When I first started writing this post at the beginning of the summer, I was in the throes of the initial breakout caused by starting topical retinoids.

I couldn’t go anywhere without makeup!

Hyper-keratinized plugs and god-knows-what-else built up in my pores, and now the retinoid was forcing it out.

My face erupted in multiple places with huge, swollen bumps.

As each lesion resolved, 2 or 3 new ones would begin forming on skin still red and tender from the previous weeks breakout.

The only thing keeping me sane was this:

I have a pretty good understanding of how retinoids work, and I knew there would be a light at the end of the tunnel.

Still though, I absolutely regret getting lazy with my skincare routine and letting my acne get the best of me yet again.

Indeed, I have only myself to blame.

Let me give you a little background info on my history of skin problems before we get into my current experience with the beautiful nightmare that is treating acne with retinoids.

My Skin: A Brief History

My first bout with inflammatory cystic acne happened about 5 years ago, which I only assume was triggered by some combination of stress, lactose intolerance, and the hormone swings that come with quitting the birth control pill.

Rather than see a dermatologist right away, uninsured as I was, I tried Proactiv and discovered I had a most delightful sensitivity to the main ingredient, benzoyl peroxide.

Such good times.

During the 8-week trial period I used Proactive, my skin became so dry that it actually hurt to smile.

My dehydrated face looked old, like I had aged 10 years over the course of weeks.

I wasn’t sure at the time if it would ever go back to normal.

Skin sapped of all it’s moisture simply cannot function effectively, and my acne only got worse under these conditions.

My skin did go back to ‘normal’ after I stopped using Proactiv, but the adult acne was still a problem.

It was time to seek the help of a dermatologist.

I visited Dr. Zellman, a dermatologist who practiced in my hometown, and he took one look at me before prescribing a two-tiered treatment plan:

Aczone in the AM/PM and Atralin 0.05% in the PM.

As my doctor and as countless others in the forums on acne.org warned me, starting a retinoid (like Atralin) would cause my skin to get worse before it got better.

I trusted my doctor and followed his instructions as precisely as possible, but I also started researching the drugs I was using borderline obsessively.

3-weeks-into-acne-treatment-in-2011

August 2011: 3 Weeks into treatment with Atralin 0.05% and Aczone

Understanding what was happening to me was one of the only things that would soothe my anxiety.

That’s how I have accumulated so much knowledge about my specific kind of adult inflammatory acne, which I am now glad to share with you all.

You’ll find that I speak very highly of retinoids and the reason is that, despite the nightmarish 3 months it took my skin to get clear the first time around, they do work quite well over time.

I was even able to dial back my usage of Aczone and Atralin and still maintain the benefits with intermittent refills on my prescriptions.

In the forums, typically people would be active and supportive of one another during their treatment process, but they would vanish after getting clear (myself included.)

I’m looking at this second bout with acne as an opportunity to share a complete and detailed account the way I wished someone had done when I was going through it.

What Causes Acne & Why Does Retin-A Micro Work?

At the microscopic level, severe and stubborn acne is thought to be a matter of skin cell dysfunction.

Sebum created by the sebaceous glands is more viscous than normal and the pores become blocked more easily.

Clogged pores lead to a buildup of dead skin cells and bacteria, and coupled with chronic inflammation it becomes a vicious cycle.

Over time, retinoids like Atralin and Retin-A Micro normalize the sebum texture and this in turn facilitates healthy skin cell turnover.

That’s why they take so long to work, and it’s also why ongoing maintenance is needed.

Topical retinoids don’t fix the underlying problem that leads to abnormal keratinization (which could be caused by any number of different things for each unique individual.)

However, they do address the symptoms by purging existing plugs and normalizing the keratinization process to prevent pores from becoming clogged in the first place.

The other medicine I use is Aczone, which is a topical antibiotic that keeps the pores from becoming infected (a constant problem when they’re being purged by a retinoid.)

Aczone is the only topical antibiotic acne medication my sensitive skin can tolerate using on a regular basis.

