Adult Acne Part 2: Treatment

This afternoon, it’s the second and final part of my series on Adult Acne treatment, you can read part 1 here. I hope the first part gave you a bit more information and most of all motivated you to make an appointment with your GP to discuss your skin if it is a problem for you. Please don’t be put off if things haven’t worked in the past or if you have met an unsympathetic ear. Try a different GP or go back to your preferred one and have an open conversation about your concerns and what you would like to do about them. A good GP will guide your decisions by informing you about the options that are best suited to you.

Today I’m talking you through the treatment options and hope to give you some understanding of who they are best suited to and why.

Lotions and Potions
The first option for treatment is a topical medicine, ie one that you apply directly to the skin in the form of a gel or cream. Don’t be fooled by the formulation, these can be as effective as oral treatments (tablets) when you find the right one.

The catch? ALL acne treatments take 2-4 months to reach their maximum effectiveness and you are a key factor in that. You need to be religious about applying it as prescribed (all over the face, not just on spotty areas,) and patient while you wait to see a difference. A rule of thumb I give my patients is to expect a 10 % reduction in acne per month and no difference for the first month. (So bear in mind if you have only a few spots, it can take a while to see even one less.) Patient and pharmaceutical info varies but most suggest around 12 weeks use to assess results. Pretty disheartening, but if you’re prepared for the long haul you’re often pleasantly surprised by the results.

The topical treatments broadly speaking have three different mechanisms of action: Those aimed at stripping the top layers of skin, those containing antibiotics and those containing Vitamin A derivatives, along with combinations of two types. Some commonly used preparations include Benzoyl Perozide (PanOxyl) Benzoyl Peroxide plus an antimicrobial (Duac, Quinoderm) Antibacterials, (Zineryt, Dalacin T,) and topical retinoids, (Differin, Isotrex, Isotrexin, Retin-A.)

Acne and The Oral Contraceptive Pill
Lots of women blame their acne on starting the pill, others want to start the pill as a treatment method. In truth, acne occurs at a time of life when many women need contraception, thereby implicating the pill in the problem, often falsely. In terms of using the pill as a treatment for acne, opinion varies.

My personal opinion is that if you have acne, treat the acne, if you need contraception, take it. Only in circumstances where women come needing contraception as a priority and hoping to improve their skin as a secondary concern, do I offer the pill. The reason for this is simple. There is no guarantee that the pill will clear up your skin. If it does, then great, but it is equally likely to increase your spots by upsetting your hormone balance or increasing skin oiliness.

From a medical point of view, the recommendation is trying a standard pill with a specific combination of hormones, like Microgynon 30, Brevinor or Loestrin 30. Of course, all the normal discussions should take place with your doctor or nurse about your suitability for the medication. Yasmin, (a different combination of oestrogen and progesterones) is often heralded by the media as the ultimate pill for skin sufferers, however it is not recommended as a first choice of treatment due to a lack of evidence for its effectiveness against acne.

Dianette is another second line option for treating acne, which is an anti-androgen and reduces oil production. Although it has a contraceptive effect, it should not be used solely for contraception and carries the usual risks of combined oral contraceptives that your doctor will check before prescribing it to you.

Lastly, the progesterone only pill and progesterone only methods of contraception can cause acne or make it worse. You may have to weigh this up against your need for contraception if the combined pill is not an option for you (if you have migraines for example) and decide which is more important.

Oral Antibiotics.
As I said above, oral antibiotics (in tablet form) aren’t necessarily the next step for acne treatment but are often used as a ‘step up’ option. One indication for choosing oral antibiotics is the need for treating wider areas than just the face, for example acne on the chest or back, where it is hard to apply a topical cream. They can also be useful where compliance is an issue. For example, you might choose not to use a cream because it feels uncomfortable on your face, or maybe you’re that person who doesn’t take their make-up off at night… not conducive to remembering a cream too! You do need to take them for just as long, I usually review patients at 4 months before considering a change of antibiotic or type of treatment. You can combine oral antibiotics with topical treatments too.


Image credit

Some of the popular preparations we use are Lymecycline, Oxytetracycline and Erythromycin. I prefer Lymecycline as it has good effectivity, low resistance against it and is a once a day preparation.

A word on antibiotic resistance. Resistance to antibiotics (and this goes for other situations they are used in too,) is only an issue when using the same antibiotic for long periods of time, so can be a problem in acne. There is an increasing amount of resistance to Erythromycin for example and we don’t recommend the use of topical creams that contain antibiotics after the acne has cleared up or for more than 6 months – switch to something without antibiotics for long term maintenance.

Specialist referral and Roaccutane.
Once all of the above treatments have been tried then your doctor might feel that you need a specialist opinion from a hospital Dermatologist. You should be prepared that your GP is likely to try and treat you without referring you (depending on their level of confidence at treating acne,) for several reasons. Firstly, many acne sufferers can get good relief from ordinary prescription drugs, secondly, it can take some time to find the right one for you and thirdly, there are strict criteria for starting a patient on Roaccutane. Although we as GP’s are not allowed to prescribe Roaccutane (because of the monitoring that needs to be done for patients who are on it,) we are aware of those criteria and there is no point referring someone who doesn’t fit them. However, if you are not being referred and your acne is leaving lasting scars or producing hard inflamed cystic lumps on your skin that take weeks to resolve, you should ask to be referred.


The Everygirl

Roaccutane is a retinoid and Vitamin A derivative which works by reducing the skins oil production. Less serious side effects include extreme dryness of the skin and peeling or flaking, particularly on sensitive areas like the lips. Skin can also be very sensitive to light so should be protected even on cloudy days with sunscreen. Roaccutane is teratogenic, which means it can cause birth defects in babies of women who become pregnant whilst taking the drug. Female patients must have fool proof contraception (i.e. a coil or implant) in place before starting to avoid pregnancy. The bit that has received media attention however is the effect on mood. There are rare cases of Roaccutane causing: depression, anxiety, aggression or hallucinations, sometimes even leading to thoughts of self harm or suicide. Sadly there have been a few high profile cases reported in the media of teenagers who have committed suicide on the drug. What we don’t know is if they would have had depressive tendencies even without taking it. The important thing to remember is that this is a very rare side effect. With every medicine available we weigh up the potential risks of taking it against the benefits the patient might experience. Many many people achieve good clearance of their acne and minimal side effects but only you can decide whether it is the right treatment for you and a risk you are prepared to take.

