u/efdinthehead

Hello i wanted to share with you my story regarding regular inflammatory acne, my severe treatment resistant fungal acne and how isotretinoin helped both of them.

The story is quite long so buckle up.

I had inflammatory papulo-pustular acne that left PIE lesions since high school that i never treated or cared for. In college and grad school it kept getting progressively worse so i went to my dermatologist about 3 years ago and i was prescribed adapelene, benzoyle peroxide and doxycycline. To be fair this combo really worked. It didnt clear all of my acne but almost 80%. I was quite satisfied and with little to no side effects besides initial purging and dryness. I was on it for 4 months and then i was taken off of doxycycline and in about 2-3 weeks i noticed newer acne lesions and the dreaded PIE lesions. My dermatologist then talked to me about isotretinoin but i was quite scared because i was a stressed depressed grad student and the psychological side effects that i heard about it seemed scary. I politely declined then resumed using only adapelene and benzoyle peroxide almost daily for the next 2 years. And of course it wasnt enough at all. This year i decided to visit another dermatologist for both my acne and my segmental vitiligo that i started to develop on my face. I was put on high intensity topical corticosteroid for a month for vitiligo spots and got put back on doxycycline and adapelene alone. And if anyone knows about corticosteroid they flare up ur acne. And yes 3 weeks later i started getting papular acne on the spots where i had to put steroid on it ... but also some tiny little itchy pustular bumps around my chin and naso labial folds and then progressively around my cheeks and forehead and temples and all over. These were so much more annoying that regular acne because your entire face looked red and bumpy. The internet took me down a rabbit hole where i discovered that this is called fungal acne. And my dermatologist confirmed it with so i got put on ketoconazole wash for 2 weeks and switched my steroids to topical tacrolimus. The ketoderm wash helped quite a bit but irritated my skin and i couldnt moisturizer well because nothing was fungal acne safe. The lesions all reappeared after i stopped the wash. My derm then got me on weekly ketoconazole wash for my face and my body which wasnt enough. I discussed with her that i think this is caused by doxycycline (which is a verfiable fact) and that i dont want to use it ... i would rather have regular acne than this. She didnt seem to buy it but i had enough. I would cry everyday and i would refuse to see myself in the mirror, i wore face masks everyday, i couldnt put on makeup because my skin was both oily and bumpy and also dry from the ketoconazole wash. I also btw tried oral fluconazole and also didnt work. I was miserable and i thought that this is it ... nothing would work. I womened up and try to talk to my derm one last time and told her i am sick of topicals and doxycyline and all of this bs, i am ready for isotretinoin(i researched its use for fungal acne and i had mixed results but oddly little to no credible posts discussing it), i dont care anymore. It took a lot of convincing and a lot of crying but i got put on it. I started with 20 mg and for reference i weight 110 pounds and tbh the first month i didnt feel many side effects besides dry lips at around 3 weeks of treatment and didnt purge which i think its due to my use of topicals and reduced inflmmation by doxycycline and tbh my fungal acne disappeared gradually and fully by the second week and my regular acne disappeared almost by the 5th week. I am now on 30 mg and i am still noticing dryness which is manageable, lower back pain, mild hair breakage and incredible smooth clear skin and also absolutely no psychiatric effect.

Please if you are able to take isotretinoin and you have fungal acne, i beg of you to openly discuss it with your provider.

Fungal acne ruined my mental health and over all being and no one deserve to feel the way i felt.