Without Retinoids, My Acne Came Back

Several years later and desensitized to the whole ordeal, I ran out of my prescription medications and, with gorgeous glowing skin, did not make it a priority to get my prescriptions refilled.

In fact, I thought I may have been cured and that my adult acne woes were behind me.

Big mistake. Huge.

It only took a few months after I stopped treating and I started to notice those little white bumps returning to my cheeks.

This was exactly how it started before, but they weren’t inflamed or even really noticeable, unless I stretched my skin out.

It’s not like I wasn’t washing my face and exfoliating like a normal person, but the prescription-strength retinoid seems to be the only thing that keeps these plugs from forming.

I figured I’d restart my regimen pretty soon and it’d be no big deal.

And maybe it would have happened that way if I didn’t keep putting off the visit to the doctor.

If I’d know about online dermatologists then, maybe I wouldn’t have let my treatment lapse.

But before I knew it, a couple months turned into a year without using my prescriptions.

Those little plugs started getting inflamed and some even became cystic, one or two at a time.

To be fair, I really wanted to find a natural treatment, so that’s part of the reason I put it off so long.

Essential oils, as much as I wanted them to work, were rendered completely useless on closed comedones. (I guess they can’t penetrate that pesky plug.)

I’d like to work essential oils into my maintenance regimen again after I’m clear, but it’s safe to say that moderate-to-severe acne requires medical attention.

UPDATE: I did discover jojoba oil to be an awesome additive to my daily moisturizer. This can mean everything when battling the dry skin that comes with adjusting to a retinoid. More on jojoba oil, essential oils, and aromatheraphy in a new post coming soon.

But I digress.

My old dermatologist used to hook me up with a bunch of free samples and a reduced consultation fee.

When I finally went to make an appointment with him, I learned that he’d retired since I last saw him.

After suffering a brief panic attack, I decided to try YoDerm, a digital platform that matched me with an online dermatologist specifically for obtaining acne prescriptions.

This was a total game-changer for me and I highly recommend giving them a try, especially if you don’t have health insurance coverage.

A consultation with an online dermatologist is only $59, but here, have a discount. : )

Learn more about my personal experience using YoDerm.

Up Next: The Purge

DISCLOSURE: I sometimes get free stuff so I can provide an honest review for you all. This post features free product from JeNu, derma|e, & YoDerm and may make use of affiliate links. All opinions are my own. Learn more about sponsored posts.

I mean, this is what you came for, isn’t it?

To gawk at the grotesque pictures of my acne breakout which I have for some reason posted on the internet for all eyes to see?

Fair enough.

Retin-A Micro Review: The Purge

Acne is a medical condition with no real “cure,” and it is so heavily stigmatized that it can lead to crippling anxiety and depression.

Even though I knew that it wouldn’t last , my self-esteem and general mental health took a prolonged nose-dive during these breakouts.

I used to have terribly mean thoughts about people with severe acne, and I couldn’t help but assume that other people felt the same way about me during this process.

Still, I couldn’t help but feel as though I totally deserved it.

I’d enjoyed perfect skin as a teenager, and had plenty of time to pass judgement.

And for all the grief acne has given me as a young adult, I’ll say this:

It has been humbling.

Below is a week-by-week look at my skin on Retin-A Micro 0.08%:

yoderm-1-week-after-starting-retin-a-0-08-and-aczone-regimen

Week 1

It took about a week from when I submitted my initial consultation with YoDerm to get my prescriptions in the mail and start my treatment. This is how my skin looks after about a week using Aczone (AM/PM) and Retin-A 0.08% (PM.) As you can see, there is a little dryness and irritation already.

YoDerm 2 Weeks After Starting Aczone and Retin-A 0.08% Regimen

Week 2

I apologize for the poor lighting here. I’ve been using the retinoid every night and it’s making my skin angry. The pink blotches are cysts: sore, tender to the touch, and not coming to a head.

YoDerm 3 Weeks Treating with Retin-A 0.08% and Aczone Regimen

Week 3 

After doing some reading, I decide to dial back my usage of the Retin-A 0.08% to every other night. I had hoped this would help my skin get more accustomed to the treatment without such painful cysts.

