Most OTC remedies have benzoil peroxide, salicylic acid, alcohol, and/or witch hazel.
If you’ve tried all four OTC treatments and have not has satisfactory results, you should see a dermatologist.
Mine gave me low dose erythromycin- 250 mg once a day- which cleared up my adult onset cystic type acne for many years. It was cheap and easy.
I had Accutane twice as a teen, and again a couple years ago (at 32 or so). Personally, my worst symptom was chapped lips, but different people clearly have different reactions to it. Third time around worked really well.
There’s another poster somewhere on the Dope that tried a method of face cleansing involving a gentle steam with olive oil + castor oil. I’ve been curious about that ever since I read it, since I have super oily skin.
I’ve found that avoiding the oily/dry cycle seems to work well for my skin, myself.
Your skin’s mileage will vary.
I get the occassional breakouts as well - especially the ones that dont come to a head and hurt like hell. I think that mine isnt really acne - or at least not the version we all first think of.
I get the quick-zap ointment for spot treatment when I feel one comin on. I def need to go to the derm dr.
Also, imho, people tend to break out if their skin is dried out. Moisturize. I think Avon has a men’s line.
Back when I was dealing w/ acne as a teenager, this site was really helpful. The routine touted on there helped keep me down to 2-3 pimples/week instead of the 12-15 I’d get just using salicilic acid or BP.
There’s also a good forum where people discuss their individual problems.
My acne finally died down around 5 years ago, so I haven’t checked it out in a long time, but it helped me out.
I was scared to try accutane because I had a friend who went on it, and it basically made him bi-polar. (looking back I think it just exasperated the underlying problem really.) Good luck! Acne sucks yak cock. 
Wow, I’m bowled over by the response, thanks folks.
There’s quite a range of responses, but somewhat of a consensus on consulting a dermatologist. I’ve started the wheels in motion on that.
Some surprisingly counter-intuitive advice too: don’t wash, don’t use harsh products, and moisturize (this made me go ?? sounded like using gasoline to put out a fire) However, I respect doper’s judgement, and it seems to fit in with those folks who talk about avoiding the dry-oily cycle.
I tried accutane as a kid, lo, these 25 years ago or so. At the time, it made my face all tight and shiny at the same time, like a polished drum. The warnings concerning birth defects with it are so extreme (don’t even keep it in the same house as a breeding-age woman) that it can give you pause, but fortunately for us, that is no longer an issue. I had hoped that in 25 years, we had progressed a bit on this front.
It’s interesting that there have been so few mentions of an higher-end cosmetics industry products. Seems to suggest that they’re not that different than J & J.
The antibiotic approach is interesting, as it seems acne is being more recognized as a bacterial infection in nature. I’m hoping there’s something topical I can use that won’t require oral systemic antibiotics, which doesn’t sound like a viable long term strategy. I will have to check out the Z-packs.
Finally, it may be corny and cliché by now, but it’s still a relief to hear from other folks in the same boat. Thanks for taking the time, dopers.
Overall advice: see a dermatologist and go to Origins and ask for samples.
My experience:
I’ve just finished 4 months on Accutane (technically Amnesteem, the generic) and my face has never looked better. I went off it because I took a vacation to the desert, and it wreaked havoc with dry skin. I was going to stop for personal reasons in about a month anyways, so I just stopped it. Prior to that, the humidity helped keep moisture.
For cleansing I use Dr. Weil Plantitude from Origins. It says it uses mushroom extract and all of this other mumbo jumbo, but I don’t care about that, I just got a sample from the store and I loved it. I also use Origins Make a Difference moisturizer and I love that too (again, started with a sample). Finally, when going through my intense dry skin, I started using Burt’s Bees Intense Night Moisturizer, which helped a ton.
Hope this helps and good luck!
Regarding Accutane- it’s a five month course. It can cause severely dry skin and chapped lips, and also can raise your triglycerides and liver functions. You have to see the doctor and get your labs drawn every month. It can also cause pseudotumor cerebri but that doesn’t happen very often. For the last few years Accutane has been very tightly controlled by the iPledge Program- we have to go into their computerized system every month and confirm that you were seen and that you understand the rules. Women have to be on two forms of birth control and get pregnancy tests before getting each prescription. I’d never heard that it used to be that you couldn’t have it in the same house as a woman of childbearing potential- that’s funny. The derms I work for have told me that not only have no studies ever shown Accutane to cause depression or psychosis, but studies have proven there to be no link. I’ve personally worked with about 300 Accutane patients, and I’ve never personally known any of them to have a problem with depression while on it that didn’t have a problem with depression before being on it.
