogena Dry Touch sunscreens.

first off

i would ditch the exfolating scrub for SURE!

they are absolute crap and im pretty sure they make acne worse not better.

i used 2 use one as it made my skin a bit dryer an i thought

"hey if my skin is nice n dry no acne is gon come up hey"

WRONG

ditch the scrub an see what happens

scrubs aggrivate the skin an most of the time make acne worse

Alright. So I should stop exfoliating completely?

Stop manually exfoliating, yes, but don't stop chemically exfoliating (which is what salicylic acid does) unless you really have problems with it, which is rare but possible. Oh, and give the salicylic acid at least a month and preferably two to see results.

Oh, I also forgot to add that you should only moisturize your whole face if your skin is dry allover. Otherwise, moisturize dry spots or skin that is irritated. Over-moisturizing the skin can be bad because it can "glue" excess sebum and dead skin cells to the skin's surface, making the chance of clogged pores higher.

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Thanks for all your help, I appreciate it. :)

I'll try everything you've suggested and let you know how I get on.

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Interesting. The last time I visited my Dermatoligist, he told me to try alternating between 2.5% benzol peroxide and Tazorac cream. Day 1: benzol peroxide Day 2: Tazorac, etc. He didn't mention cleansers or moisturizers, but a lot of the cleanser samples he gave me had salc. acid in them so my assumption is that they're ok for a routine like this aslong as the face can tolerate it. I've been using Spectro gel and benzol peroxide these past couple weeks and I've been getting oily skin and breaking out. I'm considering on using a salc. acid cleanser again and maybe even going back to Tazorac while continuing benzol peroxide like my Dermatoligst mentioned. I haven't really tested it out and I'm a little concerned my skin will get too irritated. Its rather irritated right now and all I've been using is Benzol peroxide and a non-medicated cleanser. This is because I haven't been using any medication at all 2-3 weeks ago.

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Use a soft exfoliating brush every morning and night and it will do wonders. I also highly recommend Proactiv cleanser...

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I also would suggest to take supplements. Like Vitamin B12 and B6. That'll help keep oil at bay. I would also suggest taking Zinc. Zinc aids in the headling process of your skin. AND Omega 3 6 and 9, would help you too.

But I used to use the Clean and Clear Cream Cleanser too..And thats when my skin was as its ever been..Same with using the Oil-free Neatrogena gel wash..that stuff sucked. But I would strongely suggest Aveeno's Clear Complextion Foaming Cleanser(SA will help, as you read above^^) And I am curious as to what product is the Benzoyl Peroxide gel called?(Is it the Clean and Clear one?) I am asking this, because I want to see how my skin respondes to it..I want to use that for the ugly nasty ones I get on my shoulders/ neck..What I am using isn't as fast as killing the nasty ones..How did you find the gel?

And sometimes..SA purges your pores(thus giving you some clogged pore type things..) But like someone said give it a couple monthes at most.

I wish you all the best on your skin regime, progress.

Keep us posted. :)

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I also would suggest to take supplements. Like Vitamin B12 and B6. That'll help keep oil at bay. I would also suggest taking Zinc. Zinc aids in the headling process of your skin. AND Omega 3 6 and 9, would help you too.

But I used to use the Clean and Clear Cream Cleanser too..And thats when my skin was as its ever been..Same with using the Oil-free Neatrogena gel wash..that stuff sucked. But I would strongely suggest Aveeno's Clear Complextion Foaming Cleanser(SA will help, as you read above^^) And I am curious as to what product is the Benzoyl Peroxide gel called?(Is it the Clean and Clear one?) I am asking this, because I want to see how my skin respondes to it..I want to use that for the ugly nasty ones I get on my shoulders/ neck..What I am using isn't as fast as killing the nasty ones..How did you find the gel?

And sometimes..SA purges your pores(thus giving you some clogged pore type things..) But like someone said give it a couple monthes at most.

I wish you all the best on your skin regime, progress.

Keep us posted. :)

I have heard that taking zinc can help acne, though did not experience this personally. Still, it may be worth a shot since acne and what causes it can be so complex.

That is true. Salicylic acid can cause "purging," which is basically what happens when zits that are forming are brought to the surface faster than usual. After that, a significant improvement in the skin can be noticed (although I must stress not every treatment works for everyone). Another thing that causes purging is the use of prescription retinoids, which your dermatologist should explain to you. Also, if you try a chemical peel chances are that will cause purging as well. But in my opinion it's all worth it, because the final result could be clear or significantly clearer skin. And yes, give it preferably a few months and don't get discouraged just because you see an increase in zits. Believe it or not, that can indicate the regimen is working.

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Thanks for all the replies.

In response to Rache's question, the gel is called 'Duac Once Daily Gel'.

So far I have ordered Neutrogena Clear Pore Treatment and Aveeno Ultra-Calming Foaming Cleanser.

I'll look into getting some of those suppliments and an exfoliating brush.

Thanks everyone.

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Duac is actually a great prescription. My derm gave it to me while I was waiting to start my Accutane prescription, and then I used it to spot-treat in the first few weeks of Accutane before I started to dry out. This prescription is no joke. It was definitely more effective (at least for me) than Retin-A, Retin-A micro, Differin, Tazorac, Benzamycin, Cleocin, Novacet, and all the other topicals I tried. It seems to be more effective because it combines 2 treatments, kinda like the Benzamycin does, which for me was always more effective than 1 treatment alone, (its 1% Clindamycin and 5% Benzoyl Peroxide). If thats not working for you I'd go back to the derm and see if he cant give you something else to try. Thats really what treating acne is all about... trial and error. Everyone is different, and with the help of a doctor you can usually find something that works for you.

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Yeh, I've only been using Duac for about 2 weeks, I only just changed to it, it seems a bit more effective than the one I used before though.

I have to go back to the doctor soon because it has been a year, then based on the progress she is going to decide whether to refer me to a dermatologist or not.

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