The thing with acne is that you have to attack it at its source. Once size doesn't fit all, antibiotics aren't suitable for everyone! Even if you kill the bacteria (which, 100mg of Doxycycline is fairly effective... other than potential diarrhea), you're still left with shitty skin that's flaky and full of oil at the site of eruption. That's where non-antibiotics come in, such as salicylic acid, isotretinoin/retinoic acid, benzoyl peroxide, Differin, and even Accutane. These are known as exfoliants, which basically serve to *irritate* the skin, provoking your body's inflammatory reaction, extrusion of the old skin, and growth of skin. So, antibiotics = not going to work if your skin is still an oily, flaky breeding ground for the bacteria. Fix it with BP or salicylic acid, then consider antibiotics. Also had lots of patients successful with Yaz, especially if the excess oil is due to hormones. My favorite product to prescribe for mild/moderate acne is BenzaClin, a topical combo of benzoyl peroxide and clindamycin (an antibiotic). Clindamycin kills the bugs, benzoyl resurfaces the skin. I even use it myself! For an occasional zit, 2% salicylic acid gel works wonders overnight (like Clinique acne spot treatment gel). BP is good b/c it *also* has some antibiotic properties, and you don't need a prescription up to 10% ("Clean and Clear"). However, %-wise, less is more, unless you know what you're doing.
Cystic/nodular acne, the only real hope is Accutane, which is a systemic (i.e. hardcore and non-topical) Vitamin A derivative that will essentially dry you out and produce fresh, new skin.
@DoctorJezebel: Dr. Jez, I have a question, maybe you can help. I started getting cystic acne in my early 20s, went to a facialist who gave me a product that essentially worsened it about 1000x over, I had cysts all over my cheeks, chin, and jawline. I went to a dermatologist who put me on doxycycline, benzaclin in the AM and differin at night. This has cleared the cystic acne but the result has been incomplete, I still have stubborn blackheads (esp on my nose) and these pimples that are like little flesh-colored bumps on my chin and forehead. I am afraid that going off the antibiotics will just make things worse. Would you recommend a round of Accutane for a case like this? Also, what can be done about scarring (some red marks and a few pitted scars)? My derm says nothing but time will heal these, but I'm wondering about something like a glycolic acid peel.
Resistant acne is not a recent occurrence. I had terrible acne that nothing but nothing worked on from 5th grade on. Hormonal birth control has greatly reduced the oiliness of my skin but I still, at age 26, need to use medicated face wash, masks, and pimple cream. The b.c. has downgraded it from incorrigible to corrigible with daily vigilance.
I am pretty certain that I had a tetracycline-resistant form of acne bacteria, as I went on several rounds and saw zero results. Thank God for Accutane, and please God keep it legal in the U.S.
@big.mary: You're lucky. I cut all dairy out of my diet (and was already a vegetarian), and saw no effect. In fact, I cut damn near everything you can think of out of my diet at one time or another and... saw no effect. My acne was caused largely by a genetic skin shedding condition which still causes me weirdness but no more nodular misery, courtesy of Accutane.
It's tempting to assign blame to something dietary, but for most people, it isn't a factor.
@Majrhoulihan: you have to ingest A LOT of colloidal silver over the course of many years to turn "blue". It happens but anyone who becomes a well informed user knows that colloidal silver, internally, is for short term use.
That said, my recommendation is used topically as it is an amazing bacterial "buster" - keep in mind that the Oregano Oil boosts this bacterial/fungal/viral eradicating ability and one muse not rely solely on this topical treatment, hence my other recommendations - synergy is important
Antibiotics did NOTHING for my acne. The birth control pill, on the other hand, sent it packing in a hurry. Within a month of getting on the Pill, I would go outside in tank tops for the first time in years (I had acne on my chest and back). Also, I ended up with an antibiotic-resistant case of Strep throat while taking antibiotics for acne, which may or may not be related.
I have been using Serious Skin Care's Continuously Clear stuff + long-term birth control (Implanon) for about six months and that has pretty much zapped the life out of my zits. I still get a couple from time to time, but most of the time, I am clear and happy.
Be warned, though: if you have sensitive skin, I can't see you surviving Serious Skin Care. For the first 2-3 months, I was very red and flaky and I don't even have particularly sensitive skin. Now, though, I love it. I don't even use the creams much anymore, just the cleanser.
