OT: Adult cystic acne

Kari

Have any of you dealt with acne long into adulthood? I'm not talking occasional pimples, I mean moderate to severe breakouts. My lower cheeks and jawline are covered in new cysts and healing scars.

I've spent 20+ years struggling with my sensitive, excessively oily skin. In the past 3 months, while I dealt with incredible anxiety and depression and was put on a new cocktail of meds, I've had deep, daily cysts forming around my jawline (pointing towards hormonal causes.) I'm sure stress has played a part as well.

I've been on oral contraceptives for over 15 years due to acne. I'm much worse without them. I have a couple of the possible but not severe symptoms that could point to PCOS but I'd have to get off the birth control to know for sure.

I've recently been put on spironolactone as well to try to combat the cystic acne. It can take a few months to work. I still need to baby my skin with gentle products as I am also sensitive and prone to eczema when irritated or dry. For topical treatments I use tea tree oil or an Aveda clay masque on the new spots, and they dry up a little bit overnight. These are not topically caused breakouts and they pop up deep, large, painful, and fast; I've not had such severe cystic acne like this since I a teenager.

I use very gentle, oil/scent free makeup and cleanser. My doctor and I do not suspect a topical product irritation or allergy to be the cause because my acne tends to be quite different/not cystic when a topical item is the culprit.

Have any of you been through this long past your teens? Any words of advice?

8 years ago

Off Topic

28 replies

Latest reply was from

Tina

Veteran

Hi Kari!
I sympathize. I was on steroids (prednisone) for many years because it was part of my immunosuppressant prescription due to a kidney transplant. I was also on another drug (cyclosporine) that may have contributed but I think the prednisone was the main culprit. I was on accutane several different times. That was all that seemed to work. The problem was coming from inside and topical anything just did not help at all. This was between the ages of 20 and 31. It was pretty much the same type you describe, painful and it made me self conscious.
In 2002 I had my second transplant and they put me on different meds, no more prednisone (yay!) and my skin cleared right up.
I know accutane is known to be a drug that can cause depression but I did not have that. I was just thankful to have something that cleared up my skin.

8 years ago

Kari

Veteran

Oh, Tina, that is awful to have a necessary medication cause an unpleasant side effect.
I'm glad that accutane helped. I haven't been on it, and it scares me due to the physical side effects as well as that I'm already prone to severe depression (that's actually what I'm being treated for now.)
I had a long period where my skin was better. It wasn't ever totally clear, that doesn't happen for me, but the acne was normal, sparse, and controllable. Now it's out of control. Most of the time I can conceal the damage with makeup, but without it I look awful.
I'm going to give spironolactone a couple months to work, but I fear that isotretinoin (accutane) may be all that's left.

8 years ago

Maneera

(website)

Veteran

Hi Kari

I've had adult cystic acne for most of my adult life. The problem was very acute in my 20s and even past my 30th birthday.

I first decided to get treatment when I was 25, and realized that this was more than teenage acne. I was married by then and had just stopped taking contraceptive pills (this was because contraceptives aggrevate migraine and I'm a chronic migraine sufferer). I was put on isotretinoin and the acne cleared up for a while. Like you, my acne never goes away completely; it just becomes controllable and sparse. I have a lot of scars on both my cheeks.

A couple years later I was diagnosed with PCOS and the acne returned. I treated the PCOS; the acne came and went in stages and I did another course of isotretinoin.

A few months before my 30th birthday, I had a lot of pain in one hand and tests revealed that the nerve connecting the last two fingers on my hand with the spine was displaced. It's called ulnar nerve syndrome and is much like carpal tunnel---but at the elbow instead of the wrist. The treatment was long and slow and included steroids for several months. When I stopped the steroids, my acne became a lot worse than ever ever before. The reason was hormonal changes.

I was suffering from severe depression at the time, having just lost my dog, Ginger. So isotretinoin was not an option. This time, I decided to do nothing. I went old-school to bring about an internal hormonal balance by increasing my workouts and cleaning up my diet completely. I used a salicylic acid foaming face wash to cleanse my skin and that's it. I bought an Aloe Vera plant and used fresh aloe gel on my skin. That was the only thing I put on my face. It soothed, healed and moisturized my skin. It took about 3 to 5 months, but the acne cleared out as my hormone levels became normal. I did an hour or yoga in the morning, and 60-90 minute very brisk walk in the evenings. I lost weight, felt healthier and my skin cleared up.