I hope this helps some of you consider your options – please do pass it on to any friends you have who suffer with their skin. If it can help just a few of you, I’ll be very happy.

In the meantime, again, although I can’t give individual medical advice here and I would encourage you to visit your GP (I know, I know, broken record!) I’ll do my best to answer any questions. I think some of the questions which went unanswered last week are addressed in todays post too. I’d also be interested to hear if there are any other medical issues that you would like to see covered – I’ve already had an email suggesting one topic and whilst it won’t be a regular series and I can’t guarantee it will be suitable for coverage here, I’ll do my best πŸ™‚

Here’s to clear skin!

Love,
Rebecca
xo

More resources:

  • This article was complied using my knowledge and day to day practice. I also referenced the NHS websiteΒ Clinical Knowledge Summaries, GP Notebook and the BNF.
  • British Association of Dematologists patient information leaflet: Acne
  • Patient.co.uk Patient information leaflet: Acne

Disclaimer: Although written by a qualified GP, this article does not substitute you attending your own GP and should not be used for individual medical advice. No liability can be accepted for decisions made on the strength of information contained here or elsewhere on Florence Finds.

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81 thoughts on “Adult Acne Part 2: Treatment

  1. Dianette: “Although it has a contraceptive effect, it should not be used solely for contraception”

    WHAAAT??? Shiiiiit! Um, I was on this for like 10 years and didn’t use any other contraception (TMI? Sorry). I’m sure my GP never warned me about this. Holy lucky escape, Batman!

  2. I’ve tried lots of things on this list and have eventually got my skin into a fairly manageable state, although I’m not really sure what worked and what didn’t. I think maybe I just eventually reached a stage where my hormones have calmed down a little bit and so I only now get flare ups once a month or if I’m ill or stressed.

    Recently I was given a cream by my doctor called Fucadin which really helps calm down any flare ups. I think it’s actually prescribed for cysts rather than spots, but seeing as I had cystic acne I guess that kind of makes sense. Funnily enough I’d gone to the doctors on that occasion about something unrelated and she basically said ‘your skin looks really painful, I’m giving you something for it’.

    Rebecca – I’ve read really good things about Retin A cream/gel – do you know anything about it?

    • Retin A is a retinoid, or vitamin A derivative in topical form. It is supposed to be first line therapy – that or Benzoyl Peroxide as it has good results, is anti-inflammatory and doesn’t contain antibiotic. I prescribe it a lot and see good results from it anecdotally.

      On a personal level, Isotretin gel (similar) was what I was prescribed before my wedding and I was looking at the honeymoon photos recently and thinking how good my skin looked. I was scared of it because of the association with Oral retinoids (roaccutane) – ridiculous in hindsight, but didn’t want oral antibiotics. It did a great job and I’m probably going to go back on it.

      • Thank you! I’m going to monitor my skin over the next few months to see if it has actually settled (or if it’s a temporary mind trick) but if it looks like it’s still being difficult I’ll ask my GP about that ahead of the wedding.

        • To be honest Amy, my skin can be brilliant at time and then I have hormonal breakouts that are horrendous. Although they’re only once every month or so, they are leaving scars and area’s of pigmentation on my skin that makes me feel less comfortable without a bit of make-up on. Thats what has made me go back to the Dr. You can bet the day you go your skin will be fine, but if it’s scarring thats worth sorting out. I don’t think occasional spots if they’re more than the odd one should be ignored just because they’re not always there.

  3. I am currently on Limecycline and using Benozyl Peroxide as well.

    The antibiotics have worked for me in the past but when I stopped taking them a few months ago my skin flared up and is now worse than it has ever been (only on my chin fortunately). I was referred to a dermatologist and Roaccutane was suggested but I have decided against it for now.

    I have not been back on the antibiotics for long enough to comment on whether they are working again. I do have one question though…are you suggesting above that Duac or Quinoderm can be used alongside BP? I have not tried either of these treatments before and would love to give anything else a try before I give in to Roaccutane.

    • You can use 2 topical treatments but we usually say use one in the morning then the other at night to reduce the irritating effect on the skin. However you are already on Oral antibiotics so adding in a topical one won’t add anything.

      Cou could try Retinoids though – topical ones, or have you already?

    • I have also just noticed your comment about isotretin gel. I have been to about 3 different GP’s about my skin and I have never been offered any of these topical treatments.

      I only use Benozyl Peroxide because I have successfully used it in the past when I just used to get an odd spot here and there (and it was recommended to me by a friend back then).

      • It’s difficult to comment without seeing your skin K, but it might be they thought it was too bad to try topical treatment, when in fact, I don’t think it’s any harm to add them in (in the combinations I mentioned before) and give it a go.

        • Thanks Rebecca. I will go back to the GP and discuss these treatments with them.

          Another quick question, is there anything specific you would recommend in terms of cleanser, moisturiser etc that can help. The last GP told me to put nothing on my skin except water but I feel very uncomfortable about that (not to mention that there is not a hope in hell of me going out without make-up) and the previous GP told me to only use E45 moisture cream?

          Thanks!

          • I’d like to know about this too – I am using antibiotic solution on my face at the moment but then I feel I need to moisturise over the top… but have no idea what would be best!

          • Are you using it at night Gem?