Jesus F. Christ. Is there anything that won't kill you nowadays? I mean really. Now we can cower in fear of MRSA and bionic acne. This is what makes me feel certain that the face of the world is just going to get uglier and more painful and pus-filled. Acne is the worst. And I've wondered more than once, what is its' purpose? I mean why does it crop up out of nowhere for some of us? I remember eighth grade, my face was perfectly smooth. Then, ninth grade: HUGE CYSTS ON MY HERETOFORE UN-MARRED CHEEKS EVERYWHERE AND BLOOD ON MY PILLOWS WHEN I WOKE UP OH GOD JUST KILL ME IT HUUUUUURTS. My dermatologist peddled every topical treatment you could imagine, including the stuff you had to keep in the refrigerator that had the same consistency as school paste. None of it worked, only made the skin between the cysts redder and more irritated. Then he wanted me to take oral antibiotics and I refused and flat-out demanded Accutane. He didn't actually want to prescribe it because of the myriad risks involved, but that shit WORKED. The worst side effect for me was my permanently cracked, peeling, bloody lips. Small price, I say. BUT! Every now and then, usually beginning the week of some event or another, I'll get a cyst on my chin or randomly on my cheek. Motherfuckers are persistent and only sometimes if I catch them early will they respond to benzoyl peroxide. And they always leave scars, so as to join the existing constellations of the others. I still use anti-acne cleansers and moisturizers every day and will probably always have to. Bane of my life, I tell you.
@..now it's just Aesop's Foibles.: Dermatologists really frustrate me, because they often seem to have such a limited understanding of acne and its causes. So many of them just want to push topical creams and ointments that can't get to the root of the problem, which is predominately internal, like the question of why is the body producing too much oil. And they don't want to address diet as a possible cause of acne because they can't make money off telling you to stop eating dairy products, sugar, or carbohydrates, even though Accutane and antibiotics work internally.
In my case, my dermatologist didn't want to give me birth control because she didn't think my acne was hormonal because it was mainly on my cheeks (even though I told her that my breakouts coincided with certain times within my cycle). So I had my other doctor prescribe BC and my skin improved tremendously, although I still have breakouts during the winter months. I think that may be related to not getting enough vitamin D, which has an effect on other hormones. If the doctor had listened to me, I might not have as many physical and emotional scars.
@..now it's just Aesop's Foibles.: I feel you. Every bit of it. And the worst is how incredibly unsympathetic most other people are. A skin condition that results in huge thumping lumps that lasts for months at a time and causes major scarring is A BIG DEAL.
@fouxdufafa: Well, dermatologists might also not mention diet because there hasn't been a single study that has proven a link between diet and acne. There's been plenty of research on the subject, too. Sugar, diary, carbohydrates, meat, fat, etc.--no proven link. Individual people might have luck avoiding one thing or another, but they tend to be few and far between.
There are three problems that cause acne--it isn't just an issue of too much oil. Unfortunately, in a particularly nasty twist, they usually enhance each other. The more broken-out your skin gets, the more oil your body tends to produce in response to the irritation. The more irritated your skin gets, the flakier it gets. The flakier it gets, the more clogged pores you get. The more clogged, oily pores you have, the bigger the buffet for acne vulgaris. You have to knock out one or more of the legs to get the cycle to stop, and diet has no appreciable effect on any of them.
(Few things annoy me more than someone claiming I'd have better skin if I'd just stopped eating X, Y, or Z. Trust me, I tried everything. My problem was a genetic skin shedding issue.)
@la.donna.pietra: Another insult to injury: the way people assume that you're dirty or don't wash your face enough and that's why you have festering infections under your skin. Even after, you know, all the science that says this shit is inherited and has nothing to do with hygiene. It was bad enough looking like that without the judgy stares of older people, who undoubtedly never had a zit in their life.
@..now it's just Aesop's Foibles.: @la.donna.pietra: I hate when people who have never suffered from acne, only the occasional spot, feel the need to comment on your hygiene levels, diet or make up skills if you are trying to cover acne.
Do people comment on other skin conditions in the same way?
@gherkinfiend: As for the "helpful" commentary aimed at eczema sufferers or psoriasis or what have you, I don't know. I don't have either of those, but I have a suspicion that since these conditions are medical, and the general assumption that acne is just an appearance issue, most people probably wouldn't try to offer advice. It just seems like acne is considered to be an affliction for dirty people with poor diets and since it was my fault I had these horrible things on my face, I don't get any sympathy. Just revulsion and condescending attitudes. I'll echo some of the others here and say Thank God For Accutane.
I always wonder if acne is a first world problem and we are only making it worse by all the creams, washes, treatments and such we put our skin through. So I started a study on myself. No makeup except on my eyes and no washing my face except with cool water. It has been a revelation. I barely get any zits at all, and only small ones when I am on my period.
I wore make-up on Easter for the first time in MONTHS and had a zit by the end of the day.
@Liz11685: This is similar to me. I usually just wash my face with Dove soap, which is insanely gentle. I don't wear any make-up on my face except a little concealer under my eyes. My skin is clear except for some blackheads on my nose.
@Majrhoulihan: just remember that Unilever, the makers of Dove, is the biggest buyer of palm oil in the world (which is the biggest cause of forest destruction in Indonesia).
@Liz11685: Given the number of very poor Third World people I've seen with crazy acne, no. But overwashing your face can definitely stimulate your oil glands and make the irritation/breakout cycle worse. Living in dry climates makes things problematic, too.