This was in 2013. I haven't had any acne flare ups in the last 2 years. I get the odd pimple when I use a greasy makeup product or sometimes just before my period. I use only tea-tree face wash and tone, a tea tree oil to zap the odd pimple or two (I buy it from BodyShop) and also use tea-tree makeup (BB cream and concealor). I also have a tea tree day cream.

The scars of old pimples are still there. But I can cover them with makeup if I want. I notice that my skin fares much much better when I don't use too much makeup. Like you, I tried to hide my acne with makeup 2 years back sometimes. I don't think that helped my skin in any which way, though.

In my experience, the less product you use on your skin, the better it gets. And since the problem is internal, it needs to be treated internally too. Your acne is just a symptom of an underlying cause.

8 years ago

Anonymous

I have suffered with acne well into adulthood, and now have to combat rosacea. I disagree that it's always caused by diet. I have to apply Rx meds to my face 2x/day to keep things under control, and use very gentle skin care products that are fragrance free. No scrubbing & no exfoliating.

8 years ago

marianna

Veteran

I've been on Accutane too, and it really does work. But I would proceed with *extreme* caution given the other condition you're being treated for - just not worth the risk. So, I really have no advice, just wanted to commiserate with you because I've been there.

8 years ago

Kari

Veteran

So it sounds like I'm already doing what the rest of you do, aside from accurane.
I use light, sensitive skin BB cream for makeup and only cover certain spots with slightly heavier concealer. (The cysts are so deep that it's actually not too hard to conceal as long as the extreme redness is covered.) I use tea tree oil and clay on oily/breakout prone spots. I use a botanical exfoliator and not an abrasive product, as doing so shredded my skin years ago. I gently moisturize areas that get oily.
Basically all the topical stuff is under control. This is internal and, per my doctor, hormonal.

I hope that the spironolactone helps. It's a testosterone blocker, and I have heard it can dramatically help hormonal acne, but it also can take a while to have your skin actually reflect the internal changes.

Thanks greatly for chiming in. It's very painful feeling like I'm back at 13 with acne all over. I know it could be worse, it's only a moderate case, but I want it gone.

8 years ago

Elly

Veteran

Kari-- is it possible that this is partially related to all of the stress you and your body are under? I have hormonal cystic acne that flares when I am stressed. I already use a hormonal IUD because my irregular cycle disrupts my heart condition (lowers my blood pressure further) and because of that I can't take spiro. My acne flares almost uncontrollably during periods of high stress (sometimes for prolonged periods) and then returns to nearly negligible as my stress levels lower and hormones naturally re-balance themselves. I've heard that some of the light-based treatments have helped friends with hormonal cystic acne and vitamin D deficiency or lack of absorption can affect acne and depression.

8 years ago

Anonymous

I feel for you! I went to one dermatologist after another before an effective treatment was found. I know how desperate you are to be rid of acne once and for all.

8 years ago

greycat6

Veteran

I can empathize with you. I started to have cystic acne flare ups five years ago just as perimenopause set in. Spironolactone helped, A LOT, once it was in my system. I would still get the occasional flare up and when that happened I would take Minocycline for a few days until the inflammation went down.

When I turned 50 earlier this summer, the flare ups started and the previous regime was not touching them. My dermatologist added Tazorac (a topical) to the mix. I apply Tazorac 2-3x/week and the flare ups have almost completely gone away. If they do happen, the Minocycline calms them down to manageable. As a bonus, Tazorac had anti aging benefits!

My issues are a combination for hormonal, stress and diet, but mostly hormonal since they seem to have intensified with menopause. I eat fairly clean, exercise regularly and use little makeup. I have found the Eminence brand of organic skin care products work very well for me.

Each person if different but I hope, through trial and error, you are able to find something that helps you.

8 years ago

Echo

Veteran

I had horrible cystic acne in my 30's. It was horrible and seemed to never let up. I used and still use clindamycin, which is a topically applied ointment. My dr. prescribed it, thinking it would not work for severe, cystic acne like I had, but she wanted to try the least invasive options first, so we tried it. And it DID work. I still use it sparingly on certain areas of my face (preventative), and use it immediately when I feel anything developing.

