Acne Scars

I have some acne scars and I am concerned that I could have done something to prevent them, which makes me feel very depressed and even suicidal.

Yes my skin was very bad, I had cystic acne. Is it true that most people with cystic acne are left with some marks, I don't think mine are bad and I think they have been fading over a long period of time.

My concern is that after my first course of accutane ( i had 2) my acne returned, perhaps not as severe but enough to have another course since I had great success with the first course. I am concerned that I took too long to get back on some form of antibiotics which may have resulted in the post inflammatory hyperpigmentation / scarring. I was so gutted that the acne came back because I was so disciplined with the first course of accutane despite enduring some very difficult side effects. I think from memory I may have used benzoyl peroxide at the time and also toothpaste (crazy i know but it has antibacterial properties and dries up pimples very quickly with very little if any side effects).

Please help to ease my confusion. Now my face is clear, except i get the odd pimple on my back. My doc said it is not unusual for the acne to change to another part of the body like this. I am on antibiotics for this, both oral and topical (can be quite messy and difficult for the back) (not accutane).

Please help me. I wish I was not so paranoid about my skin, it's a horrible way to live your life. I am happy to send a photo if required but I would like some expert medical advice.

Thanks,

Damian

[loiloi]

Hi. Instead of a topical antibiotic ask your doctor for a topical retinoid called Retin-a. As well as clearing active acne it will fade scars and hyperpigmentation. It can cause a bit of irritation so use a gentle cleanser like Cetaphil, Eucerin or La Roche-Posay during use.
It is not your fault the acne came back after Accutane, this happens in 20% of cases. You cannot start another course of Accutane for 8 weeks, and cannot use oral antibiotics for 5 weeks after finishing Accutane. So a delay in re-starting treatment is necessary.
I am quite concerned about your depression, does your doctor know you have suicidal ideation? A course of anti-depressants will help. I have taken these if you want to talk about it (you can send me a private message if you want).
Did you feel more depressed after the Accutane? Although no causal link has been established, 1% of Accutane patients report depression or suicidal ideation after taking this drug.
Eloise.

[damo14]

Thanks for your reply.

My skin is pretty good people keep telling me this i just have to learn to believe it for myself. Unfortunately I am a bit of a perfectionist and being depressed doesn't help at all. I have always been very self conscoius and struggled to feel confident.

I am on anti - depressants and they do help. A doctor gave me a gel for acne called eryacne (erythromicin) which is alcohol based like retin a gel and is beneficial anhd he said this helps with acne and scar tissue.
I have found it to be very drying, ususally i use it 2 times per day but sometimes have a break and just use 1 time per day.

I don't believe that the accutane was the reason for my depression, accutane helped me a lot when many other treatments didn't so i certainly dont regret taking it. I think there have been some other issues in my life. As I said previously I was a bit down when the acne returned after the first course (albeit not as badly) even though i am aware that this does happen as you say.

I am going to have some counselling soon with a psychologist.

What is the difference between isotretinoin (accutane) and tretinoin (retin a)?

damo

[loiloi]

Hi.
Retin-a (tretinoin) is a topical gel chemically related to oral Isotretinoin. It will help with active acne and scarring, if the topical Erythromycin doesn't help.
You could also consider laser treatment or a chemical peel to reduce the appearance of scarring, if topical gels don't produce the results you are hoping for.
I really understand how you feel and hope the anti-depressants help. They really worked for me and I can now see what everyone else was telling me; that my skin is good and much better than most peoples. I took Venlafaxine for a year and a half and have been off it for 7 months, without the depression coming back. Like you, I had other things going on in my life, but acne was also a contributing factor.
Eloise.

[damo14]

Hi again,

Thanks again. Acne on the back is so stubborn but I am getting on top of it now. I have read that is it deeper in the skin since the skin on the back is thicker than the skin on the face which is why it is harder to clear up.

Some doctors actually avoid using antibiotics as the primary course of treatment since there is a growing resistance by acne to antibiotics. When I first went to my family doctor for my back acne he told me just to keep washing it and not to take anything and soap really does help but can be very drying and cause itcing and irritation which can be very uncomfortable, so i mositurise my back with a gentle moisuriser.

Everyone tells me how good my skin looks same as yourself, I think when it is so bad for so long (on and off) its hard to believe that my skin is good now, although somewhere inside ofme I do actually believe this but my negative mind wants me to think otherwise.

What I thought was scarring is likely to be what is known as post inflammatory hyperpigmentation, which is common after a wound and is part of the healing process. Exfoliating once or twice per week has really helped to shed this! Just have to be careful not to overdo it and to use a gentle exfoliant.

To be honest when I had really bad acne you never really think about the possibility of scarring or pigmentation, you just think about getting rid of the cysts.

I went to see a cosmetic surgeon to get another opinion and she turned me away and said I did not need it and that I should just keep exfoliating and can used creams which help as well. A doctor told me they will fade away into my skin in time (i am lucky i have olive skin so that time is a bit less than someone with fairer skin) which is what is happening. The cosmetic surgeon also said to avoid excessive sun exposure since that can make scars look worse but I am not really a sun person anyway, i think i probably developed a fear of the sun when i was on accutane!

My depression is ok now, had been a long ongoing problem which used to be much worse than it is now, the fact that my skin is good now does help but i think that it is a medical condition in itself.

All the best to you!