YoDerm 4 Weeks After Starting Retin-A 0.08% and Aczone Regimen

Week 4

At this point I am noticing that the breakout pattern I’m experiencing is very similar to the breakout I had a few years ago: more severe on my left side than on my right side. My forehead will be the first part of my face to clear up assuming I continue to have the same experience.

YoDerm 5 Weeks After Starting Retin-A 0.08% and Aczone Regimen

Week 5

Not the best quality here either, but you get the picture. The lesions you can spot here are swollen and painful even though I put ice on them multiple times per day. Ice is one of the best treatments I’ve found for diminishing the size, redness, and pain associated with cystic acne.

YoDerm 6 Weeks into Retin-A 0.08% and Aczone Regimen plus Doxycyline Week 1

Week 6

This is my skin during my first week in LA. It’s pretty safe to assume that the stress of moving across the country (from Miami to Los Angeles) had some effect on the severity of my breakout here. It’s at this point that my boyfriend’s mother is so horrified that she insists on taking me to another dermatologist, despite my protests.

In person, I got the same general treatment plan as my Yoderm doctor gave me, although I requested a lower concentration retinoid, a generic brand at 0.05% with the addition of an oral antibiotic (doxycycline) to get me through the month. As much as I resist antibiotics, they’re a good idea when you’re having a severe acne breakout. I also decided around this time to dial back my Retin-A Micro 0.08% usage to only once per week.

YoDerm 7 Weeks into Retin-A 0.08% and Aczone Regimen plus Doxycyline Week 2

Week 7:

This is the best my skin has looked and felt in a while. I owe this to the antibiotic not wasting any time kicking P. acnes bacteria ass. The red, inflamed lesion on my right cheek is another cyst that shouldn’t have been picked at, but my left cheek is looking better than the week before.

YoDerm 8 Weeks into Retin-A 0.08% and Aczone Regimen plus Doxycyline Week 3

Week 8:

If you recall, in week 6 I reduced my Retin-A Micro usage to once per week. I didn’t put myself on a strict schedule really, but I tried to increase frequency very slowly. Frequency is important with retinoids because it is a type of cellular therapy. At this point I am probably using Retin-A Micro once every 4 or 5 days, depending on how my skin feels each day. I never apply Retin-A Micro when my skin feels dry, flaky or tight.

YoDerm 9 Weeks into Retin-A 0.08% and Aczone Regimen plus Doxycyline Week 4

Week 9:

I may be nearing the end of my 1 month round of doxycycline here. It seems like the pills stopped working as new cysts start to swell up in the same place where old scars are trying to heal. I finish the antibiotics anyway and hardly leave the house.

yoderm-10-weeks-after-starting-retin-a-0-08-and-aczone-regimen

Week 10

This is the day after my birthday, on which we stayed up all night drinking, singing karaoke, and visiting a 24-hour Korean spa. I managed to forget about my skin long enough to enjoy my birthday, but under the surface I am very depressed. At this point, my skin is always dry no matter how much water I drink or how much moisturizer I apply. Breakouts are happening in atypical places, like my chin and my temples. I’m starting to hate myself a little and I can’t even make eye contact with my own boyfriend, who has been incredibly understanding. Social obligations are the bane of my existence.

yoderm-11-5-weeks-after-starting-retin-a-0-08-and-aczone-regimen

Week 11.5:

Believe it or not, I worked up the courage to do a photoshoot around this time. I was running out of content for my blog and had a willing photographer that I hadn’t shot with in years, so I wore my makeup heavy and put on a happy face. Thank god for photo retouching, am I right?

yoderm-12-5-weeks-after-starting-retin-a-0-08-and-aczone-regimen

Week 12.5:

This is at the end of the 2-day derma|e malibu retreat, during which I wore an obscene amount of makeup and spent more time in the sun than I probably should have. Don’t get me wrong, I had an amazing time, but it was tough to put on a happy face at a blogger event (sponsored by a skincare brand no less.)