Like I said, we did not expect it to work for the sort of acne I had, but it did. I would suggest you try as many non-oral options as possible before resorting to something like accutane. That is necessary for some people, but the side-effects scare me, too.

8 years ago

Kari

Veteran

Yes, I'm certain stress has played a factor. Definitely. My brain chemistry and hormones have been so messed up from anxiety, depression, and lack of sleep that it's unsurprising to have my skin be impacted as well.
I can only hope that between the new meds, and the fact that I'm now feeling better and sleeping normally, maybe my skin will even out... I just don't know how long that will take to see! I don't want to go through months and months of this.

8 years ago

Glory

Veteran

I am so sorry to hear this. I know from my daughter how devastating acne can be. I have written about her journey here a couple of times. She has had good success with accutane but has had to go on it 3 times. She has tried a host of other medications including many topicals. For her the only lasting solution has been the accutane. She uses concealers and makeup to cover up when she goes out.

8 years ago

anya

Active Member

Sorry you have to go through this. I don't know exactly what i have, but sometimes i used to have some flare-ups
like just before the period ( maybe 1 week) and mid-cycle? it was quite annoying. For the cysts i used mario badescu buffering lotion. I also tried some AHAs ( one from lierac) and tea tree oil. I actually did do treatment for pcos and it has slowly improved . For me hormonal treatments were the most successful. I feel you. Maybe some form of activity, for me tango used to be my yoga and really centered me. Also writing . Good luck and maybe this new meds will clear it up

8 years ago

Anonymous

Have you tried benzoyl peroxide lotion? It helps to kill the bacteria in the cysts. There is a good version of it available at paulaschoice.com, but it's available in other brands, too. Not a cure, though, unfortunately. I'm so sorry you have to deal with this. But you have such a great smile that I'll bet hardly anyone notices the spots!

8 years ago

Anonymous

I strongly recommend seeing a dermatologist. I didn't get my rosacea under control (I didn't even know I had rosacea) until I visited a dermatologist. That's much better than trying to figure things out on your own.

8 years ago

Nebraskim

Veteran

I'm so sorry that this adds to your burden of stress and no doubt exacerbates your depression as well. A co-worker had cystic acne and PCOS and accutane did help quite a bit. Is cystic acne related to allergies at all? I'm not remembering if you have food allergies but they can manifest in very odd ways and may be worth trying elimination diets to pinpoint triggers. I had weird itchy hives and rashes all over my body for years until I, on kind of a whim, stopped eating wheat in any form four years ago and my hives/rashes, and other issues, cleared. About the same time, my long-standing allergy doc retired and I got a new allergy specialist, who after hearing my story said she was pretty sure I have allergies to wheat. But I'd never talked about that with my old allergy doc, only with my dermatologist. Our bodies are exquisitely fine tuned so it's hard to say what has caused your imbalances. I hope you find relief.

8 years ago

Lucy

Veteran

So sorry to hear you are going through this! It's horrible.
I guess you have tried changing brands of oral contraceptive? I have pretty bad acne when not on the Pill, but it is controlled almost 100% by being on the Pill. Some kinds work better than others for me though. I took a while to find one that controlled both acne and the remaining post hysterectomy endometriosis, lol. But if you haven't tried a few types, it might be worth a go....
It sounds like you are doing everything right in the gentle care of your skin.

8 years ago

Kari

Veteran

Thank you all so much for chiming in.

I have changed up birth control a couple times. The one I'm on right now works best for me; one critical thing is I need a pill that has only a partial week of placebos. A few years back I switched to a generic with a full week of placebos, and started getting intense migraines mid week every month. Weird!

My body is finally evening out. I'm taking spironolactone and switched to Lush Fresh Farmacy sensitive skin wash and a trial of new gentle Magical Morninga moisturizer, in addition to Aveda clay masques and tiny bits of tea tree oil on blemishes. Knock on wood, I haven't had any new cysts form for the past couple days, and those that are there have started to dry up. It's too soon to say it's a permanent change, but it's a good sign.

8 years ago

Anonymous

I don't know why it's so difficult to get acne under control, but it is. I hope you find what works for you so that your skin will clear up. Prayers!

