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 regimen 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.


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 Retin-A Micro or Atralin, 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.

This Post Has One Comment

  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!

Leave a Reply

Your email address will not be published.