None of my doctors have ever prescribed Zithromax for acne, but it is sometimes prescribed for other bacterial infections where the report shows it to be effective. And not all acne is really acne- sometimes it’s a different bacteria like staph, so it’s a good idea to see a derm just to make sure of what you’re really dealing with. I’m glad to see you’re making an appointment.
Proactive I’m not sure about. Every patient that comes in and says they’ve tried Proactive says that it didn’t help at all, but of course if it did they wouldn’t come in. Scrubbing and using harsh soap doesn’t help, it just prompts the oil glands to produce more oil because it’s being abused, but you should use mild soap.
Some of the things that people come up with for the treatment of acne are amusing, but if it works for them then it works so it’s good.
I would second this from personal experience, accutane was the brand new weapon in the doctors arsenal and while it cleared up my face as advertised, everytime I went near a mirror I would still see the pre accutane face, so I would have to say yeah , I would have been majorly depressed before the perscription.
Declan
Definitely look into these topical Rx meds I mentioned above:
Retin A worked well for me. Basically it encourages your skin to slough off dead skin cells better and faster. That way they don’t clog your pores and cause them to become infected. No amount of scrubbing with a washcloth or a scrub is going to facilitate this - that will only grind the skin cells and bacteria into the pores, which is not what you want (and it could also cause the production of more oil). The Retin A facilitates natural and healthy sloughing of dead skin, leaving clear skin behind.
You will go through a few weeks of peeling and flaking (during which time you should use a sensitive-skin moisturizer), but stick with it and your skin will adjust and become very smooth and clear. It’s very important to use a mild, fragrance-free, hydrating cleanser, and just wash with your hands and water - no scrubbing with a washcloth.
Give it 3 months and I am confident you will get good results without having to resort to the heavy artillery (Accutane).
Here’s a couple of quick quotes about Retin A with a little more info on how it works:
From http://dermatology.about.com/cs/topicals/a/tretinoin.htm
Tretinoin (Retin-A, Avita, Renova) is a derivative of Vitamin A and is the treatment of choice for comedonal acne, or whiteheads and blackheads. It works by increasing skin cell turnover promoting the extrusion of the plugged material in the follicle. It also prevents the formation of new comedones.
Side Effects of Retin-A: The effect of increased skin cell turnover can be irritation and flaking. For this reason, many people stop using Retin-A after a couple of days to weeks, then think that it didn’t work. It is important to realize that Retin-A is very effective for whiteheads and blackheads, but it may take 6-9 weeks to see a noticeable difference.
From Retin-A: Uses, Side Effects, Dosages, Precautions
All tretinoin products work by speeding up cell turnover rates, rapidly exfoliating the skin and decreasing the buildup of dead cells within the follicle. This, in turn, reduces the formation of comedones. Retin-A also makes existing blackheads less “sticky,” helping the blockages make their way to the surface to be expelled.
Like most acne medications, Retin-A takes time to work. You will likely not see any change in the skin for several weeks, and it may take several months for noticeable improvement to occur.
Actually, you DO need to moisturize. I didn’t get this until fairly recently, but even super oily skinned people need to moisturize. If you use a drying-out product on your skin, your skin will compensate for the dryness by producing more oil and you’ll break out more. If you keep it nice and moisturized, your skin will not produce more oil and you can start to heal.
Also, you need to see a dermatologist. I suffered terrible acne when I was in junior high and the only thing that ever worked was seeing a dermatologist. It was gone by 9th grade. I don’t take medication anymore and for the most part everything’s under control but every once in a while I have flare-ups, and I don’t think anything’s going to change that except another visit to the dermatologist.
My previous dermatologist gave me half a dozen refills and let me use my good sense to take the medication when I needed it, not indiscriminately. Some doctors won’t trust you; some patients don’t have good sense. I found that using one would give my problem the “jump-start” to let other remedies (benzoyl peroxide, et al.) actually get some work done. Without the meds, the topicals were useless.
FWIW, I was one who recommended not washing your face since it worked well for me. I’ll add a caveat here, I’m male and, except for a couple plays, don’t wear make-up. You didn’t mention it in your OP.
My limited experience with make-up on stage makes me cringe in disbelief that women can stand having stuff on their faces. I could feel it - weird stuff.
I’d think some sort of cleanser would be necessary for proper make-up removal.
If you’ve had this problem since you were a teen then it’s time for a trip to the derm. Good luck getting this resolved.
Thanks for that. I get one of those big uglies every 28 days (I just love being a girl), always on a side of my chin! I know you shouldn’t squeeze them, but they only have fluid in them… you’d think they would be full of gunk. They stretch my skin so much that the outside layer will peel off and then the spot seems to heal . It seems to take about 2 weeks for it to heal, just in time for one to form usually on the other side or the middle of my chin. Also, if the fluid that comes out doesn’t get wiped off my face in a timely manner, it seems to form ANOTHER big ugly in that spot… weird.
