Is there any hope for treatment of adult acne?

[DVictoria]

I am 37, I eat healthy, exercise 3x week and am in very good health.  I have had acne all of my life.  At 26 I did two rounds of Accutane, which cleared my T-zone and chest/back acne.  Now I have persistant and large acne on my cheeks and jawline, including cystic acne.  The acne is ever present and not just once a month.  My current dermo (not the one who proscribed Accutane) tells me that it's hormonal (I believe this) and that I will just have to deal with it for the rest of my life (I don't want to accept this).  She does Cortosone injections on occasion for the cysts because I cannot, for the life of me, leave my face alone.  Because I am ruining my skin, I asked my Gyno if I could be put on a low-dose birth control pill in addition to my IUD (Mirena) and she said no.  She also said that my acne could be worse because of the IUD.  (For the past 2 mos. I was also on Methyltesto 2.5 mg, but I am stopping immediately because I think this is a culprit). It is hard to tell whether my acne is worse with the IUD (in about a 1 yr. now) bc for the 5 years prior, my hormones have been in flux due to infertility treatments (approx. 1 yr., 2x), having 2 babies and breastfeeding each for 1 yr.  I am now done with all of that.  I am spending a lot of money on acne products but the problem persists.  Could you please tell me a) do you have any thoughts on whether I should take out my IUD?  I'd rather not bc I am terrified of having more kids but I will if it will solve the issue, 2) can a dermo do anything for me?  I'll seek out a new dermo if it would not be a waste of time and money; 3) do you know whether there any vitamins that I could take to help the problem?  (take Cerapholin now, which is a B12, B6 and Folic Acid combo) and 4) are there any otc products that you recommend for treatment of this particular type of acne?  I am currently using Dermologica products for cleansing and clearing, to no avail.  Thank you for your time and consideration of this issue.  -D.    

[terryb1]

Hi I left you a message i just want to make sure you got it.
Ask your Derm for Aldatone. It has worked for me. Nothing else would.
Twice on Accutane and still had Cystic acne, Also i use Duac gel at night.
Once a month or so i get a acne facial that is where they drain your pours so there is no bacteria in them, thats where acne comes from your blocked pours. and then they get inflamed. Let me know if you got the email. Really it has been a god send for me.
I will go into more detail when you recieve this. if you want oh i am taking 100mg a day in the morning. Aldactone

[loiloi]

It is likely that your IUD is contributing to your acne as it contains progesterone. A combined oral contraceptive pill containing oestrogen will help your acne and is over 99% effective at preventing pregnancy.
A third course of Accutane remains your best hope of a long term remission from acne.
80% of patients remain clear after one course but in 20% of cases a second or third course is indicated.
Do not pick at your spots. This will spread bacteria under the skin leading to more spots and will delay healing time. It could also cause a secondary infection and permanent scarring.
Eloise.

[Alan Rockoff, MD]

The key phrase in your story is, "I cannot, for the life of me, leave my face alone."  Unless you can find a way to leave your face alone, no treatment will help.  Period.  Therefore, I do not recommend that you take out your IUD or treat your hormones.  I do suggest that you consult a psychiatrist skilled in the treatment of obsessive-compulsive behavior, of which picking the skin is one example.  There are medications that can help you.  By the way, acne at 37 does not mean it will last forever--I have sen may patients whose acne finally peters out in the 40's.  But no need to wait till then.  And in your case, unless you leave your skin alone you won't clear.  But if you do leave your skin alone, you'll be a lot better off, and you'll save money on doctor's visits and skin care products too.  Think seriously about this.

Best.

Dr. Rockoff