            At night I would just leave it, then rinse your face with a muslin cloth or flannel and a bit of water in the morning and moisturise as usual.
            It won’t do any harm to moisturise over the top, that said. Just let it absorb and dry first. There is evidence that it’s about the application rather than the duration, half an hour is enough for it to do it’s work.
            x

          • Most dermatologists recommend Dove or Simple skin products. Obviously you need to wash your face! Was it a man by any chance?!
            My advice would be to find something that doesn’t leave your skin feeling ‘stripped’ or tight after using it and stick with it. Something fairly fuss free.

            Moisturiser doesn’t cause acne, unless it’s reacting with your skin and causing inflammation, so find a lightish one and use it as you need. A good moisturiser should absorb well, require only one application (I’ve found oil free ones in the past a false economy as they need more than one application.) and not leave you feeling greasy.

          • The dermatologist prescribed me something called Dermol 500 but I think you can buy it too. It’s an antiseptic cream that can be used as a soap substitute (doesn’t foam but you just apply it all over then use a cloth to take it off) and also as a moisturiser. My skin has never been so soft since I started using it as my moisturiser.

  4. Oh I so could have done with this post two and a half years ago… at least to spell out all the things I would go through for my skin! Last year (just months before our wedding) I was on Roaccutane for my skin. It did work but oh boy did it have some side effects in the final month. Think everyone is different but I totally underestimated how strong some of the side effects would be (hair loss, peeling skin on my lips, inside my nose etc). I’m never very sure if I was to go back in time if I’d take it again.

  5. Great informative post Rebecca. I’ve had lots of things for my skin and am still seeing the dermatologist and trying out a new cream along with antibiotics. In my experience I think its worth pointing out that not all skin problems are acne. Mine appear to be a mixture of mild acne, rosacea and a tiny bit of some type of dermatitis. Lucky me!!

    • Linsey you are an excellent example of why self diagnosis and internet medicine doesn’t work! There’s no substitute for casting an eye over a problem, particularly with skin. And treating that collection of problems with otc acne treatments would have no effect, no to mention make some of them worse! Well pointed out πŸ™‚

  6. My skin hasn’t been great since coming off the pill, but it’s not bothering me enough to see my GP – yet. Good to hear of the different options out there though, and to know that if it doesn’t clear up then the GP is an option, even if I don’t have full-blown acne!
    I know it must be difficult for you to delve into medical posts too much Rebecca – but I would welcome more posts like this on typical topics affecting women if you felt you were able to do them!!

  7. Brilliant post! My skin I luckily relatively spot free these days with one exception: if I get within 100 ft of sunblock, my chin and jawline breaks out into about a hundred tiny white spots. I’ve tried every different kind of sunblock available – cheap, expensive, none at all and wearing a hat (inevitably some from my arms ends up in contact) and nothing makes any difference. After about 4-5 days it clears up and I can then use sunblock with no problem. Help?? It’s a bit of a downer when I go I holiday! Thanks!

  8. Thank you so much for this post Rebecca! It’s an often lonely subject when at the age of 31 there are so many things to worry about in life, having clear skin seems such a teenage problem. However it has always affected my confidence and seems to have got quite bad lately since I came off the pill and has made me quite miserable of late (and my spend on make up has doubled, ha!).

    I have a very strong family history of breast cancer hence why I came off the pill but I’ve now gone back on it (Cilest) in the hope it helps again which isn’t ideal given my element of risk (my GP was a bit concerned but think she knew how miserable I was!). I have Duac which seems to help, though I was never told it would take long to notice the effects, so will ensure I am more religious about applying so thanks for this and all advice!

  9. Hi Rebecca

    Thank you so much for posting this, as a long-term acne sufferer I was beginning to feel this was something I’d just have to ‘put up with’. However I recently switched my contraceptive pill to Marvelon, which while it’s begun to clear the spot problem it has given me dark brown patches covering my nose, forehead and parts of my cheeks. A trip to the gp left him and me feeling very confused as he had no idea what it was. Nonetheless he did investigate it further and has since told me its probably chloasma (more commonly known as the mask of pregnancy) due to the hormones in the pill. Que much frustration – I’ve cured one skin problem, but with the same thing created another!! Not sure which is worse?! If anyone has heard of this or knows a way I can minimise its appearance I’d be ever so greatful. I have tried cliniques ‘even better skin corrector’ but with little success.

    Thanks A

    • This is not an uncommon problem – your GP diagnosed it right, in fact my Mum had it in her 30’s.

      You need to stop the pill (it’s a recognised side effect unfortunately) and then stay AWAY from the sun – it will darken them. Use a really high factor sunscreen daily – even under make up, Clinique city block comes in factor 40 and 50 and has a bit of cover to it too, and over time (- I’m talking months and years here) it will fade.

      • Thank you, I guess despite my fears of the acne flaring up all over again, will have to be tested. I’m just ever so worried about changing things, when finally after 11 years of misery I’ve found something that’s beat the spots! Nonetheless I don’t want the brown spots to get any darker, people are beginning to notice even under makeup. One even asked me if I’d fallen over and now had a big scab on my nose πŸ™ v embarrassing. I was offered azelaic

  10. Oh man Dianete made me a little kerazy! Luckily my current pill is much better.

    From the doctors I have Zineryt, which lasts about 6 weeks. I tried the PanOxyl one but it was so harsh on my skin. I think I tried pretty much all the topical lotion thingies before finding success with Zineryt. Even now I don’t use it everyday, just when I have a break-out.

    xoxo

  11. I went on the pill many years ago to combat my acne. It took me a few attempts Including dianette to find marvelon worked for me and I didn’t feel bonkers or too bloated.

    I came off the pill last year and my skin seemed fine until about 8 months down the line and I had a bad breakout along the sides of my jaw. Total bummer, but I didn’t want to return to the pill. I opted for an alternative therapy approach, Zineryt as a topical application(occasionally) and a change in diet.

