Brief Answer:
Improved life style & expert advise would help.

Detailed Answer:
Hi XXXXXXX
Thanks for your query under HCM forum.
Acne is a most disturbing skin problem causing change in facial skin quality & affecting personality - which is vital these days of competition. I understand your concern.
* The causes for Acne are -genetic predisposition/ infection/hormonal/life style factors ( smoking, high glycemic diet, obesity, excessive vitamin B12 )/ psychological stress.
You have tried medications in almost all forms . So the main causes we need to consider are hormonal/ lifestyle factors which cause recurrence. From this point of view I think your problem to be due to-
1 - Hormonal cause. Though you have tested hormones & they are normal, there are natural changes in female hormones in woman's body & a person may be sensitive to this change.. this causes crop of acne at certain stage of menstrual cycle.
Most of the times combined contraceptive pills help in resetting the hormonal cycle/ adjusting the skin response to hormones.
- In female body the male hormone Testosterone is also present along with predominant female hormones. This hormone stimulates excessive sweat & sebum production.In such cases Testosterone inhibitors are helpful
2 Life style factors-
- Smoking is common cause of repeated crops of acne.. this needs to be curtailed
- Diet with high glycemic index( excessive carbohydrates/ fats .. in form of sweets, chocolates, food rich in fats, fast food ) facilitate acne development.In this respect insulin also needs to be considered.
- Routine care of skin with cosmetics having high oily base exaggerate acne
- Face washing to remove sweat / oils on skin is of utmost importance.
* Management-It is mostly consists of
- local antibiotics, retinoids, .. along with oral preparations as per need of patient.
- hormonal preparations to alter patient's sensitivity ,
-Anti androgenic medications ,
( The Accutane you have tried is a oral retinoid.. & needs to be taken under expert care, as over dosage may be harmful.Some how Accutane along with lifelong hormonal management is known to have permanent effect.)
- Different procedures like .. light therapy./ Dermabrasion/laser therapy.
- use of natural things like tea tree oil is useful in few patients.
* The treatment has to be selected carefully as per needs of individual patient. So I would appreciate your plan to consult a skin specialist & follow his instruction s strictly.
Thus an expert advise & management under expert care along with a acne friendly lifestyle would solve your problem.
I hope, the answer was both helpful & informative to you. Any follow up query is welcome.
Thanks.

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Brief Answer:
Only water based cosmetics/ self care/ dermatologist's specific advise.

Detailed Answer:
Hi,

Thanks for your follow up query.

1. I was happy to note you have already started cutting down your high glycemic index diet.

2. Yes Spironolactone is an anti androgenic drug. But I don't think you need it as you say testosterone was found to be normal. Moreover there is no flare up of acne before onset of menses. (If there was a patterned flare up before menses along with excessive facial hair, then it would indicate high testosterone levels in female)

Apart from testosterone, estrogen also causes acne by increasing oily face.This condition can be associated with problems of Ovary ( PCOD - which indicates insulin resistance / Ovarian cyst / Lutinizing hormone problems.

Further more excessive cortisol ( due to steroid medication/ adrenal problem ) can lead to acne.

So when you visit your dermatologist after examining your skin carefully.. he may advise you for related hormonal tests & get exact diagnosis of the acne .. followed by specific medication( local/ oral ) as per your need.
The cause of acne being mainly hormonal/ infective.. many a times non infective acne is treated in females with combined oral contraceptives to reset miner hormonal imbalance .. & it mostly helps.

3. Now about make up.. All make up you use - from foundation to blush/ eye shadow has to be non greesy, non acnegenic, hypoallergenic, non irritant & oil free. It should be preferably water based.

4. Alcohol used on skin is mainly as anti bacterial . But at the same time it activates more keratoss .. there by causing clogging of skin pores & thus eases acne crops. So no alcohol based cosmetics please. Though they are long lasting & more concealing.. THEY ARE HARMFUL IN ACNE.

In short your dermatologist will be the best judge about your management. When you follow his instructions & pair them with self care./ positive attitude... you would win the match !
Not to forget to continue the suited skin care even after getting rid of acne.

I hope I have answered all of your sub queries & you find them helpful. Any follow up query is welcome.
Thanks.

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