8 years ago

Anonymous

I had acne into my 30's, which effected my confidence. I took accurane for 6 months and it was great for 5 years. Can't believe I waited so long. I do gave a predisposition to depression but never suffered while taking accutane.

Then I had a terrible bout again just before I turned 40 and my new dermatologist would not prescribe it. So we have used topical creams and minocycline. I took the mino continuously for 4 months then just take one about every 5 days. this has been my 'routine' for over 5 years. The derm was also big on diet (first one ever, I often thought this but many dismissed it) and recommended I give up gluten. I think that helps. So no brilliant ideas but you have my sympathy, I felt I could never look anyone in the eye.
Coincidentally we moved last year and I am seeing my new derm tomorrow, I am very curious what he will say

8 years ago

Anonymous

Yes! All through my thirties and forties. It's horrible! Mysterious and frustrating!

Because it stopped when I got older I'm thinking it may be fundamentally hormonal? A poorly synched combination of skin type and reactiveness?

I had trouble with sodium lauryl sulfate, toothpaste/canker sores, shampoo/hair loss, soap/ dry skin, and I'm sure that eliminating it from all my skin care products was helpful but not necessarily critical.

I also eliminated very acidic foods, like citrus, tomatoes,etc. because it seemed like the precursor tingling often occurred after eating those things.

For about two years I was on a very low daily dose of tetracycline and virtually break out free but I developed some brown spots and decided to discontinue the medication.

I can honestly say that as much as I don't love developing some little wrinkles I am thrilled that now that I'm in my fifties I get "something" maybe three times a year instead of three times a month!

8 years ago

Kate

Veteran

Kari, Just saw this, and I feel your pain. I started getting deep cysts on my chin and jawline that popped up overnight when I was in my 30s, around the same time that my acne rosacea was diagnosed. After trying lots of things that didn't work, I found my current dermatologist who prescribed a compound of Nutracort and Metronidazole. The Metronidazole is a pill that is ground up and mixed into the Nutracort. It makes a thick lotion. This was prescribed for my rosacea, which worked like a charm, but I found that it also worked for my deep cysts. I put a dab on when I feel the skin tightening and itching along my jawline, before the cyst can even be felt, and then when it pops up. Along with that comes keeping your fingers off the cyst. That's really hard to do, I know, but necessary. I've had this condition now for 28 years, and this compound has been a godsend. Perhaps your dermatologist might be willing to prescribe this for you.

8 years ago

Kimbacat

Active Member

I echo the advice to see a dermatologist. This happened to me, too, at around 40. Very upsetting, as you know, and new to me as I had never had such severe trouble before. After experimenting unsuccessfilly with home remedies, the dermatologist was able to get it controlled quickly. Good luck to you.

8 years ago

AnnFlannery

Member

I am very pleased with Dermalmd Acne Serum and how it is treating my moderate hormonal acne around my jaw area. It is quite drying so up your moisturizer or be prepared for flaky skin. I've only been using dermalmd for a couple of nights but can already see a difference.

7 years ago

Aziraphale

Veteran

Has no one mentioned Accutane? I'm surprised your doctor hasn't suggested it. From what I hear, it permanently puts a stop to cystic acne. Everyone I know who started to get really bad acne in their teens or twenties -- the kind that leaves scars -- immediately went on Accutane and now they all have better skin than I do.

ETA sorry, I read down the thread a bit and I see that you don't want to take Accutane, so disregard what I said! I'm sorry I can't suggest anything else. Well, benzoyl peroxide does work on "regular" acne, if you use it right, but I'm not convinced it'll work on the deep cystic kind.

I'm really sorry you are going through this.

7 years ago

Aziraphale

Veteran

A couple more thoughts: I don't know of anyone who had bad side effects from Accutane, and I've talked to a lot of people who've taken it. So there's that. Most people only need to take it for a couple of months.

Also -- how can I suggest this gently -- is it possible that having cystic acne is making your depression worse? Are the potential side effects of Accutane worse than depression?

7 years ago

Milliepujals

Member

I have hormonal acne and dermalmd blemish gets rid of zits in 2 to 3 nights. If I catch them during any other time of the month, it quickly stops them from becoming embarrassing blemishes that I have to worry about concealing.

5 years ago

Anonymous

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5 years ago

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