How do I sort out a complex product problem and acne?

Dear Dr. Irwin, If you had to make the best between 2 bad choices, which would you choose? the choice is no daily sunscreen with less acne, or daily sunscreen and large horrible cyctic acne and blackheads? I am so exhausted battling acne (had accutane 2x in my 30s), every sunscreen brand makes me break out worse (ive tried dozens including some your recs.) And i figure superficial sun damage can later be fixed with lasers? I'm careful never to "bake" on the beach, i wear a wide brimmed hat, and use sunscreen everywhere except the face and chest in the summer and on sunny holidays (most of the year i live in foggy, rainy north europe). I work indoors, but enjoy being outdoors a few hours a day with my kids, regardless of weather. I'm 43, type 3 skin, some rosacea and lentigoes. Recently iv'e switched to a minimal routine which seems to control the acne: scrub (clinique), organic argan oil, plus Differin (adapalene) only on the problem areas (jawline/chin), and a multivit high in B5. Retinol facecreams and benzoylperoxide just makes the acne worse. I remember you saying, use retinol if you can tolerate it, else don't beat yourself up about it if you cant. I am hoping to hear the same thing about daily sunscreen! Or do your really think its nonnegotiable? Also, any suggestions for fading the red/brown acne scars? I have no pitting, but though hydroquinone 4% reduces the brown age spots it dosn't reduce my postacne redness. Thanks so much for your great website, and wishing you a succesful new year! Petra

Petra  – thank you for writing and I hear your frustration on this.  A couple of general thoughts that may help and then some specifics.   Remember that while products can make certain types of acne somewhat worse, they don’t cause cysts.  And, at the end of the day, your hormones and your genes are far more important, especially for cystic acne.  Also at 43, you may be trending into perimenopause with more variation month to month in your hormone levels. Here is more information on acne for you.

Regarding controlling your acne well, have you seen a good Dermatologist and at least considered either spironolactone (helps to control your hormones levels without birth control) to help with the cystic acne.  Another route to consider, is oral antibiotics only for 7-10 days with severe, cystic breakouts.  Again, your Dermatologist can help you.

Regarding products, have you worked with the mineral powder sunscreens like Colorescience or  the Jane Iredale Mineral Powder foundation which has an SPF 20?   SkinMedica has a new product out Calmplex which is helpful to reduce redness.  I would vote against the argan oil, it may make you worse over time.  Please make sure all your products say noncomedogenic.  Your prescription meds from your doctor are good.  Remember it takes 8-10 weeks to see a difference most of the time when you change products.   If you have a breakout two weeks into a new product, it’s usually the hormones, not the product.    Hope this helps,  Dr. I

Dr. Brandith Irwin, MD

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