    I had a few accupuncture and reflexology sessions, I no longer drink cow’s milk and had a CACI facial. I’m not sure if it’s a combination or if it’s one of those things but I no longer suffer from acne. Hope one of these methods works for somebody else…

    • Hi Mez,

      I’m coming off Marvelon which has completely cleared up my acne but given me ‘the mask of pregnancy’ instead over my nose and forehead. (Something to do with the hormones in it). I’m hoping and praying the spots won’t make an unwelcome return though πŸ™

  12. I was on Dianette for years, probably a lot longer than I should have been. Then I changed GPs and was taken off it quick smart! My GP at the time was great, really understanding about my acne. As I needed contraception too, she prescribed me Yasmin and I’ve been on it since. For me, it’s been a godsend, my skin is clear and it’s the only pill I’ve taken that doesn’t make my weight balloon πŸ™‚

    I know one day I’ll have to come off the pill and it really worries me. I’d like to think at my age that my skin will have naturally got better, but past experience doesn’t convince me. Shall probably come back to visit this page then!

    • Hi,

      I’m pleased Yasmin has worked for you. My doctors have been particularly un-bothered about my acne since I started with it at age 8.
      They’ve recently stuck me on Yasmin and my skin is, if anything, more cystic than before and the flare-ups last longer. It’s also making me pretty down a lot of the time. I wanted to know if your skin was better immediately or after a number of weeks/months?

      Thanks,
      Ropes

  13. Any tips for acne in pregnancy? Obviously I can’t take much in the way of medical treatment for it but its really getting me down- skin looks terrible! I have always had problems with spots, mostly on chin and jawline and a very oily forehead and nose but usually only v. bad at time of the month- now its constant and the stops seem to take an age to heal. I was using clinique 3 step for oily skin as that helped in the past but it seems to have stopped reducing the oiliness. Anyone got any tips? x

    • There’s quite a few topical treatments that are fine for use in pregnancy. Obviously nothing is 100% safe and we have to warn people that, but the absorbtion into your system with a topical treatment is negligable. Duac or Benzoyl Peroxide are fine.

      • Thanks, will speak to my GP when i’m next there, seemed a bit silly to bring it up as my skin doesnt seem as important as other things going on in my body right now, but skin really does affect how you feel and I have always been conscious about it. Bad enough I cant fit into my best clothes anymore for work, but having such bad skin makes me feel like even more of a frump! At least I have nice long strong nails and hair at the moment- positive symptoms of pregnancy!

  14. I really adore this blog !!!! I am 38 and suffered from severe acne as a teenager then adult acne. I have tried metrogel and just about everything else. I got success by using a jojoba oil treatment by mama nature (teenage dream). iIt is the only thing that has ever worked and I will use the word miraculous (well for me anyway). I’m afraid I can’t use the word miraculous with regards to the price (Β£30) but I suppose you can’t have everything. I still use this daily to moisturise and don’t using anything else on my face apart from this.

  15. A bit late reading this, but thank you so much for this post. I’ve been suffering with my skin for about a year. Having bad skin in my late twenties has really been getting me down, but felt it wasn’t something I could go to the doctor for. It’s really good to read an article from this perspective-after spending ridiculous amounts on skincare (which could never really have helped the hormonal side of things) I’ve taken your advice Rebecca and gone to see my doctor, who’s changed my pill and prescribed Zineryt. Fingers crossed and thanks again x

  16. I’ve just come across this to, which has been quite helpful and reassuring to read! I had a terrible and random breakout on my forehead in April this year and i’m still struggling with it. I’ve always had the odd spot here and there but on my forehead it really has turned into ‘acne’ as my complexion has changed and i have areas of redness and stubborn small spots, often tiny whiteheads, that reoccur randomly. My forehead also feels really unbalanced. The annoying this is after some research i got some of Paula’s Choice products (the 2% bha). Using that means i’ve not had a SINGLE blemish on my whole face since about May (it’s also softer etc), but it’s had little effect on my forehead. So the areas i used to have trouble with are now lovely and the area i never had trouble with is awful. It really has consumed and ruined my summer (and not autumn πŸ™ ).

    I finally plucked up the courage to go to the doctor who was disappointingly dismissive in this almost throw-away attitude. He didn’t really fill me fill confidence in that he cared or knew that much about skincare, despite being the one recommended to me. He gave Dalacin T lotion first of all but that didn’t really do anything apart from make my forehead more oily. I’ve balanced using a bha and benzoyl peroxide and while it helps a little i’m still having difficulty clearing it. I went back and he gave me Isotrex gel. This stuff seems really powerful and reading about it on the internet is very daunting! But i have convinced myself i need to start it, and stick with it. I have a question though (i know it’s taken a while for me to get to it!), you say to apply the topical all over the face, not just on spotty areas? How much of a difference does that make? Is it necessary? For me there are only 3 or 4 recurring areas and i’m worried that after reading how this gel works, applying to areas that are actually not that bad, might prove counterproductive.

    Hopefully i can fix my forehead soon. It really has had a huge emotion impact/drain on me (i’ve become a recluse and spend all my time reading about skin) and as i graduate next month i want to be able to at least get into a more positive frame of mind.

    Thank you.

    • Hi Lindsay πŸ™‚

      firstly, about the Isotrex gel – it’s great, but not to be confused with isotretinoin – it is essentially a topical (gel) form of that drug, which is better known as Roaccutane and very potent. It has very little systemic absorption (which means it acts on your skin and very little is absorbed into your blood stream,) so you don’t get the scary side effects that the tablets would give. I think you may have been reading about the tablets side effects as the main side effects with the gel or cream is skin irritation, that’s all!

      Regarding your question, you can use it just on your forehead if you feel there’s no problem everywhere else of course. The main reason we advise people to use the cream all over is because we want to distinguish between treating individual spots as and when they occur. Although topical treatments are trying to get rid of spots for you, they’re also meant to prevent them occurring in future, so you need to treat the skin that isn’t affected, although that may mean the unaffected sin around the spots on your forehead rather than your whole face if you see what I mean.