The 12 week mark is significant because this is how long doctors tell you the initial breakout should last before you see some improvement. It took me closer to 4 months in 2011 and, although I was optimistic this time around, it’s going to be several more weeks until I see real improvement.

The important thing with retinoids is to not give up too soon.

yoderm-13-5-weeks-after-starting-retin-a-0-08-and-aczone-regimen

Week 13.5:

Finally, I can see the breakouts are slowing down. I am probably using the Retin-A Micro every 2 or 3 nights now, depending on how my skin feels. With makeup, I’m able to feel almost normal. The derma|e Hydrating Night Creme is my saving grace.

yoderm-14-5-weeks-after-starting-retin-a-0-08-and-aczone-regimen

Week 14.5:

My skin was actually looking feeling and feeling better right before I took these photos. I got a little carried away inspecting my skin in the mirror and I ended up picking at a few blemishes, hence the puffy pink appearance.

yoderm-16-weeks-after-starting-retin-a-0-08-and-aczone-regimen

Week 16:

By week 16, I am in the clear, so to speak. Compared to the beginning of this journey, the texture of my skin is significantly softer and smoother to the touch. The breakouts have calmed down, and in turn the inflammation is much improved. The occasional zits I get in this phase are small and manageable. My greatest challenge now is keeping my skin moisturized as  the dry LA weather shifts to autumn. Around this time, I start using the JeNu Plus Ultrasonic Infuser to make sure my skin absorbs as much moisturizer as possible.

Learn more about Emerging Skincare Technology

yoderm-20-weeks-after-starting-retin-a-0-08-and-aczone-regimen

Week 20:

A month later, a full 20 weeks into treatment, and my hyper pigmentation scars are noticeably lighter. I’m feeling back to myself and can go out in public and face the world (with or without makeup) and not feel self-conscious about my skin the entire time. The journey is nearing it’s end, though I know the struggle for clear skin will never be completely over.

It was hard enough documenting of the progress of my skin for as long as I did.

When your acne finally improves, all you want to do is just live your life again.

Staying Clear with Retin-A Micro: Life After Acne

The challenges that ensued after the last photo of my progress became more about battling dry skin than about acne.

Indeed, the dry LA weather has taken a toll on my fragile skin.

This simply was not a problem when I got clear the first time in Florida, where the humidity in the air nourished my skin.

Particularly dry were the areas on the sides of my chin, the corners of my mouth, and my nasolabial folds.

At some point I started trying to use the Retin-A Micro 0.08% every night, but my skin just wouldn’t tolerate it.

I had dry patches on my chin that would get red and scaly no matter how much I moisturized them, they would just peel endlessly.

I’ve also seen great results by adjusting my skincare techniques with the changing seasons –

My holiday skincare routine video below offers a detailed explanation of why this works:

I ultimately decided to stop using the Retin-A Micro 0.08% and instead switched to the generic tretinoin 0.05% that I had received a few months prior.

With topical retinoids, you want to use the highest concentration your skin can tolerate as frequently as possible.

Even after months of slowly increasing my frequency with Retin-A Micro 0.08%, it was just too strong.

After switching to using tretinoin 0.05% every other night or so, and applying lots of vaseline to my dry patches, they finally stopped flaking.

I’ll probably keep the remaining Retin-A Micro 0.08% for a rainy day, but I’m definitely asking for tretinoin or Atralin 0.05% on future prescriptions.

All in all, my experience getting clear this year has been very similar to 2011.

Increasing the concentration of the retinoid did not seem to make the initial breakout faster or easier to deal with, in fact I would say it was even more severe this time around.

There are a lot of different factors to consider besides the concentration of the retinoid though, like the stress of moving, physical activity, and the dry climate.

Life with severe acne is not a life fully lived.

If you’re struggling with acne, don’t delay any longer.

Talk to a doctor, whether in-person or with an easy digital diagnosis with a YoDerm online dermatologist – it’s only $49 if you use my link.