@Majrhoulihan: Ultraviolet light can help a whole lot with acne bacteria... but it can also irritate skin, thereby making it oilier and making the whole problem worse. Many sunscreens are also either clogging or irritating, too. Can't win for losing!
@RodolfoRabulous: ...aparently someone thinks having their Ben & Jerrys is more important
@la.donna.pietra - Verilux Blue/Red spectrum lighting works wonders - I saw a complete transformation with my friend who bought one....and it doesn't have harmful UV rays.
On posts like this, I sometimes feel guilty for never having experienced acne. I mean, I got (and still get) the occasional pimple. But I've never had more than 2 zits on my face at the same time.
So yeah, I feel guilty...until I remember all the money and tears I've spent trying to deal with my eczema. My dry skin has been drug-resistant for years. Now I don't feel so bad.
@battleaxonista: Holy shit, who DOES that?! Don't answer that. I know. Well-meaning relatives and undermining friends. But seriously, what kind of soulless beast DOES that?!
@fol_de_rol: And total strangers in the supermarket, helpfully examining the contents of your shopping cart and recommending that you don't eat dairy/strawberries/peanut butter/whatever the hell else. Yeah. Super-helpful, random stranger!
Does these mean that acne is like a virus I caught from someone?? If I hadn't shared mascara with my broken out college roommate, could I have avoided the last ten years I spent all zitty-chinned?
God it just makes me want to die. Please don't tell me this was avoidable.
@i_believe_in_peace_bitch: Nah, chin acne is generally hormonal. I have an on-and-off goatee of zits, and my doc and I have tried everything save actually putting me on hormones (i.e., BC), which I've resisted.
@i_believe_in_peace_bitch: Nope, you got the acne bacteria in your system from your mom prenatally. Seriously. It hangs out in your system until your oil glands go bonkers in puberty, and then acne ensues.
Hmm, maybe this swarm of antibiotic resistant acne will sweep the population, resulting in fewer 'Oh battleaxonista, but you'd be SO PRETTY if you just fixed your face.' I am a bitch. I will eat popcorn and call schadenfreude if that day every comes.
04/14/09
Cystic/nodular acne, the only real hope is Accutane, which is a systemic (i.e. hardcore and non-topical) Vitamin A derivative that will essentially dry you out and produce fresh, new skin.
04/15/09
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It's tempting to assign blame to something dietary, but for most people, it isn't a factor.
04/14/09
oregano oil diluted in colloidal silver - face rinse or spot treatment
EFA's to balance hormones (no fish sources!)
Women's Precious Pills (TCM)
Verilux Clearwave Light
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That said, my recommendation is used topically as it is an amazing bacterial "buster" - keep in mind that the Oregano Oil boosts this bacterial/fungal/viral eradicating ability and one muse not rely solely on this topical treatment, hence my other recommendations - synergy is important
04/14/09
04/14/09
Be warned, though: if you have sensitive skin, I can't see you surviving Serious Skin Care. For the first 2-3 months, I was very red and flaky and I don't even have particularly sensitive skin. Now, though, I love it. I don't even use the creams much anymore, just the cleanser.
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In my case, my dermatologist didn't want to give me birth control because she didn't think my acne was hormonal because it was mainly on my cheeks (even though I told her that my breakouts coincided with certain times within my cycle). So I had my other doctor prescribe BC and my skin improved tremendously, although I still have breakouts during the winter months. I think that may be related to not getting enough vitamin D, which has an effect on other hormones. If the doctor had listened to me, I might not have as many physical and emotional scars.
04/14/09
04/14/09
There are three problems that cause acne--it isn't just an issue of too much oil. Unfortunately, in a particularly nasty twist, they usually enhance each other. The more broken-out your skin gets, the more oil your body tends to produce in response to the irritation. The more irritated your skin gets, the flakier it gets. The flakier it gets, the more clogged pores you get. The more clogged, oily pores you have, the bigger the buffet for acne vulgaris. You have to knock out one or more of the legs to get the cycle to stop, and diet has no appreciable effect on any of them.
(Few things annoy me more than someone claiming I'd have better skin if I'd just stopped eating X, Y, or Z. Trust me, I tried everything. My problem was a genetic skin shedding issue.)
04/14/09
04/14/09
Do people comment on other skin conditions in the same way?
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04/14/09
I wore make-up on Easter for the first time in MONTHS and had a zit by the end of the day.
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Use Dr. Bronner's
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@la.donna.pietra - Verilux Blue/Red spectrum lighting works wonders - I saw a complete transformation with my friend who bought one....and it doesn't have harmful UV rays.
04/14/09
So yeah, I feel guilty...until I remember all the money and tears I've spent trying to deal with my eczema. My dry skin has been drug-resistant for years. Now I don't feel so bad.
04/14/09
Revenge is sweet. I will eat popcorn with you.
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God it just makes me want to die. Please don't tell me this was avoidable.
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One more thing to blame mothers for!
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I am not willing to use this as a long-term solution.