      Hope that helps and get going with it – the sooner you start the sooner you’ll see an improvement!

      xo

      • Hi Rebecca! Thank you for the reply. I’ve found it quite overwhelming due to my doctor not being particularly interested or knowledgeable as well all the self diagnosis and experiences over the internet, so it’s nice to have a clear and positive response!

        So you had a positive experience with an isotrex gel? How long did it take for you to see results? Do you think the gel is something that is likely to have a more lasting effect than something like benzoyl peroxide? I have found that to work well on individuals spots but not really a ‘solution’. And I think i did get some of the side effects mixed up, but the skin irritation is still something i’m apprehensive about. I have very sensitive skin, along with eczema and areas that are prone to redness and irritation for no reason at all (what a wonderful combination). So i am a little worried about whether if a reaction happens, it’s something to push through as it’s merely getting used to the topical, or my skin just doesn’t like it. I suppose there is only one way to find out. And i feel like i’ve tried everything else!

        I will only use it on my forehead as the rest of my face is actually in great condition. Is something like that common? To have one area (my forehead) experience a sudden and lasting break out, but for no other area to be affected? I have applied a tiny tiny bit of the isotrex to 3 or 4 small areas on my forehead for the past 4 nights and i’ve actually seen no redness or peeling. There is obviously no sign of effectiveness yet but not waking up with itchy or irritated skin from it is at least a little positive. I’m going to increase the amount i use each night and also increase the area of coverage. Should the gel help with redness too? I have one small area where a spot was maybe 4 months ago and it’s still red! I asked my doctor and he flatly replied that he had no idea.

        Again, thanks for the reply and information!

        Lindsay πŸ™‚

  17. Hi, I suffer from PCOS – which causes me to have bad skin. I was taking dianette, which worked great, but am now trying for a baby, so have been off it for nearly a year now, which means my skin has been bad. Dr gave me Panoxyl, but it really dries my skin out (as in flaking!) are there any other products you can reccommend?

    • Hi Tascha,

      The problem you’re going to have here is that you’re trying for a baby. Obviously we always want to reduce potential side effects towards the baby of any medication, so we avoid as much as possible. That said, the systemic absorption (ie how much of the drug is absorbed into the body from the skin) of a cream, gel or lotion is likely to be very small and harmless. Of course that depends on the drug in question and obviously there are not experiments on pregnant women so we don’t really know the effects – hence Doctors hesitation.

      If the Panoxyl is working then it’s certainly the least concerning when it comes to pregnancy or trying to conceive, so if it’s just flaking, that’s the least of your worries – invest in a good moisturiser – the Panoxyl is treating bacteria so adding extra moisture to your skin won’t adversely effect the benefits you’re getting from it. If it isn’t working, head back to your GP and discuss it with them – there’s no concrete answer, it has to be a decision between you and your doctor about the risk you’re prepared to take.

      • Hey Rebecca,

        Thanks! I have now started (after intense exfoliation) to do the following – which seems to help. I remove my make up every evening using a daily scrub, I apply tea tree oil to the spotty areas, i then massage bio oil into my face & I apply panoxyl on the affected areas just before I go to bed. I apply Clarins HydraQuench every morning (after washing my face) before applying make up

        Seems to be working great so far, no flaking & spots are improving πŸ™‚

        The skin was just getting me down & just can’t wait to get pregnant – wish it would hurry up & happen already.
        x

  18. Hello Rebecca. I found this from googling around about the gel called Isotrex and like the poster a few up it has been useful to read. I was unsure about using it to begin with because of all the internet stories (i’ve now learned to stay away from internet stories!), but i am glad i did. Hopefully i don’t jinx it but i’ve been using Isotrex for about three weeks now and there has been good improvement. I had a little redness in some places but it had subsided. I still get stinging and irritation (but no redness) sporadically through the day but if i can see improvements i don’t care. For Lindsay above, the key is to use it very sparingly. For the first few week i literally used more of a residue of the gel, almost nothing, but i could still see its effects. I’m now using a little bit more, and over most of my face.

    Rebecca, i had a quick question for you since you’ve used the gel: it seems to be clearing up active acne well, but will it also have a good effect on my complexion? The active acne is decreasing but there are still areas of uneven tone and that feel ‘imbalanced’. And if so, will this happen over a much longer period rather than just under a month? Also, should i be worried about my skin getting worse again in the future, or has the gel essentially changed the inner make up of how it reacts? I asked my doctor about this and he gave me a really ambiguous answer.

    Thanks! xx

    • Hi Annie!

      I’m so glad you found this and it has helped πŸ™‚

      The short answer to your Q is that isotrex has some anti-inflammatory properties and will help even out skin tone from that perspective. Pigmentation will also subside as the lesions stop occurring, like scarring heals. However both of these things will take a long time to notice, months. The good news is that sun exposure increases scarring and pigmentation, so the winter will be kind to you for something at least!

      Good luck! Xo

  19. Thanks Rebecca. I know the purpose is to stop active acne (which i think it seems to slowly be doing), and i understand i don’t want to tackle too many problems at once…, but i have found that, especially on my forehead, the skin appears more wrinkly and a bit ‘ruddy’ (but not red), especially if i raise my eyebrows etc. I don’t know if this is the fault of the isotrex, or i’m merely noticing now that the active acne is decreasing (and that i’ve become obsessed with mirror-looking), but it’s still disheartening. Is there anything you’d suggest to tackle this? I know that isotrex is a retinoid and after reading about those it appears they fight wrinkles so perhaps i have the answer already?

    My final question, and then i’ll stop bothering you haha – should i read isotrex as just a retinoid brand? All the different names are confusing and when i’m looking at effects it’s hard to know what i should be paying attention to. Would you say the gel and something like retina are essentially the same?