A side note about Salicylic Acid. That’s ASPIRIN. If you’re allergic or sensitive to aspirin, it will have the opposite effect on your skin. I learned the hard way… from experience. Noxema and Witch Hazel worked for me, but I didn’t have really bad acne as a teenager and now only have the aforementioned big ugly.
I third/fourth/fifth (???) seeing a derm, and I see from your latest post you are.
Personally before you try Accutane I would at least ask the derm about BenzaClin - it’s a Rx strength combination benzolperoxide and clindamycin.
All of my girlfriends as well as I have our little tub for when a break out happens - it’s kind of amazing - it will fry the shit out of a pimple that pops up somehow without drying out the surrounding skin. Periodically you could put it all over your face and it will really diminish the oil production and then just use it if a pimple pops up.
It’s worth at least talking to your derm about - it’s MUCH less invasive and nasty than Accutane (and pretty well never causes anal bleeding, probably even if you put it on your anus although I haven’t actually tried that) and is kind of amazingly effective for everyone I know who has tried it (and that’s a whole variety of people of various ages and skin types.)
Whatever you do, no matter how frustrated you get, don’t do what my dad did. Let’s just say it rhymes with borox. He recovered OK but damn that was stupid.
I want to back up the moisturizer thing. I had a hell of an oily face as a teenager (and I worked as a cook, w/ all the fun of fryer/grill grease coming on top of my already oily face), but if I just used BP or salicylic acid, my face would break out no matter what I did.
Applying moisturizer (MAKE SURE IT’S NON-COMEDOGENIC[that means doesn’t clog pores]) really helped out w/ the drying out that Salicylic Acid and BP did. The drying from the SA/BP totally offset the benefits I originally got from using either anti-acne product on their own. Once I figured that out my pimple outbreak dropped about 80%. I’m sure your dermatologist will tell you the same thing.
FWIW,
I did a cycle of accutane back during my teen years. It worked extremely well - my skin looked great.
But I just didn’t feel right. Difficult to explain. Just a general overall feeling of unwellness. Nothing terrible, just a constant…not right feeling. I was happy to quit it after a few months.
from wikipedia:
[quote=Depression
Several studies have suggested a possible link between isotretinoin and clinical depression.[16]
[17] However, no conclusive evidence has been produced. Despite this, the argument that isotretinoin caused depression and suicide has won a few lawsuits, and is partially responsible for the strict control of the drug, especially in the United States. Various case reports of depression, suicidal ideation, suicide attempt, and suicide in patients treated with isotretinoin have been reported to the U.S. FDA Adverse Events Reporting System, with 431 cases reported between 1982 and May 2001 – of these 37 patients had committed suicide.[18] While analyses have suggested an association between isotretinoin therapy and depression, no causal relationship has been established and further studies are required.[19][20]
Studies have shown that patients with acne, the population group eligible to receive isotretinoin therapy, have an increased risk of clinical depression compared with the general population.[21][22] Chee Hong describes Isotretinoin-related depression as “an idiosyncratic side-effect”, claiming, often anxiety can bring on acne and depression, creating more anxiety.[23] Correspondingly, treatment of severe acne with isotretinoin has been shown to reduce anxiety and depression, for tests have shown acne to be a main depressant in most tested patients’ lives.[24][25]
One study utilising positron emission tomography (PET) showed functional brain imaging changes in patients treated with isotretinoin, however the clinical relevance of this finding is unclear.[26]
U.S. Representative Bart Stupak (D-MI) is known for his distrust of Accutane. He believes unadvertised psychological side effects from the drug drove his teenage son, Bartholomew Thomas “B.J” Stupak Jr., to commit suicide in 2000.
Psychological effects
In addition to possible anxiety, several studies have shown that male patients taking isotretinoin show increased sensitivity to testosterone, and related psychological effects such as unusual irritability, over-inflated self-confidence and increased sexual desire. It should be noted that none of these symptoms have been known to last more than one month after the end of the treatment. Am J Psychiatry 2007;122(5):996-67. PMID 16363402
[/quote]
Wikipedia certainly isn’t a proper medical journal so I don’t give it full credibility. But I will say I never felt “right” when I was on accutane. I remember contemplating this “not right” feeling well before I was even aware of any suggested links with Accutane to psychological problems. I know lots of people use it with few or no side effects, and it does work very well at treating acne.
…adult now, I still get mild acne, but it doesn’t bother me much.