At my breaking point [acne]
Title. I (30F) have been struggling with acne since I was a teen. I’ve tried oral antibiotics (allergic to most), all forms of hormonal birth control, tretinoin, rx azelaic, spironolactone, other rx topicals, drug store topicals, even accutane. I used…
Title. I (30F) have been struggling with acne since I was a teen. I’ve tried oral antibiotics (allergic to most), all forms of hormonal birth control, tretinoin, rx azelaic, spironolactone, other rx topicals, drug store topicals, even accutane. I used accutane 1/2025-7/2025. I was using tret 0.025% prior to accutane for about a year, and upped it to 0.05% a few months after finishing accutane. My skin barrier is healthy and I don’t over treat my skin. Everything is under the guidance of my derm NP who I’ve been seeing for years. I get professional facials a few times a year. I have no issues with treatment consistency and have put quite a bit of time and money into healing my skin. The only successful treatments have been oral doxycycline and hormonal birth control. Being on long term antibiotics isn’t something I think is wise, and I’ve been on birth control off and on (mostly on) for the better part of 15 years. I really don’t want to go back on birth control. I stopped birth control once and my skin remained fine, went back on and coming off it went haywire again. The same happened once I stopped taking BC after finishing accutane. My acne typically appears hormonal in nature with deep cystic acne along the jaw. Bloodwork reveals hormone levels are within range. My chest/back acne responded really well to the accutane but my face is still a mess. I was using the ordinary azelaic with niacinimide & zinc every morning, and tret 0.05% every other night. My skin was so-so. Still getting big deep painful pimples, but not all of the widespread texture and red bumps noted here. Derm suggested 15% azelaic and now I look like this. Wasn’t sure if it was purging or a reaction, so I stuck with it since I’ve used OTC 10% azelaic with no issues. As of a few days ago she directed to stop the 15% and add an antifungal cream. tldr: I can’t keep doing this. I’ve tried literally everything. I’ve tried taking different supplements (inositol, zinc, fish oil, panothenic). I’ve researched different foods to increase or decrease to help skin. I’ve read books on balancing hormones and stabilizing after long term contraceptive use. Nothing seems to work. I can’t believe I’ve tried so many things and nothing works. I’m to the point where I’m about to start another round of accutane, which I absolutely detested. I just can’t fathom that my skin can be THIS fucked with how much care and attention it gets. Open to any other suggestions because this is destroying me. I feel hideous, and like people at work don’t take me seriously because I look like a 9th grader with fucked skin. I don’t know what to do anymore.
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Spironolactone didn’t work for me. I was also under the care of a cardiologist at that same time, and since I’m hypotensive at baseline he recommended I stop spiro due to “soft” blood pressure.
Thank you 🫶🏼 I appreciate your kind words!
I’m going to suggest this at my appointment. Might be worth considering. Thank you!
I’m just about at that point where I completely cut everything back and go way back to basics.
Thank you! I’ve considered a new derm but then again I’m not sure what else another would do? But something has to change!
Well I was using snail mucin for years before with no issues, but after accutane I’ve noticed my skin is more finicky. Maybe I can’t use it anymore. I think I’ll stop the cosrx and see if that could be causing it.
I’m just about at that point. “When you’ve tried everything, try nothing” kind of thing.
I’ve never tried that, but adding it to my list for things to try later. I tried head & shoulders shampoo on my face a few months ago when I had the fungal acne, but never tried nizoral
I’ve tried BP as a spot treatment in the past and have panoxyl wash, never really saw much improvement with either
I just want to say that as someone who struggled with cystic acne pretty much from 13 to 23, I see you and it's really tough. I would definitely revisit the accutane and I would find a different dermatologist and start over. When I took accutane, I took 20mg for 10 months, then 10mg for another 14 months, so I took it for 2 years total. I would say that when I was 6 months in, the entire times you took it, my skin still hadn't fully cleared up. During this time I also had a lifestyle change where I tried to reduce how much processed food I was eating and I lost 10kg, I also improved my skincare routine, I use 15% azelaic acid 3/4 times a week. Double cleanse everynight, suncream everyday and my skin is now better than I ever could have imagined it was. Please let me know if you have any other questions. I might get one tiny tiny pimple every few months, but that's it.