    I hope i haven’t bothered you with all these πŸ™‚ ! xx

  20. This might be a long one so bare with! I’m 27 and for the past year have suffered with mild adult acne. I have been prescribed Retin-A and have been using that alongside dianette for the past 12-14 weeks.. the problem i’m having is that my skin goes fairly clear (apart from some scarring which just won’t budge!) for about a week and then i get spotty again, and its a constant cycle. The spots are usually either side of my nose on my cheek and around my cheek bones, and occasionally on my chin. The doctor won’t refer me to a derm because she said its too early to telll if its working but surely I should know by now?! Also i feel very tired all the time and pretty down in the dumps, partly down to the acne. I have given up dairy and eat really helathy, I am fairly fit and the right weight. I am at my wits end with it all, please help!? I should also add when i first got acne it was whiteheads and now theyre just bumps!
    Thanks, Vicki

  21. Hi Rebecca,

    I have been using isotrexin gel for 5weeks now and I have noticed my skin getting worse. Is it a case that it gets worse before it gets better? I want this gel to work so plan to stick at it for at least 8 weeks to see if it helps. I apply it every night before bed at around the same time each night. The reason I started this gel was because I came off tetralyscal (spelling might not be correct!) as I was worried I would become resistant to the antibiotic I was on it for 4 months I have started back on this antibiotic a few days ago to help my skin. I’m really running put of patience as my skin was never bad before I know there are no quick fixes but the flare ups since using isotrexin are concerning me. I would appreciate your advice.

    Thanks,
    Anon

  22. Thank you to everyone (obviously mostly Rebecca) for this blog/website.

    Sometimes I feel so alone as an acne sufferer, especially when the GP has no time to talk through options with me. I spend so much time trying not to go out and googling treatments – this at least gives me a starting point for my next GP visit (I’m due a visit after 3 months on Yasmin). 17 years of acne has made me feel beyond repair.

    Good luck to all those out there trying new treatments.
    Ropes xx

  23. I have always suffered with mild manageable acne then last year I had alot of stress aswell as making alot of changes to my life. I stopped taking the contraceptive pill, gave up smoking and started to eat healthily all things that i thought would benefity my health and my skin, certainly not make it worse! My skin progressively got worse and worse to the point where i now have moderatly severe acne according to the derm i saw. I eventualy got an appointment with a dermatologist recently after waiting for an appointment through my G.P. I was so pleased to finally get to see someone that could help but when i got there it seemed like she just wanted rid of me and wasnt very understanding. She said I need Roaccutane and that nothing else will help me so theres no point trying anythinng else but I am currently pregnnat so I obviously cannot have this treatment and need to come back after baby is born. I asked if she could give me anything in the mean time just to calm things down a bit as I am currently signed off work and will not leave my flat or see anyone (I think ive developed body dysmorphic disorder because of my skin) She said there was no point as nothing else would work I just sobbed at the side of her desk as I feel so desperate and alone and thought she would be able to help in some way. I begged for something and she said fine she would prescribe a wash that i can also use as a moisturiser and prescribed me something called dermol 500 lotion. I just wanted to know if this is likely to be breaking me out as it seems to be making my skin worse or do you think its completley unrelated to using the dermol 500 lotion to wash with. Please answer my question, I dont know who else to ask or where to turn. Ive done alot of research on Roaccutane for after ive given birth and im still not keep on even taking it then to be honest. I thought that when I saw a dermatologist she would do some tests and things to try and get to the root of why my acne has got so bad, i dont want to mask the problem anymore I want to find out why so I can fix it. I just can’t live like this anymore and wish I didnt care and could just get over it and learn to live with it. I wonder if my skins p.h and acid mantle is just upset and im not doing the right things to try and correct it? but im clueless really.

    Many thanks in advance for a reply,

    Candi

  24. Hi! i am 37 years old started having severe acne at 16 after trying different treatments out i was prescribed dianette i was on it for 10 years with perfect skin and not one spot each time i stopes it to have a baby my acne would come back to the point it left scars… i moved from dianette to yasmin but it didnt work as well.. recently i have gone back on dianette nearly a year but the spots are still coming and scaring… I tool lymcycline twice 6 months treatment which helped but when i stop the acne comes back… Please advice me like others i am desperate.. im at my wits end have tried holostic expensive natural lotions but nothing helps…. its getting me down and stops me from going out as the scaring and spots last for ages… ive been reffered to a derm but i was prescribed istorex and a face wash things calmed down as i went on dianette but now after stopping lymcycline im getting spots everywhere how long before it will settle or do i need to be on pills for life… its depressing!!

  25. Hey I am Saima, and I have actually never posted on any sort of blogs or forums but now i guess it seems like i should.
    I have been suffering from moderate acne for 4-5 years now. My acne journey has been a roller coaster ride. I have always been a very curious teenager and never ignored my acne. I have been prescribed many different types of antibiotics in the past and alot of topicals (Benzoyl peroxide and duac).sadly nothing has worked.. Recently I was prescribed accutane but I sort of turned it down.
    For me staying healthy is also very important and thought I shouldn’t go for the last resort(accutane). Instead he prescribed me the topical isotrex and the contraceptive (Dianette).
    Its been two days since I have started my Dianette and really hope it works for me.
    I have some questions I want to ask.
    None of the topical has ever worked for me, and instead always had a reaction. I am not sure if I should start with isotrex? any advice on that would be appreciated.
    Also my acne is still bearable but the scaring is such a put off. If Anyone could recommend a specific cream or gel for scarring?
    Saima.

    • Hi Saima,

      Reading this, the most important thing is that you stick with your treatment to really judge the effect. Lots of the topicals cause mild skin reactions, but most people get used to them. I usually suggest applying just a small thin patch and increasing the surface area you are applying the gel/cream to, over a couple of days, until you are covering the whole face. Topicals should be applied to the whole face not just the affected area. Also, don’t make the mistake of applying more for a better effect. You only need a thin layer, regardless of the preparation and often only for it to be on the skin for an hour or so. Leaving it longer doesn’t increase the efficacy.

      Lastly, re your scarring – do you mean red marks or ‘holes’ in the skin? Red marks are inflammatory and will pass as the acne resolves and your skin regenerates. If however you have what we call ‘ice pick scars‘ they will probably not heal. You may want to look into laser treatment or see if is available from your doctor.