Follow the instructions and warnings carefully; prescription skincare products are surprisingly powerful.

And remember to moisturize, moisturize, MOISTURIZE!

Hang in there & don’t give up.

If I can get through this (twice) then anyone can.

DISCLOSURE: I sometimes get free stuff so I can provide an honest review for you all. This post features free product from JeNu, derma|e, & YoDerm and may make use of affiliate links. All opinions are my own. Learn more about sponsored posts.

This Post Has 4 Comments

  1. I just want to thank you so much for sharing your story. I too was on Retin-A, it worked great, I was sure it cured my acne, I wanted to use natural products so….I got off of it and my skin went crazy! I have been back on it now for just over 3 weeks and I am seeing new, big and painful breakouts daily. It is so discouraging, Even though I know there is a purging phase with retinoids, it is still so hard to deal with. Finding you blog and reading your story really does make me feel so much better that there is an end in sight. Thank you again SO much for sharing this!

    1. Rachel,

      Omg I’m so glad this helped you!

      It sucks that you’re going through it again, but try not to stress because that only causes more inflammation in the body. 🙂

      I too stopped using my retinoid religiously and am re-starting it again, though I am using a weaker concentration this time (0.05%) and it seems less severe so far.

      I’m also planning to swap the gel for the cream during the winter to help with dryness.

      Although I still swear by the brands in this post for external care, ultimately I’ve come to accept that my acne is a problem that can only be permanently addressed from the inside out – with stress management and a clean diet.

      I’ve read so much about how a high glycemic diet can actually cause your ‘acne genes’ to switch on and it takes sustained, clean eating to switch them back off and restore the body’s natural healing.

      So I urge you to also look into the connection between blood sugar, chronic inflammation, cortisol, insulin resistance, vitamin deficiencies, and how it all contributes to acne so you can get clear and stay clear once and for all!

      Thanks for reading,

      – Caitlyn

      1. Thank you for the reply! I totally agree that stress, nutrition, blood sugar, etc all play a big role! I do eat extremely healthy (I am actually a nutritionsit! LOL!). I avoid processed foods as well as dairy and gluten. I drink at least a gallon of water a day and workouts 5 days a week. I feel like I am doing everything right! Lol! I have to say that stress and anxiety do play a big role for me. The worst part is, the more I breakout the more I stress and the more I stress the more I breakout. It is a vicious cycle! I am working on it.

        I am currently at the 7 week mark back on Retin-A and am just trying to trust the process and KNOW that it will work. While I would love to use natural products, I am at the point now that ultimately, if safe science is going to help my acne, I would much rather go that route than be breaking out! It is all about balance.

        Thank you again for sharing your journey! Wish me luck on cleaning up ASAP!

        1. Rachel,

          That must be so hard to be doing everything right and still not getting any relief.

          I wonder – how long have you been gluten and dairy free?

          Some people say it takes months for their system to stop flaring and their skin to improve.

          I have long had issues digesting dairy and since my health has been failing in other strange ways (vitamin deficiencies and swollen lymph nodes) I’m looking at gluten as well for the first time.

          My current theory is that the presence of dairy and gluten in my diet throughout my youth has contributed to chronic inflammation and a decreased ability to absorb nutrients which may be, directly or indirectly, responsible for a hormone imbalance (still haven’t done the bloodwork yet, but I’m gonna test my hormone levels soon.)

          I’m currently avoiding the most obvious sources of gluten and dairy now too, and I’m liking how I feel so far.

          Since I restarted tretinoin about 5 weeks ago, I’m still breaking out (as expected) BUT I will say it’s been much more tame on the days following a fast or eating clean.

          I’m also working with a holistic doctor that has me taking spironolactone for the first time (something I always wanted to try) and minocycline so that may also be part of why it’s not as bad as last time.

          How’s your skin coming along??

          And do you notice any improvement at all when you avoid gluten/dairy?

          Have you had your hormone levels tested?

          Sorry for all the questions, it’s just not very often that I get to talk about this with someone who understands!

          Hope you’re well,

          CR

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