I'm sorry I'm not well informed enough to give advice,but I just wanted to send a hug and say imo this doesn't look nearly as bad as you think it does 💕 But also,I totally get it. I've tried all sorts of skincare and have struggled with similar issues for years,and it gets so demoralizing. I try to remind myself that no one is scrutinizing or judging me as harshly as I am myself,and if they are it's 'cause they're a turd ;3
Have you tried clindamycin benzoyl peroxide gel? Its perscription
I have struggled with hormonal acne from age 12-30 and tried many products. Last year, I just gave up and threw away all my products except for a moisturiser I only apply after showering (RLP Lipikar Baume) and my daily SPF 50 (I switch between CeraVe and Korean brands, but none break me out anymore). I only wash my face with water in the morning, and that's it (note that I don't wear any make-up). For the first time since my early teens, my skin is completely free of acne, except maybe for the occasional small pimple during my period. It did not happen immediately, but I think at first I was simply noticing my skin did not get worse when I stopped it all, and actually, after some months started to get better, and is now fully healed about a year later. This may all have been a big coincidence and maybe my hormones just randomly balanced from getting older, but I do want to share my experience ditching all products lol. It was the easiest and cheapest solution I could have wished for.
Niacinamide gives me a lot of redness. Maybe try stopping that too? Does your skin itch? With everything that you’ve tried I agree with your derm considering treatment for fungal acne. Could also ask about whether demodex could be contributing. What does your routine look like?
Have you considered lifelong microdose accutane? More and more derms are doing it. I finished an accutane round and if my acne comes back, that is my plan. Like 10-20 mg, 2x week. I hope you figure something out I know this is miserable.
Mine got better with spironolactone and a Clindamycin cream. I use azelaic acid as well, which has also helped. It took about 3 months of constant use for the spironolactone to work. The rest help with individual breakouts .
My next step in my acne journey was about to be laser treatment through the doctor’s office. Expensive but apparently worth it. I just lucked out with spironolactone finally working in addition to my other treatment. I also saw you mention snail mucin in an earlier comment. Have you already ruled out that snail mucin isn’t causing any issues? I recently removed cosrx from my routine and my skin did improve a bit
This may be a very dumb question but have you rolled it all back to just a plain cleanser, moisturiser and SPF? No actives (maybe a hypochlorous acid spray a few times a day) and just give it a few weeks. You sound (justifiably) exhausted by it all so maybe have a break, take the pressure off and give yourself some time before diving back in.
I’ve tried for years to use tretinoin. But every time I try I break out horribly. I went through accutane last year and as soon as I tried adding tretinoin (after finishing). I broke out horribly again. I’ve given up on it and now use differin gel. My derm says some people just can’t use it. I thought it was just still purging or something. Nope. New acne.
I’m not sure what the cause of my break out was last December, but I stopped BC around then and was doing a bunch of hot yoga. I started aldapene and that helped and then added in benzoyl peroxide in the AM. The combo has really cleared my skin, I had one little pimple last night and that’s it. Took a while (I think largely bc I added the benzoyl peroxide only a few weeks ago). Might be worth trying! Just be careful bc benzoyl peroxide will stain clothes!
Do you drink milk and ingest things which whey protein? Shakes, bars, etc?
You could try using Diffrin Epiduo. Its sold over the counter in the USA now. I used to use adapalene and benzoyl peroxide separately and still broke out but now that I've switched to Epiduo my skin is actually doing much better. I also wash my face with Nizoral shampoo once a week while in the shower. That's what finally worked for me after about 10 years of trying all sorts of different things.
What finally helped me (39F, hormonal cystic acne since I was a teenager) was mint tea. I saw a recommendation here and thought, might as well try it - it's cheaper and easier than a lot of other things I've tried. I started drinking mint tea most nights at the beginning of the year, and I've seen a drastic improvement. I've been hesitant to post anything because I don't want to jinx myself, but I've been really happy with the results.
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