      Hope that helps!

  26. My 19 year old daughter has had acne since she was 10. She has been prescribed antibiotics and all kinds of topical solutions but the only thing that really worked for her was Dianette. She had hardly any side effects and it cleared her skin brilliantly. However, after 2 years the doctor took her off the Dianette and she had Microgynon, and Loestrin and is currently taking Yasmine. Non of these pills have helped at all and her back and shoulders especially are really awful. She decided against Roaccatane because of the side effects and didn’t want it to effect her concentration for study. Is it safe to go back onto Dianette? Because her GP at home says not but her GP at uni says she can! I’m concerned about the health risks and I know that she is only concerned about how she looks and how the acne affects her self esteem. I understand this as my mother and I bother had terrible skin and were both under the skin hospital for years. I really feel for her but am concerned for her health … Can you give any advice please πŸ™‚

    • She could try Dianette again but it’s only recommended for a 12-18month max duration so it’s not a long term solution for her by any means and giving multiple courses is at the GP’s discretion. Knowing it wont be a permanent solution I would often choose to pursue something else instead. I would suggest she visits her Gp again to discuss the pro’s an con’s of the options available to her, Roaccutane included.

  27. Hi! So as soon as I started puberty, the acne began! I only started puberty around 17/18 and I am now 20 so I have only suffered with acne for a few years. So I was put on many different contraceptive pills to help reduce my acne. I tried Yas and I tried Marvelon. Yas made my mood swings unbelievably bad although my acne was not that bad. I also started having convulsions so my GP gave me Marvelon. My convulsions were still bad and Marvelon made me feel down so I came off the pill completely last year. Since coming off the pill my convulsions have stopped completely but my acne is awful! I only have acne on my can and forhead. I get whiteheads, blackheads and really red spots. Sometimes scabby ones. I cannot bear to show my make up free face to anyone but my boyfriend. In february, my GP gave me duac once daily gel. Its helped a little but not that much. I have stuck with it for 2 and a bit months but I feel like it has not done a great deal. Before this I have tried Benzyl Peroxide which did nothing either, and tea tree oil etc. I now feel like I don’t have many options. I feel that my acne is not severe enough for antiobiotical tablets, but my face is just horrid to look at without makeup! I also have a lot of acne scars. I have also tried zineryt but that was alongside Yas a few years back and was a weak dosage. What would you recommend? Thanks x

    • Jess, antibiotic tablets or gels and creams are all the same strength, but each work better for different people. If you have tried creams and your skin is clearly making you miserable, consider antibiotic tablets. I resisted them for years with no good reason and had a great result with them.

  28. Hi Rebecca,

    What a great site! I battled acne in my teens and finally was able to get rid of it with retin a micro gel and spironolactune. I only used spironolactune for a few years but continued to use retin a micro. I moved to the UK three years ago and my GP can’t prescribe me retin a micro gel since it’s discontinued in the United Kingdom.:( So upset as my face has been breaking out so much without it! As I’m just about to turn 30, I looking for a retinoid that helps my acne and wrinkles. Would isotrex gel or differin gel be the best for this? I tried to get tazorac prescribed but it’s for psoriasis over here. Please help! Thank you.

  29. Hi Rebecca
    I’ve been reading all your advice and it has been truly helpful. My acne nightmare started in my late teens and I am now 36 and it is worse than ever. I left it for a while then decided to seek medical help in my late 20s. I was put on Duac and doxycycline and it was very affective until i started to develop serious breakouts. On moving house and changing doctors my medication was changed to lymecycline 408mg and Isotrexin gel. My skin is worse than it has ever been (even my daughter and mother questioned what had happened) I have gone back and asked to be put back on Duac but was told that they do not recommend doxycycline anymore. Now Im on Duac and lymecycline 408mg, I’m concerned is that the right move? I was under the impression that Isotrexin gel is very effective but it seem to be horrible for me… Did i need to give it more than a couple of months?
    Thank you in advance

    • 8 weeks is probably the minimum you can give a trial of any skin treatment but if your skin was still reacting then maybe the isotrexin wasn’t for you. Lymecycline is the best antibiotic currently available – better than doxycycline.

      Have you considered Roaccutane? It sounds like you have tried everything else… you will need a dermatology referral from your GP to discuss it but if things are that bad it’s worth considering.

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  31. Hi Rebecca
    Please can you give me advice for my 16 yr old daughter. I’m worried sick. She has had problems with acne since she was 11. Her periods started at 11 also but remained very irregular. She has used zineryt, duac, epiduo, benzoyl peroxide 10% , has been prescribed tetralysyl which she took for over 12 months with good results but her skin appeared to become resistant to it. Eventually 18 month ago she was prescribed dianette after a blood test showed higher levels of testosterone, she was scanned for pcos and whilst they put her down as borderline because her ovaries were “chunky” whatever that means, they don’t think she has pcos. She has been much more challenging attitude wise since going on dianette, I put this down to her age; life at home over the last 18 months has been like walking on eggshells! However over the last 2-3 months her mood swings and outbursts have become worse. She is low in herself and very teary saying she feels sad and lacks interest and concentration. She has been off school for 2 days saying she can’t face anyone – she used to be such a happy thing. Last night I was awake with her at 2 am as she had woken up crying and exhausted. She has read what others says about how they feel emotionally on dianette and she says it’s exactly how she feels! In July I was told about tretinoin gel 0.5% and she has used this on her skin if she has felt she has needed to. Could the combination of the two exacerbated her emotional symptoms? I have stopped her using the gel. Her skin is generally good but still quite oily but her periods are regular with the pill and manageable for her.
    I think she needs a break from dianette but she is terrified about her skin. I have asked her derm for a referral to endocrinology and this is in hand. I have read about Yasmin and cilest as alternatives to dianette but also spiro !? For testosterone levels?!
    Any advice and guidance would be very much appreciated
    Kate x

    • Hi Kate,

      I’m sorry, I can’t give individual medical advice here and the first thing I would say is that if you have such strong concerns you should be having an open and honest discussion with your GP – go back, write down all your concerns and questions beforehand and perhaps book a double appointment so you have plenty of time.

      However, just a few general points here:
      Dianette can affect mood, the bottom line is that you won’t know if it is the Dianette or as you rightly point out, just her age unless you have a trial off it.
      Tretinoin gel doesn’t have any ‘systemic’ effects – i.e. it doesn’t go into the blood and cause changes throughout the body, including mood changes, it only affects the skin. Combination treatment could be very effective for her BUT using ANY skin treatment as and when ‘she feels she needs to’ is not going to give results. It takes 6-10 weeks as a general rule to see any real difference of consistent daily use with any acne treatment.
      If she has exhausted all options available in general practice (and given them all a 2-3m trial before discounting them,) the next option would be to get a dermatology referral and consider Roaccutane, but I would suggest discussing this and the other points above with your GP.

      Good luck!

  32. Hi,

    First if like to say what an informative and honest article this was, thanks!

    Second, my situation:

    I had roaccutane for cystic acne when I was 26 (after having acne since I was 13, using creams/OCP/oral antibiotics on and off for years). When I was 26 the skin on my cheeks started scarring and I got really bad spots on my shoulders for the first time. I had 9 months of treatment and had clear skin for nearly 5 years. For the last 2 years I’ve used Duac or panoxyl on/off and I remain on loestrin.
    My question really is, as a 33 year old woman with what feel like hormonal flare ups/spots, greasy skin and spots that reacts to lifestyle and routine changes, what are my options!?
    I find the Duac makes my skin hypersensitive, itchy and red. The panoxyl does the same just takes longer to feel it.
    When I started the roaccutane I was at my lowest ebb, taking days off work because I couldn’t look at my face in the mirror, or my uniform hurt my shoulder-spots. Roaccutane literally gave me my life back. I don’t want to be back in that place again, but as I can go days with “good skin” before getting a flare I don’t really know what the next thing to try is!?

    Thanks
    Katie xx

    • Hi Katie,
      Thank you, firstly! Secondly, I would start at the beginning again. Just because you needed Roaccutane previously doesn’t mean you need to jump straight to the top of the ladder now, so to speak. The Duac and Panoxyl contain benzoyl peroxide which is probably what is irritating your skin. Go back to your GP and discuss your other options. Perhaps Adapalene, or antibiotics. Good luck!

  33. Hi Rebecca,

    I am thinking of undergoing Micro Needling to get rid of my acne scarring.

    I still have acne and use Dalacin T twice a day to control it (I have had acne for approx 10 years) one or two spots a week if i keep using it. the moment i stop it goes crazy.

    Would there be any problem undergoing micro needling if I already have acne? I also need to use some vit c and vit A lotions before and after the needling would the Dalacin T react badly to this?

    • Hi There,
      I’m sorry I can’t give individual advice here and I don’t know enough about micro needling to comment but I’d always suggest returning to your GP to see if there are better treatments for you on the NHS before paying for private or cosmetic procedures.

  34. It feels good to know that there are many people out there experiencing problems with their skin.

    I no longer live in the UK and so can’t visit a GP about my skin. My best option would be to pay for a private dermatologist but not sure how expensive that would be and how helpful they would be with a hormone related skin problem.

    I have been taking Marvelon for many years and it really worked to clear the skin on my face, chest and back. I am now 32 and really want to try for a baby, however I am faced with the dilemma of my acne returning. I tried to come off Marvelon last year thinking I could get my body ready for pregnancy and my skin went crazy! The oiliness returned and I seemed to get more spots than I have ever experienced and on different places including my neck. Because of this, I have gone back on the pill. My skin has cleared …apart from the sides of my chin which seem permanently congested.

    I know lots of you have your own issues, but I wondered if there was anyone else who has experienced the same problems when coming off Marvelon and has anyone advice for how best I could prepare to treat my skin from the go when I do take the plunge to come off this pill. Because I have started a new job in a new country, I feel especially conscious of how my skin looks … I guess it really affects your confidence and how you feel people judge you.

    It would also be great to hear from anyone with pre-pregnancy/pregnancy skin tips that won’t harm the baby.

    Many thanks in advance xxx

  35. Hi Rebecca

    Much like the people who have posted here, i have had a second round of acne at 27 which is now beginning to leave scars – which annoys me far more than the spots. I have been allowed to have Yasmin (I previously wasn’t due to migraines but have spent several years with no migraines) and after 5 months it has been a big disappointment.

    Two readers have mentioned spironolactune – what are your opinions on this and as a GP do you see it prescribed often in the UK? It is often mentioned in blogs in the US.

    Many thanks

    Rebecca

  36. Hello! I’ve never had acne before and suddenly at the age of 27 I started having red spots all over my face. I’ve been dealing with this problem for 8 months now. My GP prescribed Dalacin T (which made my skin oiler), Erythromycin (made my stomach upset and wasnt really helping the pimples) and Diffirin (didnt do anything). I was finally refered to a Derma and now an using 5% Benzyol Peroxide and Isotrex gel. I am not week 8 and have seen some improvement. My skin is a little less oily but still have occasionaly acne that wont go away and spots. I am most concered about redness. Even after 8 weeks my skin is always red and has been peeling. But before peeling my skin turns brown and scaly. I have spots all over my face and the color of my face is so different to my body. Is the treament not working? Is it common to have redness and patchy skin even after 8 weeks of treatment? I have an appointment with my derma in about a month. Should I stop the treatment?

  37. I know I am years behind on this post but I came across it whilst I was looking for information on Marvelon, my dermatologist has just put me on it for my post inflammatory hyper pigmentation but the areas where I had the dark marks are now red since I’ve been using the cream. She said it was normal and part of the process and that I shouldn’t worry as the rest of my skin isn’t reacting to it its just the areas of hyper pigmentation? Is this normal?

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